Synchronized cardioversion

See critical care quick reference for doses by weight.

Indications

It is important to note that the procedure for and indications differ between defibrillation and cardioversion

Defibrillation (Unsynchronized cardioversion)

• Ventricular fibrillation
• Pulseless ventricular tachycardia
• Polymorphic ventricular tachycardia

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)

See Also

• ACLS (Main)
• PALS (Main)
• Defibrillation

References

• AHA 2010 ACLS Recommendations

Authors

Ross Donaldson