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

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: 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

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