Test almost all of your most important ECG rhythm interpretation skills with this case.

Sent by Anonymous, written by Meyers, edits by Smith:A female in her 70s with history of HTN woke up around 2am with severe shortness of breath. EMS found the patient in moderate respiratory distress, hypoxemic on room air, with diffuse rales. CPAP was initiated. The prehospital ECG is unavailable but reportedly showed a wide complex regular tachycardia at around 150 bpm. 150mg amiodarone was given for presumed VT with no obvious effect.She arrived at the ED at 2:52 AM. She had normal mental status, and was in moderate respiratory distress with diffuse rales, with respiratory rate 30/min, and initial blood pressure 129/60.  Her oxygen saturations were in the 90 ' s. Bedside US showed severely reduced global LV function and bilateral diffuse B-lines. Here is her initial ECG (no prior for comparison, she ' s on vacation from out of town to visit family, with no other available history): What do you think?At this point in the case you face some very interesting and difficult questions:1) Is the patient stable or unstable? 2) What do you think the ECGs show? What is the rhythm?3) Do you think the rhythm is the cause of the symptoms? What is happening pathophysiologically with this patient?4) Given the above, how will you proceed?Stable or Unstable:By the ACC/AHA definitions, the patient could be called " unstable " based upon the presence of acute heart failure (assuming you attribute the acute heart failure to the rhythm). Regardless, this patient has a ...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs