This rhythm strip represents an idioventricular rhythm: the QRS complexes are wide and the rate is very slow. There are no P waves associated with the QRS complexes. In this Lead II strip, there appears to be an underlying atrial flutter. If that is the case, the patient has a complete heart block preventing any of the flutter impulses from activating the ventricles. Checking in more leads would confirm atrial flutter if present. Note that the idioventricular rhythm is subtly slowing. This patient was pulseless and not breathing.