Is it VT or SVT with Aberrancy?

Here is a classic ECG, presented and analyzed by Ken Grauer:Figure-1: The initial ECG in this case, obtained by the EMS team (See text).===================================MY Comment by KEN GRAUER, MD (4/18/2020):===================================The 12-lead ECG in Figure-1 was obtained from a woman in her 80s who was seen by EMS for symptoms of new confusion and hypotension. She had a history of an MI in the past.WHAT is the rhythm in ECG #1?How certain are you of your diagnosis?Smith ' s comment on management:First, what do you want to do?The patient has confusion and hypotension, so she is in shock.  And she has a regular wide complex tachycardia that cannot be sinus (because it is rate 180 and she is 80 years old).Therefore, cardiovert immediately.Assuming this works, then you can proceed to analyze the 12-lead--If it is SVT with aberrancy or VT, electrical cardioversion should do the job.--Consider etomidate or ketamine sedation, depending on how " confused " or awake she is.--Adenosine is not contraindicated when there is reasonable probability that SVT is the etiology; that isnot reasonable here, as Ken will tell you below.--If cardioversion does not work (or the rhythm recurs after successful conversion), then an anti-dysrhythmic to treat (or prevent) needs to be given, and/or the underlying etiology needs to be reversed (e.g., acute coronary syndrome).  Choice of anti-dysrhythmic for recurrent refractor...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs