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.

A 55 year old male presents to EMS with complaint of intermittent shortness of breath.

Symptom onset occurred while he was taking his daily walk about 15 minutes prior to EMS arrival.

According to the 2000 AHA ACLS Guidelines, tracheal intubation should only be attempted “by healthcare providers experienced in performing this skill”, and expand further by stating that “ALS providers unable to obtain regular field experience… should use alternative, noninvasive techniques for airway management”.