You are monitoring a patient. Chest discomfort has been relieved with sublingual nitro and morphine sulfate 4 mg IV. He suddenly has the above persistent rhythm. You ask about symptoms and he reports mild palpitations, but otherwise he is clinically stable with unchanged vital signs. Your next action is:
give immediate synchronized cardioversion
give immediate unsynchronized defibrillation shock
administer magnesium sulfate 1 to 2 g IV diluted in 10 mL D5W over 5-20 minutes
administer amiodarone 150 mg over 10 minutes; seek expert consultation
give sedation and perform synchronized cardioversion
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