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Despite two attempts at a modified Valsalva, the patient is now feeling short of breath, dizzy, nauseated, has chest pains and palpitations, and states he feels like he is going to pass out. You are unable to palpate a radial pulse and blood pressure is unrecordable.

1 What are your treatment priorities now and what interventions may be required to prevent further deterioration and cardiovascular collapse?In‐hospital treatments may include antiarrhythmic drugs such as betablockers or adenosine, which are often used to try to slow AVN conduction and induction of an intermittent AV block. Adenosine also has a short half‐life and works within 6–10 seconds, so its effects are short term. However, in this case the patient has no other treatments available pre‐hospital, so DC cardioversion should be initiated.