Scenario — Rapid onset palpitations at community fun run

intermediate Cardiac · Adult · 35yr · female

Patient Information

Dispatch	A 35YO female who has walked into the FAP complaining of a racing heart and feeling dizzy. (Sarah Nguyen)
Patient	Sarah Nguyen — 35yr (65kg)
Incident History	Pt was standing at the finish line cheering on a friend at the Perth River Run when she suddenly felt her heart 'take off'. She sat down immediately and a volunteer directed her to the FAP.
Emergency Contact	David Nguyen (Husband) — 0412 874 331

Initial Rapid Assessment

Response	Alert
Airway	Patent. Nil airway obstruction. Nil stridor or swelling.
Breathing	Slightly increased respiratory rate. Nil wheeze or crackles. Speaking in full sentences with mild effort.
Circulation	Rapid, regular and weak radial pulse. Skin pale and diaphoretic. Nil external bleeding.
Disability	GCS 15 (E4V5M6). Oriented to time, place and person. Mild light-headedness reported.
Exposure	Nil visible rash, injury or swelling. Patient in running attire, no medic alert jewellery noted.

Vitals

Time	SpO2	Resp Dist	RR	Pulse	BP	CRT	GCS	PERL	Temp	BGL	Pain
Initial	97% (RA)	Mild	20	172	94/60	3s	15	4 4 ++	37.1	5.4 mmol/L	2
10 mins	98% (O2 simple face mask 6L/min)	Nil	18	168	100/66	2s	15	4 4 ++	37.1	5.4 mmol/L	2

History Taking

Scenario Progression and Treatment Objectives

Diagnosis

This patient is suffering from a symptomatic supraventricular tachycardia (SVT) presenting with rapid onset regular tachycardia at approximately 172 bpm, dizziness, mild chest tightness, diaphoresis and borderline hypotension consistent with reduced cardiac output.

Facilitator Triggers — if trainees miss a critical step

! (If the trainee does not sit the patient down and limit her exertion within the first 2 minutes — patient becomes more distressed, reports increasing dizziness and GCS drops to 14.)
! (If oxygen is not applied within 3 minutes of assessment — patient's SpO2 drifts to 95% RA and she reports increasing shortness of breath.)
! (If the trainee attempts to administer GTN without checking blood pressure first — facilitator prompts: 'What is the patient's blood pressure?' Blood pressure is 94/60 — GTN is contraindicated due to hypotension below 90mmHg systolic. Do NOT administer GTN.)
! (If the trainee correctly identifies SVT features but asks about GTN — facilitator notes GTN is an Intermediate Care intervention for cardiac dysrhythmia and is outside Primary Care EHS scope for this indication. Guide trainee back to Primary Care management steps.)
! (If ambulance is not requested within 5 minutes of the scenario start — patient reports feeling like she may faint and pulse becomes weaker. Reinforce this is a Priority 1 transport situation.)

Treatment Objectives

1. Ensure scene safety and don appropriate PPE.
2. Perform Primary Survey — Airway, Breathing, Circulation, Disability, Exposure.
3. Sit patient down immediately in a position of comfort — do NOT allow patient to walk or stand unsupported given dizziness and haemodynamic compromise.
4. Apply SpO2 monitoring and obtain full baseline vital signs including blood pressure, pulse rate, respiratory rate, GCS, BGL and temperature.
5. Identify rapid regular tachycardia at approximately 172 bpm with associated dizziness, diaphoresis, mild chest tightness and borderline hypotension — recognise features consistent with SVT causing reduced cardiac output.
6. Administer oxygen via simple face mask at 5–8 L/min — titrate to maintain SpO2 94–98%.
7. Provide continuous reassurance — explain what is being done, keep patient calm to avoid further sympathetic stimulation.
8. Limit patient exertion — keep seated, assist with positioning, remove from crowd noise if possible.
9. Obtain IMISTAMBO history: Allergies (NKDA), Medications (OCP), Pertinent history (previous self-resolving episode, two coffees this morning), Last oral intake (water 20 mins ago), Events leading (standing at finish line, sudden onset).
10. Perform pain assessment — document chest tightness 2/10, reassess post any interventions.
11. Note GTN is contraindicated — systolic BP is 94 mmHg which is below the 90 mmHg threshold required for GTN administration. Do NOT administer GTN.
12. Note GTN and Modified Valsalva Manoeuvre are Intermediate Care interventions for SVT — these are outside Primary Care EHS scope. Management at this level is supportive care, reassurance, oxygen and urgent transport.
13. Request ambulance — treat as Priority 1 time-critical patient given symptomatic tachycardia with haemodynamic compromise (borderline hypotension, diaphoresis, reduced CRT). Pre-notify receiving facility.
14. Record full observations every 10 minutes (or 5 minutes given time-critical status). Document vital sign trends.
15. Monitor for signs of deterioration: decreasing GCS, worsening hypotension, loss of consciousness or cardiac arrest — prepare resuscitation equipment including AED at bedside.
16. Scenario ends on arrival of ambulance and IMISTAMBO handover.
17. Attention to hand hygiene will be given throughout the scenario.

Clinical references: Cardiac Dysrhythmia · Chest Pain / Acute Coronary Syndrome · Glyceryl Trinitrate (GTN, Nitroglycerin) · Oxygen · Primary Survey · Pulse Oximetry · Blood Pressure · Pain Assessment

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Signs/Symptoms	Sudden onset racing heart, dizziness, mild chest tightness, feeling of anxiety. Denies shortness of breath at rest. No syncope.
Allergies	Nil known drug allergies.
Medications	Oral contraceptive pill (Levlen ED). No other regular medications.
Pertinent History	No prior cardiac history. No known thyroid disease. One previous episode of 'fast heart' three years ago — self-resolved, never investigated. Non-smoker. Social drinker. No recreational drugs.
Last Oral Intake	Water approximately 20 minutes ago. Light breakfast 4 hours prior.
Events Leading	Patient was standing at the finish line spectating the Perth River Run fun run. Had consumed two coffees earlier in the morning. Sudden onset palpitations with no clear precipitant.
Treatment Prior	Sat down immediately. No medications taken.

Onset	Sudden onset approximately 15 minutes ago while standing at the finish line — was not exercising herself.
Pain	Mild chest tightness rated 2/10. Not sharp. No radiation.
Quality	Tightness, not crushing. Palpitations described as 'heart going crazy'.
Radiates	Nil
Severity	2/10 chest tightness. Palpitations very distressing — patient rates them 7/10 for distress.