EMS is called to a local nursing home for a 85 year old female with a chief complaint of respiratory distress.
On arrival the patient is found lying in bed in obvious distress.
Respirations are 40 and shallow with a prolonged expiratory phase and accessory muscle usage.
Auscultation of the chest reveals a poor tidal volume with tight expiratory wheezes.
There are signs of cyanosis around the mouth and nail beds.
The patient appears weak and listless.
Past medical history: CHF, COPD, NIDDM, Breast CA, Depression
Vital signs are assessed.
Pulse: 130 and irregular
The patient’s external jugular veins appear prominent but the patient is lying flat.
A 12-lead ECG is captured.
What is your interpretation of this ECG?
What do you think is wrong with the patient?
What is your treatment plan?