Scenario: This is a bedside ECG strip of lead I and the accompanying arterial waveform in a 24-year-old female trauma patient. She presented 24 hours earlier to the emergency department after an all-terrain vehicle accident in which she sustained multiple injuries to her head, neck, torso, abdomen, and limbs.

Interpretation: Sinus rhythm, with bigeminal premature ventricular contractions (PVCs), and a ventricular couplet.

The underlying rhythm is sinus with distinct P waves that initiate a normal QRS followed by a premature QRS complex that is ≥0.12 seconds in duration and not preceded by a premature P wave (as seen in the first sinus beats). The wide, premature QRS complexes are PVCs and because there is a sustained pattern of 2, the rhythm is called ventricular bigeminy. A ventricular couplet, seen after the fifth sinus beat, is the presence of 2...

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