Strange ECG

[firefighter523]

To all who think this rhythm is atrial. Extreme right axis means that the impulse is originating deep in the ventricles and has a retro , meaning from bottom to top pathway!! It is physically impossible for this to be anything but VT. ERAD and the fact that the QRS is 120ms or greater further puts the nail in the coffin!!

Elvis has left the building!!

[ERDoc]

To all who think this rhythm is atrial. Extreme right axis means that the impulse is originating deep in the ventricles and has a retro , meaning from bottom to top pathway!! It is physically impossible for this to be anything but VT. ERAD and the fact that the QRS is 120ms or greater further puts the nail in the coffin!!

Elvis has left the building!!

I agree that I would treat this as VT, but I have to disagree about the ERAD. There are a few other causes other than VT (albeit not many). You can also see it in hyperkalemia, COPD and with a pacemaker.

[firefighter523]

Thank you for the info Doc.

[Aussieaid]

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This is a tough one. This could be V-Tach but I'm wondering if it might be multifocal atrial tachycardia with a huge right bundle branch block just to throw you off. You can see about 3 different P wave morphologies and the rate is greater than 100. (Some of the p-waves seem to be buried in the preceding T-wave and the rhythm is slightly irregular.) This rhythm is usually significant in decompensating chronic lung disease, (i.e. COPD) or CHF, sepsis, MI or pneumonia. If he is having a lateral wall infarct that could be the cause. If they are hemodynamically stable I would treat them with O2, monitor, pulse ox, IV and transport without delay. Adding nitro and morphine if complaining of pain and an aspirin sure won't hurt him.

Thanks for sharing this interesting strip.

(By the way before anyone takes my head off......peace.. )