ECG of the Week - 6th May 2013

I don't have any clinical information on this case unfortunately but it looks like an interesting ECG :-)

ECG of the Week VAQ Corner

For those planning to sit the ACEM Fellowship, or any of our other interested readers.
 I don't know anything about the real case so I've made up the clinical details for this question.

A 76 yr old female presents to your ED following a collapse at home. 
She complains of feeling dizzy and lethargic for the last 2 days.
She has a history of IHD, CCF, and hypertension.
She is on multiple medications but can not recall them.
Observations: BP 85/45 RR 16 Sats 95% RA GCS 14 (M=6 V=5 E=3)

a) Describe & interpret the ECG (50%)
b) Outline your management (50%)

I appreciate this is probably a long question in terms of VAQ format but it's nice to think about what would you do with the patient in light of the ECG.