This strip offers several good teaching opportunities.  If it were a 12-lead ECG, no doubt it would be a bonanza!  First, there is sinus tachycardia at a rate of about 138 per minute.  The P waves are all alike and regular.  The T waves are tall and narrow, with a sharp peak.  This is often a transient sign of hyperkalemia, and should be investigated with serum electrolyte tests and with a 12-lead ECG.  In addition, the baseline shows a wandering type of artifact.  This is due to the patient's deep breathing, and the fact that the arm electrodes were placed on the chest.  This patient was a diabetic in ketoacidosis with hyperkalemia.