I have an question regarding the symptomatic tachy/brady directive. A patient with a hx of atrial fibrillation, currently in a rapid afib at 180 BPM. But they have periods of chest pain and pre-syncope every minute or so due to a sinus arrest lasting approximately 8-9 seconds before they flip back into rapid afib. My understanding is that sick sinus syndrome is often the culprit, which can cause alternating rhythms on an ECG and needs to be treated in hospital. In terms of ACLS and pre-hospital care, which would be most appropriate? cardioversion or pacing? providing indications are met and the pt is unstable. Hypothetically, in different scenario, a patient with an underlying regular/brady rhythm and prolonged symptomatic runs of Vtach. What would be most appropriate in that scenario? Any input you could provide is greatly appreciated! 
 
Thanks 

In these scenarios, we would suggest consulting the BHP via a patch for the best possible advice to obtain clear direction on individualized management of each patient’s unique presentation. in the prehospital realm. In hospital, these patients often have an internal pacemaker placed to provide a safe back up rate and are concurrently initiated on medical therapy to suppress the tachydysrhythmias. 

Emergency Childbirth,Procedural

AOM, Association of Ontario Midwives, Emergency Childbirth, Paramedic Emergency Skills Program, PESP

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