Here's an interesting case study from the Right Honorable Mark Glencorse of Tyneside. In addition to being a founding member of EMS 2.0 and the Chronicles of EMS, he also hosts the popular ECG Geek series at 999Medic.com.
Here is the situation (and no, I'm not talking about Mike Sorrentino).
Called to a 60 yr old female patient. She had been suffering with dizzy bouts and collapses for a couple of weeks and had been diagnosed with vertigo.
Has a medical history of MI (with cardiac arrest) in 2009, severe heart failure, COPD with home O2 via NC @ 2 LPM 24hrs per day.
She called 999 as she felt her dizzy bouts were getting worse and the medication that had been given to her for the vertigo was not working.
On arrival she was dyspnoiec (although in her normal state), slightly pallid and feeling dizzy. No chest pain.
Resps : 32, use of accessory muscles
SaO2: 95% on 2 litres/min O2 via nasal cannula (all normal for her)
Pulse: 92, irregular and weak radial pulse
Skin was warm to touch and dry.
She complained that her dizzyness was worse today and that sometimes she felt as though she was falling even when she was lying in bed.
Whilst completing my assessment, my partner rechecked her blood pressure and mentioned that her pulse had gone very irregular and she seemed bradycardic.
A rhythm strip was taken.
Chest electrodes were applied and a 12 Lead ECG was captured.
Patient was moved to the ambulance via carry chair and once on the stretcher called out to say that she had gone dizzy again. Leads were immediately attached to the monitor again which showed the following rhythm strip.
What do you think of these ECGs?