A 20 year old presents to the Emergency Room because his palpitations changed and felt more “severe.” He is awake, conversant, and his pulse is thready and tachycardic – the nurse thinks it was “fast.” His initial blood pressure: 80/60. His initial EKG, clocking in at 285 beats/min, is shown:
“Yikes!” says the resident.
“Yikes!” says the ER attending.
So what do you say?
Remember the first rule of ER medicine: Take your own pulse first. Then, what could this be and what therapy would you recommend?