A 32 y/o female presents with complaints of shortness of breath. She has a leg immobilizer on, and had noticed some swelling in that leg earlier this week. She is tachycardic, and had a pulse ox of 70% when EMS picked her up. She is 98% on 6 L nasal cannula, but when she tries to exert herself in any way, she desats to the upper 80’s. She is tachycardic, but her blood pressure is normal. You take a look at her heart and you see the above image. What is going on? The answer, case, and outcome to come later this week in a new EM Res Podcast Case Conference.