Synchronized cardioversion

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)

• 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