USMLE Step 2 - Question 24

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.

Atrial-Flutter2to1

Which of the following is the most appropriate initial therapy?

A. Intravenous amiodarone

B. Intravenous beta-blockers

C. Intravenous calcium channel blockers

D. Emergent direct current cardioversion

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