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You are called for a 65 year old female patient complaining of increased shortness of breath. Upon arrival you find her sitting on her couch. She is on oxygen at 3 LPM. She tells you that she has been experiencing increased shortness of breath times 24 hours. She states that it started after going outside in the cold. She is conscious, alert & oriented, her skin is pale, warm & dry & her & pupils is equal & reactive. Upon further exam you note no JVD, trachea is midline. Patients lung sounds reveal wheezes. Her abdomen is soft, non tender & slightly distended. Patient has good cms. Patients vital signs are as follows BP 136/66, Pulse 137, Respiratory Rate 22. Patients Finger Stick is 118, Pulse Oximetry is 96% & her EKG reveals an Atrial Fib at a rate 137 with pacer spikes noted. She tells you that she has a history of Intermittent Atrial Fib, Hypertension, High Cholesterol, Tachy-Brady Syndrome, Pulmonary Hypertension, Mild Leaky Heart Valves x4, Asthma, Dual Chamber Pacemaker, GERD & Anxiety. Her medications include Albuterol MDI PRN, Dulera MDI, Lasix 40mg BID, Aspirin 162mg BID, Zantac 150mg BID, Zoloft 75mg QD, Zocor 10mg QD, SL Nitro 0.4mg PRN & Metoprolol 100mg BID. You have a 30 minute ETA to the ER. So what do you do?