Unstable Atrial Fibrillation: Rapid Decision-Making
A branching clinical case simulation for a patient presenting with chest pain and palpitations. Take a history, examine, investigate, diagnose and treat while the patient responds to every decision, then see the score by clinical domain with the reasoning for each mark.
Year 5hard20 min6 stages
- Patient
- 66 years, male
- Presenting complaint
- Chest pain and palpitations
- Decision stages
- History, Examination, Investigations, Diagnosis, Treatment, Monitoring
The presentation
A 66-year-old man, Arthur Hughes, is brought in by ambulance to the emergency department with sudden palpitations, central chest pain and lightheadedness. He is anxious, short of breath, sweating and dizzy. The paramedic handover says: 'HR 160 irregular, BP 85/55, RR 24, SpO2 94% on air.' He is clearly unwell. You are a final-year medical student on placement, and the registrar is busy with another case. You must act quickly. What is your first step?
What this case teaches
Distinguish stable from unstable tachyarrhythmia; choose synchronised cardioversion over rate control when compromised; manage anticoagulation decisions afterwards.
How the case unfolds
- 1Rapid History GatheringHistory
- 2Focused Physical ExaminationExamination
- 3Investigations and PreparationInvestigations
- 4Formulating the DiagnosisDiagnosis
- 5Definitive ManagementTreatment
- 6Post-Cardioversion CareMonitoring
The decisions available at each stage, and what each one costs or earns, appear when you run the case.
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A free account opens the simulator: the patient's observations move with your decisions, and every choice is scored and explained.
Taught in
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Educational content for students and clinicians in training. It does not replace professional judgement, local protocols or current prescribing information.