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Look through the information provided in this case study and highlight all of the information that might concern you as a paramedic.

1 What are some differential diagnoses for this patient? (Consider both regular and irregular rhythms.)Regular: Physiological sinus tachycardia, inappropriate sinus tachycardia, sinus nodal re‐entrant tachycardia, focal atrial tachycardia, atrial flutter with fixed AV conduction, AV‐nodal reentrant tachycardia (AVNRT), orthodromic AVRT, idiopathic VT, Wolff–Parkinson–White syndrome.Irregular: Atrial fibrillation, focal atrial tachycardia or atrial flutter with varying AV block, multifocal atrial tachycardia (MATT).

1 What are your treatment priorities for this patient?The 12 lead ECG has become one of the most important prehospital diagnostic tools. In cases such as this where a patient has suddenly collapsed, an early 12 lead ECG is required. If the patient is haemodynamically stable, conduct modified Valsalva manoeuvres (vagal manoeuvres).

2 What is your plan if the patient begins to deteriorate?Request intensive care paramedic backup, prepare for synchronised cardioversion, position patient appropriately, oxygen if hypoperfused/hypoxemic, place defibrillation pads on patient, IV access, crystalloid fluids.