Drug Overdose with a Fascinating Arrhythmia

===================================MY Comment by KEN GRAUER, MD (5/28/2020):===================================Today ’s case features another look at a fascinating arrhythmia that Dr. Smith first posted on June 10, 2011. The patient presented to the ED following a drug overdose with oxcarbazepine. Although details of the case beyond this were not available — we ’ll assume this patient was hemodynamically stable at the time the ECG in Figure-1 was recorded.What is the cardiac rhythm in Figure-1?Is there AV block?HOW would you proceed inassessing this arrhythmia?Considering the clinical context (ie,adrugoverdose) —HOW would youmanage this patient?Figure-1: The initial ECG in the ED for this case (See text).My THOUGHTS on ECG #1: This is an extremely challenging ECG. In the interest of illustrating an approach to complex arrhythmia interpretation — I thought I ’d walk through the Step-by-Step Process I used to evaluate this tracing.There are 5 KEY Parameters to assess in evaluation of any arrhythmia. I like to recall these by the saying, “Watch your P’s and Q’s, and the 3 R’s”:Are there P waves? — or, if no clear P waves, then are there signs of atrial activity (such as “fib waves” or atrial flutter)?Is the QRS wide? — for which we accept anything more than half a large box in duration (...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs