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Paramedic Education at Monroe Community College, Rochester, New York

You are called to meet a BLS unit who is seeing a patient in the patient's home. You arrive to find a 62 yo patient who is complaining of weakness that began suddenly this morning when he got out of bed. The patient has been healthy and is not taking any medications and has not been exposed to any chemicals. The EMTs have started him on 10 lpm of oxygen by NRM. The EMT also states that the patients BP is 118/50, RR 18 lungs are clear, and pulse rate is 15 and regular. You smile and say, "Did you forget that multiply by 4 step?" The EMT looks back at you with a non-amused expression and says, "No I didn't." In all of your experience you have never seen such a good patient with such a bad heart rate, so you decide to take the pulse for yourself. You note a very slow pulse, but that little voice in you head calms you with the thought "the patient must have a peripheral pulse deficit" and you apply your ECG machine

Press here to aquire an ECG in lead MCL1

Press here to Zoom QRS complex

You quickly evaluate the EKG and reassess vitals - They are unchanged from the previous set. You place an IV saline lock, check the patients Blood glucose and oxygen saturation. Both are normal.

Your interpretation of the rhythm and your next step should be:

A) This is Sinus bradycardia and should be treated with atropine or pacing

B) This is Idioventricular escape and should be treated with pacing

C) This is atrial fibrillation with CHB and junctional or high ventricular escape, no treatment is needed at this time. Atropine & Pacer on standby

D) This is junctional rhythm with ventricular bigeminy and lidocaine should be given


* ANSWER

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Updated: February 26, 1998
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