Consulting cardiology (a)is a good choice as they will implant a per-
manent pacemaker and manage any underlying cardiac disease. However,
the patient must first be stabilized. Cardioversion (b)is used to treat unsta-
ble patients with reentrant arrhythmias, such as atrial fibrillation. It is not
helpful in a setting of conduction abnormality, such as heart block. Meto-
prolol (c),aβ-blocker, is contraindicated in complete heart block. This
agent prolongs AV nodal conduction. (d)Amiodarone is an antidysrhyth-
mic used in patients with wide-complex tachycardias or atrial fibrillation.
48 Emergency Medicine