Run of the mill

Can you interpret these ECGs?

Editor’s Note:

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: 02/24/2011 - Patient Follow-Up Posted.  CLICK HERE FOR THE ANSWER

EMS responds to a fitness center where an elderly female has experienced a syncopal episode.

On arrival, the staff leads a paramedic and her EMT partner to the 68-year-old female who is lying supine next to a tread mill.

She appears pale, diaphoretic, and acutely ill.

A nurse is holding a gauze pad to the patient's forehead. A look under the gauze reveals a laceration and hematoma the size of a silver dollar.

Vomit is noted on the floor next to the patient's head.

The patient is conscious but listless and oriented to person, place and time but not event.

When asked if she has any pain the patient says, "Yes" and then rolls on her side and begins throwing up.

The radial pulse is slow and barely palpable. The patient seems very weak.

She denies neck or back pain. There is no pain or tenderness on palpation of the cervical spine.

The patient is placed flat on the gurney and vital signs are assessed.

Resp: 12 and shallow
Pulse: 40 and regular
NIBP: 81/43
SpO2: 96 on RA

Breath sounds are clear bilaterally.

The cardiac monitor is attached.

A 12-lead ECG is captured.

How would you treat this patient and why? Tell us in the comments below —  get it right and you could win an EMS1 T-shirt and bottle opener.

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

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