Synchronized cardioversion
Revision as of 13:52, 22 March 2016 by Ostermayer (talk | contribs) (Text replacement - "Category:Cards" to "Category:Cardiology")
See critical care quick reference for doses by weight.
Indications
It is important to note that the procedure and indications differ between defibrillation and cardioversion
Defibrillation (Unsynchronized Cardioversion)
Synchronized Cardioversion
- Supraventricular tachycardia (SVT)
- Atrial fibrillation
- Atrial flutter
- Ventricular tachycardia with a pulse
Contraindications
- None
Equipment Needed
- Defibrillator
- Consider sedation medication in conscious patient (e.g. etomidate, ketamine), but do not delay procedure in unstable patient
Procedure
Cardioversion
- Apply pads (anterior-posterior placement is preferred)
- Select appropriate Joule setting
- Ensure machine is "synced" before each discharge
- Give sedation, if indicated
- Cardiovert
- Repeat PRN
- Ensure R or S wave is bigger than T wave
- Machine may read T wave as depolarization and shock during an actual repolarization phase
- May induce shock on T and subsequent VT/VF
- Move leads to avoid this
Doses
Initial recommendations:
- Tachycardia with pulse
- Narrow regular: 50-100 J
- Narrow irregular
- Biphasic: 120-200 J
- Monophasic: 200 J
- Wide regular: 100 J
- Wide irregular: defibrilate (NOT synchronized)
Complications
See Also
External Links
References
- AHA 2010 ACLS Recommendations