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so next up were going to change gears and talk a little bit about electrocardiograph II an ECG mimic now Ive got ten minutes so I think the title of this was tricks and mimics and mallya talk about one mimic and Im going to really try to pound this mimic into your heads over the next ten minutes or so so again back to a real case real case forty-five year old male who was not feeling well complaining of palpitations no surprise blood pressures 115 s and not too bad and what you see up here is this wide complex tachycardia looks fairly regular and so what is your drug of choice all right now you could say my drug of choice is propofol followed by 200 joules and I would not argue with that all right fantastic its fast its reliable kind of fun you build more for it also but lets say that this patient is wide awake and hes like no give me a drug what is your drug of choice well Ill tell you what the the physicians in this case use again this is a real case they chose no