Trending Topics

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: 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.

2011_08_EMS1_02-SMALL.jpg

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

2011_08_EMS1_01-SMALL.jpg

What do you think of this 12-lead ECG?

How would you treat this patient and why?

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.

RECOMMENDED FOR YOU