EKG Challenge #4: Sometimes electricity works better than narcan ...

You are riding along with EMS when you get a call for "difficulty breathing".  You enter the house to find fire department on scene already performing CPR on a high school age male.  The paramedics 2mg of intranasal Narcan is given without response.  The patient is placed on the monitor and the following rhythm strip is obtained:

The patient is defibrillated x 2 with ROSC and his post-defibrillation strip:

After return of pulses, the patient is bagged on transport to the emergency department.  An additional 2mg of narcan is given IV without effect. A 12 lead EKG is obtained on ED arrival:

 What is your diagnosis?

Read our case conclusion here