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In this scenario, the patient presents with shortness of breath, chest discomfort, and a rapid heart rate of 230 beats per minute, which is suggestive of a tachyarrhythmia, potentially supraventricular tachycardia (SVT). After establishing intravenous (IV) access and obtaining a 12-lead ECG, the next appropriate step involves managing the patient’s tachycardia.

Vagal maneuvers are commonly used as a first-line intervention to attempt to slow down the heart rate in cases of SVT. These maneuvers can help stimulate the vagus nerve, leading to a decrease in heart rate. They are non-invasive and can be effective in terminating certain types of tachycardia.

While cardioversion may be necessary for patients with severe symptoms or unstable rhythms, it is typically not the first step when the patient is stable enough to tolerate vagal maneuvers. Additionally, adenosine is an effective treatment for certain tachycardias, but it is usually administered after vagal maneuvers have been attempted, unless the patient is experiencing significant hemodynamic instability.

Preparing for advanced airway management would be reserved for patients who are either apneic, unable to protect their airway,