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Can you interpret these ECGs?

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.

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A 12-lead ECG is captured.

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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.

Tom Bouthillet, NREMT-P, is the battalion chief of EMS for Hilton Head Island Fire Rescue. He is a member of NHTSA’s High Performance CPR Working Group, program director of the South Carolina Resuscitation Academy, member of the Editorial Advisory Board of EMS World, content reviewer for the British Paramedic Journal, co-producer of the Code STEMI web series, and editor of EMS12Lead.com. Tom is interested in system performance, process improvement, and evidence-based performance measures for time-sensitive diagnoses.

He graduated with a paramedic/paramedicine degree from Parma Community Hospital EMS Education Program. 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.