ECG Challenge: The path (more) traveled

UPDATED: 04/26/2011 - Patient Follow-Up Posted.  CLICK HERE FOR THE ANSWER

Here's an interesting case submitted by Adam Thompson from Paramedicine 101. Some changes have been made to preserve patient confidentiality.

EMS is called to a hardware store for a 59-year-old male with palpitations.

On arrival the patient is found sitting in a chair in the storeroom.

He appears anxious. Skin is pink, warm and moist.

He states that this has "happened before" but it's "been a while."

The patient is a poor historian. He states that he's seen a doctor for palpitations before and they "wanted to some kind of procedure but I said forget it!"

Medications: None

Vital signs are assessed.

RR: 14
Pulse: Extremely rapid and irregular
NIBP: 138/91
SpO2: Does not register

The patient denies chest pain or shortness of breath.

Breath sounds are clear bilaterally.

The cardiac monitor is applied.

How would you treat this patient and why?