EKG of the Week – Week 9

I had a real doozy come in over the holidays in the STICU as a second year resident.

85 yo F with pmh of HTN, CAD, DM, HLD, and probably a couple of other 85 yo problems.  She came in because she fell while gardening.  She thinks it’s possible that she tripped over a bush.  But all she knows is that she woke up on the ground.  She gets admitted to the STICU because she has a very small SHD and needs q1H neuro checks.  She arrives the nurse mentions to you that her heart rate is in the 30s.  She’s also vomiting and feels super dizzy. 

Naturally, you get an EKG . 

Maybe it would help if she wasn’t shaking so much? 

You repeat the EKG. 

What the heck is going on?