ABSTRACT
This chapter presents a case study of a 56-year-old man who is found lying alone on a park bench next to several bottles of whisky and brought into the Emergency Department (ED) due to concerns about his safety. The electrocardiogram (ECG) shows an irregularly irregular rhythm with no evidence of P waves, as well as tachycardia, consistent with atrial fibrillation (AF) with rapid ventricular rate, colloquially known as 'fast AF'. AF is the commonest cardiac arrhythmia and is frequently encountered in the ED as well as in inpatient wards. The initial evaluation of this patient should include checking a full blood count, electrolytes including magnesium, clotting screen, thyroid function and a chest radiograph. The acute management of the patient should proceed along the 'ABCDE' approach, with delivery of supplemental oxygen. The other treatment approach in patients with AF is restoration of sinus rhythm via electrical or chemical cardioversion.
