EKG Challenge No. 18: A Nurse Hands You this EKG…

You are the attending in the critical care area of a busy ED, and several patients arrive in rapid succession:  a confused young man with a scalp laceration who fell off a 10 ft. ladder, a middle aged woman with a suspected femur fracture from an MVC screaming in pain, and a lethargic patient with an alarming LVAD.  As you finish your phone call accepting a Level 1 trauma transfer, an RN hands you this EKG:  

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What's your interpretation of this EKG, and what's on your differential?  To whom of the above three patients does this most likely belong?