EKG of the Day?

Initially looking at the RR interval it appears irregular. With dropped beats and and irregular RR interval this would most likely be a Second Degree Type 2.

The real question when I look at these is it a Second Degree Type 2 or a 3rd degree block. Here is the way I learned:

Step 1 Look at the RR interval
If its irregular then its a Second Degree Type 2. The thinking is that is is irregular because it is not a static escape rhythm and therefore being conducted from the atria

If the RR interval is regular then you have to look at the PR interval
IF the PR interval is regular then its a Second Degree Type 2
If the PR interval is irregular then its a Third Degree

Treatment is admission for pacemaker as this can degrade to a third degree

PS it also appears that there is a RBBB morphology.
This is a very dangerous EKG and although your going to call CARDS and admit anyway because of the Second Degree Type 2 the addition of the RBBB only should make you more nervous