Electrical Cardioversion

■ Equipment: Oxygen, suction, intubation, IV, oxygen sat monitor, defibrillator, paddles or hands-free defibrillator pads, electrode patches, and paddle gel.

■ Sedation/Analgesia: (one of the following) Valium, Versed, MS, Demerol, barbiturates, ketamine, etomidate, methohexital.

■ Setup:Turn on defibrillator, attach ECG electrodes, press “synch” button, and verify that R-waves are sensed by machine.

■ Note: It may be necessary to adjust the gain until each R-wave has a synch-marker (see Synch Marks following).

■ Energy level: Select energy level based on presenting arrhythmia.

■ PSVT or Atrial-flutter: 50 J, 100 J, 200 J, 300 J.

■ VT or Atrial-fib: 100 J, 200 J, 300 J, 360 J.

■ Paddles: Apply paddles or hands-free pads to Pt’s chest.

■ Paddles: Sternum-Apex.

■ Hands-free defibrillation pads: Once applied, no need to contact the Pt or pads (discharge buttons are located on the defibrillator itself).

■ Charge: Say, “Charging defibrillator, stand clear!”

■ Clear: Say, “I’m going to shock on three. One, I’m clear, two, you’re clear, three, everybody’s clear.”

■ Cardiovert: Apply 25 lb of pressure (n/a for hands-free pads) to both paddles, press and hold both defibrillator buttons simultaneously until a shock is delivered.

NOTE: Delays are normal; do not release discharge buttons until shock is delivered.

■ Assess rhythm: Refer to appropriate algorithm for treatment.

Caution: Most cardioverters default back to defibrillator mode after each cardioversion. If subsequent synchronized cardioversion is needed, confirm that the cardioverter is in the correct mode.

Note: If QRS is too wide for machine to identify R-waves, switch to unsynchronized cardioversion (same steps as above, but turn lead select to “paddles” or “defibrillator” instead of “synch” mode).

Electrical Cardioversion