EMS is dispatched to a "cardiac patient in distress".
On arrival paramedics are led to the bathroom where the patient is found sitting on a foot stool. He is conscious but appears acutely ill. Skin is pale and he is slumped over. He states that he feels weak.
Past medical history: High blood pressure, high cholesterol, valve surgery.
Medications: Numerous but his spouse can't locate them. When the patient is asked for his medication list he states, "Ask my wife."
- RR: 18
- Pulse: Rapid and weak
- NIBP: 85/53
- SpO2: 99 on RA
Breath sounds: Clear bilaterally.
Cannon waves are noted at the patient's neck.
The cardiac monitor is attached.
A 12-lead ECG is captured (retrieved here from the LIFENET).
What is your impression of the patient's ECG?
How would you treat this patient?