During my 2^nd year placement in the acute medical unit, I was assigned to a patient who was uncooperative and had a past medical history of Non-ST-Elevation Myocardial Infarction (N-STEMI). Upon doing his observations I noticed that his heart rate was abnormally high at around 180 bpm. At first, I suspected a possible machine malfunction; however, after manually checking his heart rate, it became clear that it was genuinely that elevated. This situation prompted me to notify my supervisor. She conducted an ECG on the patient and instructed me to bleep the on-call doctor. I communicated the details using the SBAR (situation, background, assessment, recommendation) framework over the phone. The doctor advised me to perform another ECG and to prepare the crash trolley while we waited for them to arrive. When the doctor and ANP (advanced nurse practitioner) arrived on the scene, they instructed the patient to blow into a syringe. I later discovered that this was called a Valsalva manoeuvre and it slows the patient’s heart rate in a non-invasive manner. The patient was struggling to comply with many of the interventions and it took considerable encouragement. The doctors prescribed a heart rate lowering medication and instructed us to re-assess his vital signs every 15 minutes. As this was my first time experiencing such a fast-paced and intense situation, it felt overwhelming. However, thanks to my close monitoring and clinical judgement, we were able to prevent any further deterioration in the patient’s condition. I was able to reflect on my experience and tie it back to my ‘Preventing and Managing Deterioration’ module, which emphasised the importance of the ABCDE assessment. It is crucial to not rely solely on just machine data; instead, we should also trust our clinical judgement and take the initiative of manually checking the patients’ vital signs when applicable. I wish I had done things differently such as taking the time to reassure the patient and ensuring they feel heard and understood. However, it was challenging to consider some of his wishes since he did not have a DNAR (Do not attempt resuscitation) form in place. I also could have consulted the nurses and doctor if we had a continuous ECG monitoring machine rather than checking it manually every 15 minutes.