ECG of the Week - 23rd February 2015

The following ECG is from a 50 yr old male. Nil relevant past medical history. The patient had an out-of-hospital witnesses cardiac arrest with immediate bystander CPR. On paramedic arrival he was found to be in VF and ROSC was achieved following DC cardioversion.

On arrival to the Emergency Department the patient was agitated and combative with episodic abnormal posturing. 

Vital signs: GCS ~5-7 (M=2-4 E=1 V=2), BP 136/78, RR 12, Temp 36.5 (97.7F), BSL 8.4 mmol/L, Sat 100% on 15L/min

The patient received iv sedation to facilitate initial assessment, his ECG is below.

Click to enlarge

Things to think about

• What does his ECG show ?
• How would you manage this patient in the Emergency Department ?
• What happened next ?