2024 EMS Cases Part III

Baltimore City EMS Cases with Dr. Amal Mattu


A 75-year-old man with PMHx of hypertension on metoprolol is being brought in for 3 days of nausea, vomiting, and weakness. He reportedly appears dehydrated and is found to be hypotensive with concern for an unstable bradycardia. Standard prehospital ACLS treatment with atropine and transcutaneous pacing is failing. The following EMS ECG is obtained and transmitted:

Before watching the video, ask yourself:

      1. What is the heart rate and rhythm?
      2. What is the most likely cause of this ECG pattern? 
      3. How would you manage this patient on arrival?