Cardioversion

Section 9 Procedure Guidelines

9.07 CARDIOVERSION

INDICATIONS:

• Supraventricular Tachycardia Practice Parameter 4.07
• Ventricular Tachycardia With A Palpable Pulse Practice Parameter 4.09
• Wide Complex Tachycardia - Uncertain Origin Practice Parameter 4.10
• If the patient presents with one or more unstable criteria, (significant discomfort of suspected cardiac origin, severe dyspnea, altered mental status, or hypotension with signs of decreased tissue perfusion), DEFIBRILLATION may be administered at the same joule setting listed in the Practice Parameters to avoid delays associated with synchronization.
• Symptomatic Atrial Fibrillation / Atrial Flutter with RVR.
  • Check the equipment - Turn on the monitor / defibrillator.
  • Apply monitor per Procedure Guideline.
  • Verify function of synchronizer button.
  • QRS complex must be upright on monitor - inverted or low amplitude complexes may not trigger synchronizing circuit. Turn up machine gain until a small dot appears on the QRS complex. This indicates that the synchronizer circuit has been activated.
  • Confirm the rhythm.

CARDIOVERSION PROCEDURE:

• Confirm the rhythm.
• Select synchronization and look for flagging of the QRS.
• Check paddle or fast patch pads position and conduction.
• Select appropriate energy level per Standing Order.
• Check to ensure all people, including yourself; are clear of the patient. Ensure EMS personnel are in a safe operating location.
• Apply 20 - 25 pounds of pressure to paddles, (If applicable).
• Discharge energy by pressing discharge buttons simultaneously and hold until energy is delivered. Machine will not deliver energy until the proper time.
• Observe for rhythm change and check the patient for a pulse, (If applicable).
• Repeat per Practice Parameters.