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Unstable atrial fibrillation — RCPSC EM MCQ

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HardCardiovascular emergenciesUnstable atrial fibrillationRCPSC EM

A 72-year-old man is CTAS 2 with palpitations and dyspnoea for 4 hours. His blood pressure is 78/48 mmHg, heart rate 168 irregular, oxygen saturation 94% on 2 L, and he is clammy. ECG shows atrial fibrillation with rapid ventricular response and no ST elevation. What is the most appropriate next step?

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Correct answer: D — Immediate synchronized electrical cardioversion

Haemodynamic instability in acute atrial fibrillation requires urgent synchronized cardioversion rather than rate control. Anticoagulation should be addressed after immediate stabilization.

Reference: CAEP Acute Atrial Fibrillation/Flutter Best Practices Checklist; ACLS