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

• AED
• Defibrillator

Procedure

Cardioversion

• Must repush "Sync" button after each discharge
• Consider sedation (fentanyl or etomidate useful if hypotensive)

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