6th March 2024

A 23-year-old student presents to the ED reporting palpitations for the last few hours.

A 23-year-old student presents to the ED reporting palpitations for the last few hours. She has been up all night preparing for her university exams and has been drinking energy drinks to keep her awake. Her heart rate is running around 140 bpm and blood pressure is 112/63 mmHg. The ECG shows a narrow, complex, irregularly irregular rhythm consistent with atrial fibrillation. She is sat up comfortably, speaking in full sentences and denies chest pain.  Examination reveals an irregular radial pulse and is otherwise unremarkable. How should you manage this patient in the immediate setting?

Select the SINGLE most appropriate initial management from the list below. Select ONE option only.