A 32-year-old previously healthy man presents to the ED with a 4-hour history of palpitations. He denies chest pain, shortness of breath, or history of similar palpitations. He does admit to heavy alcohol use in the past week, drinking 1 pint of vodka and a 24-pack of beer each day. In the ED, his vital signs are BP 135/75, HR 115, RR 14, and oxygen saturation 98% on room air. An irregularly irregular rhythm is heard on auscultation and an ECG shows atrial fibrillation. What is the next step in management

Based on the scenario being described within the question it can be said that the best next step in this situation would just be Observation. This is because the individual seems to be suffering from Holiday heart syndrome which is an irregular heartbeat pattern that usually arises in otherwise healthy individuals and whose symptoms include all of the symptoms which the individual in this scenario has. This syndrome usually goes back to the regular heart rhythm within 48 hours, therefore the best option would just be to observer the client.