You are treating a 55-year-old female with rapid atrial fibrillation at a rate of 190 bpm. She exhibits altered mental status and hypotension. Initial synchronized cardioversion was attempted at 120 J but was unsuccessful. What is your next step in management?
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✓ Correct answer: D. Increase joules and cardiovertThe patient exhibits unstable hemodynamics due to rapid atrial fibrillation. After unsuccessful cardioversion at 120 J, increasing the joules for synchronized cardioversion is the correct approach. Medications like diltiazem and procainamide are not indicated in the setting of hemodynamic instability. Defibrillation is inappropriate for a patient with a pulse.
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