((If the trainee does not limit patient exertion — e.g., allows patient to stand or walk — patient reports worsening dizziness and nearly faints; HR remains at 178 bpm))

((If oxygen is not applied within 3 minutes, patient's respiratory rate increases to 24 and reports feeling more short of breath))

((If the trainee does not take a blood pressure before any other intervention, facilitator prompts: 'The patient asks if everything is okay — what are you checking first?'))

((If the trainee asks about GTN for the chest discomfort without first checking BP, facilitator prompts: 'What does the BP need to be before you consider GTN?'))

((If the trainee attempts to administer GTN — note: GTN is not an authorised EHS treatment for cardiac dysrhythmia; facilitator prompts: 'Check the CPG — what indication does GTN have here?'))

((If no reassessment vitals are taken at 10 minutes, facilitator states: 'Five minutes have passed — the patient asks if the ambulance is coming; what are you doing right now?'))

This patient is suffering from Supraventricular Tachycardia (SVT) with haemodynamic compromise indicated by borderline hypotension, diaphoresis, and symptoms of reduced cardiac output.

• Ensure scene safety and don appropriate PPE
• Perform Primary Survey — confirm patent airway, assess breathing and circulation
• Seat patient — limit all exertion; do not allow patient to stand or walk
• Perform Vital Sign Survey — HR, BP, RR, SpO2, BGL, GCS, pain score, temperature
• Apply oxygen via simple face mask at 6–8 L/min — titrate to SpO2 target 94–98%
• Perform history taking using IMISTAMBO / SAMPLE framework
• Reassure patient continuously — explain all actions calmly
• Do NOT administer GTN — GTN is not indicated for cardiac dysrhythmia at EHS scope; chest discomfort is secondary to the rapid rate, not ischaemic in origin
• Recognise SVT: HR ~178 bpm, sudden onset, regular, rapid, with signs of reduced cardiac output (borderline BP, diaphoresis, dizziness)
• Recognise this patient is time critical — haemodynamically compromised SVT requires Priority 1 transport
• Request ambulance upgrade / Priority 1 transport with pre-notification to receiving facility
• Monitor patient persistently — record full observations every 10 minutes (or 5 minutes given time critical status)
• Position patient seated and at rest; do not allow mobilisation
• Document pre- and post-intervention pain scores
• Consider Methoxyflurane (Penthrox) 3 mL inhaled via Penthrox inhaler — ONLY if chest pain escalates above 3/10 AND it can be safely self-administered; monitor for dizziness or over-sedation
• Prepare resuscitation equipment at bedside — defibrillator, BVM, suction — given peri-arrest risk
• Scenario ends on arrival of ambulance and IMISTAMBO handover
• Attention to hand hygiene will be given throughout the scenario.

Clinical references: Cardiac Dysrhythmia · Chest Pain / Acute Coronary Syndrome · Oxygen · Methoxyflurane · Glyceryl Trinitrate · Primary Survey · Pulse Oximetry · Blood Pressure · Pain Assessment