Problem:
63-year-old female presents to the Emergency Department complaining of dizziness and shortness of breath. VITAL SIGNS PMH: HTN, Diabetes, TIA Home Meds: Lisinopril, Metformin Allergies: Penicillin HR: 180, O2 Sat 94%, BP: 107/78, RR: 21 The patient is a full code Atrial Fibrillation with Rapid Ventricular Response 12 lead EKG, TSH, CBC, CMP, INR · These tests are all indicated to evaluate this rhythm and the potential pathophysiology related to this rhythm. Metoprolol tartrate 2.5mg IV bolus over 2 minutes · Rate control in this patient is the first priority in order to enable ventricular filling and cardiac output. Anticoagulation is indicated unless there is a contraindication. Rate control and anticoagulation are the priority, then Cardiology will advise on TEE/Cardioversion.