What is your clinical decision making and rationale on acute pharmaceutical management? What do you order, and when might you adjust your treatment plan?

You are managing a 75-year-old male who developed a new onset atrial fibrillation with rapid ventricular response at the rate of 180–220, thought to perhaps be new over the last few days and intermittent in nature. He is currently a bit short of breath and lightheaded when ambulating.
What is your clinical decision making and rationale on acute pharmaceutical management? What do you order, and when might you adjust your treatment plan?

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