ECG Challenge: Get to the point!

What is happening to this patient?

EMS is called to the residence of an 82 year old female with altered level of consciousness.

At the time of EMS arrival the patient is found lying supine in bed. She is awake and making incomprehensible sounds. She will not make eye contact and she is not conversant. She withdraws from painful stimuli.

Past medical history: Mild hypertension, NIDDM, UTI

Medications: ASA, Lisinopril (Prinivil), Metformin (Glucophage), Nitrofurantoin (Macrodantin)

The patient appears flushed and is hot to the touch. Radial pulses are rapid, weak, and thready. The daughter states that she "seemed fine" when she went to bed the night before but did not get up for breakfast this morning.

Temperature by temporal thermometer is 103.5°F (39.7°C).

Vital signs are assessed.

  • RR: 20
  • HR: 140
  • NIBP: 98/61
  • SpO2: 95 on RA

Breath sounds are clear bilaterally.

A 12-lead ECG is obtained.

The paramedics load the patient for transport.

In the back of the ambulance the following heart rhythm is observed on the monitor.

What is wrong with this patient?

What is the heart rhythm?

What, if anything, should the paramedics do about it?

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