ECG Challenge: The path 'more' traveled

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

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!"



Vital signs:

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?

About the author

Tom Bouthillet is a Fire Captain/Paramedic with Hilton Head Island Fire & Rescue, Editor-in-Chief of the, Chief Content Architect of, host of the Code STEMI web series at First Responders Network, a member of the Editoral Advisory Board of EMS World Magazine, and developer of the 12-Lead ECG Challenge smartphone app. He has taught nationally in the Critical Care Transport (CCEMT-P) program out of UMBC and his writings have been referenced in the American Heart Journal, the Journal of the American College of Cardiology: Cardiovascular Interventions and the EP Lab Digest. Contact Tom at

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