"A 65 year old male with a history of hypertension, stage IV kidney disease on dialysis presents to the emergency department with dizziness and palpitations for 1 hour. He denies chest pains. His temperature is 37.0 C, blood pressure 80/40, heart rate 150, respirations 24, and oxygen saturation 85% on room air. Physical examination reveals pulmonary rales throughout his lung fields, elevated jugular venous pressure, a regular tachycardic rhythm without murmurs, and trace lower extremity pitting edema. Laboratory studies are normal. His ECG is below. What is the next best step

The answer is - Emergent direct current cardioversion

Explanation:

The ECG is in the attachment below.

The options are;

A. Intravenous amiodarone

B. Intravenous beta-blockers

C. Intravenous calcium channel blockers

D. Emergent direct current cardioversion

The answer is D-  Emergent direct current cardioversion

An ECG (Electrocardiogram) is used for measuring the electrical activities of the heartbeat. It is used to check for high blood pressure, signs of heart disease, and normality of the rhythm of the heartbeat.

According to the man's ECG it shows atrial flutter with rapid ventricular rate.  The patient's symptoms currently shows that he is hypertensive; dizziness, low blood pressure. Hence to restore the sinus rhythm there has to be application of shock which is emergent direct current cardioversion. A Direct Cardioversion (DC Cardioversion is a medical procedure which is used by medical professionals to normalize heart rhythm, that is to convert an abnormal heart rhythm to normal.

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