Rosh Emergency Medicine Practice Test

For a patient suspected of having atrial fibrillation, what is the most appropriate immediate management?

1. Adenosine IV

2. Defibrillation

3. Diltiazem IV

4. Synchronized cardioversion

The correct answer is: Diltiazem IV

In the case of a patient suspected of having atrial fibrillation, the most appropriate immediate management is the use of intravenous diltiazem. Diltiazem is a calcium channel blocker that helps to control the ventricular rate in patients with atrial fibrillation, especially if they are experiencing rapid ventricular response. By providing rate control, diltiazem can stabilize the patient and alleviate symptoms associated with tachycardia, such as palpitations, dizziness, or chest discomfort. This choice is particularly relevant in a stable patient who is not experiencing significant hemodynamic compromise. Diltiazem works by slowing conduction through the AV node, which helps to reduce the heart rate effectively. This intervention is appropriate in the initial management phase while further diagnostic and therapeutic options can be considered. Other choices, such as adenosine, would primarily be used for paroxysmal supraventricular tachycardia rather than atrial fibrillation. Defibrillation is generally reserved for life-threatening arrhythmias like ventricular fibrillation or unstable ventricular tachycardia and is not indicated for stable atrial fibrillation. Synchronized cardioversion is crucial for restoring normal rhythm in cases of unstable atrial fibrillation but is less appropriate in a stable