99 year old with bilateral pneumonia respiratory acidosis and AF with a ventricular rate of 160 BP 100 /60 Given IV digoxin 500 micrograms without response.Given 2 doses of metoprolol 5 mg each without heart rate coming down.patient presented at 1400 hrs.Digoxin given at 1340 hrs.metoprolol given at 1700 and 1720.Antibiotics given at 1540.Patient heart rate remained elevated at 160 even after antibiotics one dose of digoxin and 2 doses of metoprolol.patient was known to have copd and AF was on apixaban and ivabradine.
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