Scenario: This electrocardiographic (ECG) rhythm strip was obtained from a 54-year-old male admitted to the intensive care unit following a motor vehicle accident. The patient had sustained a spinal fracture at the C5 level with a closed head injury. He was on a ventilator for respiratory support and a vasopressor to maintain his blood pressure. The patient’s blood pressure was 90/40 mm Hg during this arrhythmia, which was unchanged from his baseline pressure. He was sedated and therefore unable to provide any verbal information regarding symptoms. Since admission, the patient’s rhythm varied from sinus rhythm to sinus bradycardia.

The initial rhythm is irregular sinus bradycardia that is followed by a nearly 3-second pause (after the third beat) which triggers 2 junctional escape beats. Sinus bradycardia resumes after beat 5.

Cardiac rhythms may take the form of an “escape” beat or rhythm following a significant period of sinus bradycardia or atrioventricular...

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