Middle-Aged Women Found Down: Seen in the ED

History of present illness: A woman in her mid-50s is transported from the streets to the emergency department (ED) after being found down without evidence of trauma in front of a business. She is a poor historian and is unsure if she might have fainted or just fallen asleep. She denies chest pain or other complaints but seems quite sleepy.

Vital signs and physical examination:

• Heart rate: 52 beats/min
• Blood pressure: 115/73 mm Hg
• Respiratory rate: 12 breaths/min with O₂ saturation of 94% on room air
• Neurologic examination is nonfocal but she is uncooperative and so it is limited.
• ECG findings are shown here