A 68-year-old man with no prior history of arrhythmias or structural heart disease is admitted to the ICU with septic shock secondary to community-acquired pneumonia. He has been on norepinephrine 0.2 mcg/kg/min for 6 hours, is intubated and mechanically ventilated (FiO2 0.5). Vital signs: temperature 39.2 °C, heart rate 140 bpm irregularly irregular, blood pressure 85/50 mm Hg, respiratory rate 22 breaths/min, SpO2 95%. Laboratory results: WBC 18,000/mm3, lactate 4.5 mmol/L, potassium 4.2 mEq/L, magnesium 2.0 mg/dL, TSH 2.3 mIU/L, free T4 within normal limits. Chest X-ray shows bilateral infiltrates. He develops new-onset atrial fibrillation. Which underlying precipitant should the critical care pharmacist prioritize addressing to manage his arrhythmia?

A 62-year-old male patient is admitted to the critical care unit with acute respiratory distress syndrome and is on assist-control ventilation. He is receiving a continuous norepinephrine infusion via a central venous catheter to maintain mean arterial pressure. During evening rounds, the nurse reports a sudden change in his cardiac rhythm. His blood pressure is now 78/42 mmHg, heart rate 165 bpm, respiratory rate 30 breaths/min, and he appears acutely confused. A bedside ECG shows new-onset atrial fibrillation with rapid ventricular response and no evidence of pre-excitation. Given the patient’s hemodynamic instability and ECG findings, which of the following is the MOST appropriate immediate management?

A 30-year-old man with known Wolff–Parkinson–White syndrome presents to the emergency department with palpitations. He is hemodynamically stable (blood pressure 125/80 mm Hg, no chest pain or dyspnea). ECG shows atrial fibrillation with a wide QRS complex and variable pre-excitation. Considering his stability and underlying accessory pathway, which of the following is the most appropriate initial pharmacologic intervention?

A 68-year-old male patient is on mechanical ventilation for acute respiratory failure and receiving a continuous norepinephrine infusion via a central venous catheter for blood pressure support. He develops new-onset atrial fibrillation with rapid ventricular response (AF with RVR). His vital signs are: heart rate 145 bpm, blood pressure 105/60 mmHg, respiratory rate 22 breaths/min, and oxygen saturation 96% on FiO₂ 0.5. His history includes heart failure with reduced ejection fraction (HFrEF) with an EF of 25% and hypertension. An ECG confirms AF with a ventricular rate of 145 bpm. He remains hemodynamically stable despite the RVR. Which of the following is the MOST appropriate initial pharmacologic agent for rate control in this patient?

A 72-year-old man, 48 hours after bowel resection, is in the ICU on mechanical ventilation and norepinephrine at 0.1 µg/kg/min. His MAP is 65 mm Hg and HR 150 bpm irregular. Labs: Cr 1.4 mg/dL (CrCl ≈50 mL/min), K 4.3 mEq/L, Mg 2.0 mg/dL, platelets 200,000/µL; no active bleeding. He has HFrEF (LVEF 30%), CHA₂DS₂-VASc 4, HAS-BLED 1. He develops new-onset atrial fibrillation with rapid ventricular response, onset ~12 hours ago. Considering his hemodynamics and comorbidities, what is the MOST appropriate initial pharmacologic management?

A 68-year-old man with a history of heart failure with reduced ejection fraction is admitted to the ICU for acute decompensated heart failure. He suddenly develops new-onset atrial fibrillation with a rapid ventricular response of 150 beats per minute. His blood pressure drops to 80/50 mm Hg, he appears diaphoretic and confused, and his mean arterial pressure is 60 mm Hg. Which of the following is the MOST appropriate immediate intervention to manage his arrhythmia and hemodynamic instability?

A 72-year-old woman (weight 70 kg, height 160 cm) is evaluated for long-term anticoagulation after an episode of new-onset atrial fibrillation with rapid ventricular response noted 3 days ago. Her past medical history includes uncontrolled hypertension, type 2 diabetes mellitus, heart failure with reduced ejection fraction (35%), and a transient ischemic attack 6 months ago. Her current laboratory values are: serum creatinine 1.8 mg/dL (eGFR ≈ 35 mL/min/1.73 m2), hemoglobin 11.5 g/dL, platelets 210 × 10³/µL, and normal liver function tests. She has no contraindications to anticoagulation. What is the MOST appropriate long-term stroke prophylaxis strategy for this patient?

A 68-year-old man with hypertension and type 2 diabetes mellitus is successfully cardioverted to sinus rhythm after new-onset atrial fibrillation. His echocardiogram shows an ejection fraction of 55%, and his renal and hepatic function are normal. With a CHA2DS2-VASc score of 3, which of the following represents the most appropriate comprehensive post-cardioversion management plan to reduce stroke risk, maintain rate control, and ensure a safe transition of care?

A 68-year-old man with hypertension and diabetes mellitus is being discharged after a hospital stay for atrial fibrillation with rapid ventricular response. He has a history of recurrent paroxysmal AF and has been maintained on amiodarone for rhythm control. Relevant labs at discharge show serum creatinine 1.1 mg/dL and an estimated creatinine clearance of 65 mL/min. His weight is 80 kg. His calculated CHA2DS2-VASc score is 4 and HAS-BLED score is 2. Which of the following represents the most appropriate long-term management strategy upon discharge?

A 65-year-old male patient in the ICU was recently diagnosed with new-onset atrial fibrillation and successfully cardioverted. He is currently receiving amiodarone for rhythm control and apixaban for stroke prevention. As he prepares for discharge, the critical care pharmacist is tasked with providing patient education to reduce the risk of atrial fibrillation recurrence and hospital readmission. Considering this clinical scenario, which educational strategy should the pharmacist prioritize to optimize long-term management and prevent recurrence?