EMS was dispatched to an 82-year-old female complaining of smoke inhalation following a fire originating in her clothes dryer.

On arrival at scene the patient is conscious, alert, and anxious. She is being treated with high flow oxygen in the cabin of a fire engine. She has visible soot on her clothes, hands and face.

A 45 year old male with unknown medical history was taken into police custody under concern for trafficking illegal drugs.

While he was in the back of the squad car he told the police he had swallowed a large amount of cocaine and may need to go to the hospital.  Not long afterwards he became unresponsive and paramedics were called to the scene.

EMS was dispatched to a 48-year-old female having a seizure.

As they walked into the residence the patient was laying on the couch, not responding to commands. Her carotid pulse was palpable but the radial was absent. She was noted to be cyanotic and breath sounds were clear.

EMS was called to an office building for a 61-year-old male complaining of chest pain.

Just prior to EMS arrival the patient became nauseated and lightheaded. When they found him he was lying supine on the floor and appeared ashen.

This is a case from the “old days” when prehospital 12-lead ECGs were still a bit of a novelty. Many of the details have been lost to time but patient’s heart rhythms will be the focus of this review.