No Takers? tsk tsk

Yes MDL, I think, from the few dismal answers i recieved, that they definately need some attention.

You hinted at answers, you haven't given any yet...

The first one is a 2nd degree type II AV block on a ratio of 1:1, where every second QRS complex is dropped.
The second ECG is a 3rd degree AV block with an underlying Atrial Fibrillation. IT is not very clear but you can see an absence of definable P waves with the very fine AF in the back ground. 
The third strip is the same as the second one, but AFTER Atropine was given (a total of 1.5mg in three doses of 0.5mg). The two options that most likely could have achieved this result would be either drug administration or electrical pacing, but no pacing spikes are visible, therefore drugs were the most likely option. The reason atropine was given in an apparently unstable patient (as per vitals) rather than electrical pacing as an initial treatment, was that this was the patients third episode of this type, and when the family was questioned they stated that previously she had been given atropine with a positive result. The ECG was prepped for pacing should the drugs not have worked.

<sigh> I got bored

Give this one a try -


(click on the image for a longer strip)
This was from a 78 yr old male with a Hx of hypertension, on antihypertensives (name unknown) and Simvastatin. He had 6/10 chest pain, Pulse 93, BP 70 systolic, SpO2 83% FiO2 .21, GCS 15/15. The patient went into VF twice after this strip was printed, and was succesfully resussed.
Diagnosis of rhythm? - pm me your answers

No Takers? Is it that bad an ECG?

The rhythm is an accelerated Junctional (nodal) rhythm with ST elevation and peaked T-waves. At first glance it appears to be a ventricular (wide QRS complex) rhythm, but if you look closely and measure it accurately you will see that the QRS complexes are in fact within their normal ranges of 0.12s (or three small blocks) and that it is the ST-segment that makes it appear widened. Narrow QRS complexes are ALWAYS supraventricular in origin, and since there is a complete absence of P-waves, we can assume that it does not originate in the Sino-Atrial node, therefore it cannot be a Sinus rhythm, and by default must originate somewhere around the Atrio-ventricular node.