How is atrial flutter typically managed in an unstable patient?

Atrial flutter is characterized by rapid reentrant tachycardia originating in the atria and can lead to hemodynamic instability, particularly if the heart rate is excessively fast. In an unstable patient, immediate intervention is critical to restore normal rhythm and stabilize cardiac function.

When a patient with atrial flutter presents with signs of instability—such as hypotension, altered mental status, or signs of shock—immediate cardioversion is the most appropriate management strategy. This is because electrical cardioversion can rapidly terminate the arrhythmia and restore a stable sinus rhythm, thereby improving hemodynamic status effectively.

In contrast, options like medication adjustment, observation, or activity modification are not appropriate in the context of an unstable patient. These strategies do not provide the urgent, effective rhythm control needed to address the critical situation presented by instability. Therefore, immediate cardioversion stands out as the most effective and necessary intervention in this scenario.