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Home > Topics > Cardiac Care
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EMS 12-Lead
by Tom Bouthillet

ECG Challenge: Es muy rapido

Through an interpreter, the patient advises EMS that she has a history of arrhythmias but she does not take any medications

By Tom Bouthillet

Editor's Note: Check out this month's ECG case study and submit your treatment plan in the comments below. Get it right and you could win an EMS1 T-shirt and bottle opener. Good luck!

--> UPDATED: 07/12/2011 - Patient Follow-Up Posted. CLICK HERE FOR THE ANSWER

EMS is called to a local volunteer medical clinic for a 35 year old Spanish-speaking female complaining of palpitations.

On arrival the patient is found sitting in a chair in an exam room. Through an interpreter she advises EMS that she has a history of arrhythmias but she does not take any medications. She denies any other medical history.

Her skin is pink, warm and moist. She admits to mild dyspnea and a little bit of chest discomfort that she describes as tightness.

Breath sounds are clear bilaterally.

Vital signs are assessed.

RR: 20
Pulse: Very rapid
NIBP: 127/68
SpO2: Does not register

The patient is placed on the cardiac monitor.

A 12-lead ECG is captured with the following computer measurements.

HR: 174
PR: 0
QRS: 82
QT/QTc: 250/425
P-QRS-T: 0 67 -69

What do you think of this 12-lead ECG?

How would you treat this patient and why?

About the author

Tom Bouthillet is a Fire Captain/Paramedic with Hilton Head Island Fire & Rescue, Editor-in-Chief of the, Chief Content Architect of, host of the Code STEMI web series at First Responders Network, a member of the Editoral Advisory Board of EMS World Magazine, and developer of the 12-Lead ECG Challenge smartphone app. He has taught nationally in the Critical Care Transport (CCEMT-P) program out of UMBC and his writings have been referenced in the American Heart Journal, the Journal of the American College of Cardiology: Cardiovascular Interventions and the EP Lab Digest. Contact Tom at
The comments below are member-generated and do not necessarily reflect the opinions of or its staff. If you cannot see comments, try disabling privacy and ad blocking plugins in your browser. All comments must comply with our Member Commenting Policy.
Peg Hansen Peg Hansen Monday, March 31, 2014 7:01:12 AM PSVT vs A Fib with RVR. looks regular. Would try vagals first as pt is stable. Possibly adenosine to break or see underlying rhythm. If A Fib, Cardizem or metoprolol to get rate under control. If she becomes unstable, cardiovert.

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