Viva 8

An obese patient with a history of emphysema has been admitted to Intensive Care with a HR of 23 and a BP of 80/40. He is drowsy but able to talk. He has been feeling very tired and washed out for two (2) days and had a fall after feeling dizzy. He has no injuries.
Image of ECG showing complete heart block omitted.
Comment on the ECG and outline your treatment options for this problem.

Disclaimer: the viva stem above may be an original CICM stem, acquired from their publicly available past papers. Or, perhaps it is a slightly altered version of the original CICM stem. Or, it is a completely original viva stem, concocted by the monstrously amoral author of Deranged Physiology for nothing more than his own personal amusement. In either case, because the college do not make the main viva text or marking criteria available, almost everything here has been confabulated. It might sound like a plausible viva and it could be used for the purpose of practice, but all should be aware that it does not represent the "true" canonical CICM viva station.