2015 Trumbull Memorial Hospital Demo

Cardioversion

Cardioversion

Clinical Indications:  Unstable patients with a tachydysrhythmia require cardioversion.  For pulseless patients with tachydysrhythmia, refer to Defibrillation.

Steps

Performed? Yes No

1. Ensure the patient is attached properly to a monitor/defibrillator capable of synchronized cardioversion. 2. Have all equipment prepared for adverse effects if the patient fails to cardiovert or if the condition worsens (ex: loss of pulse). 3. Consider the use of pain or sedating medications (20-40mg of Ketamine per protocol).  Do NOT delay cardioversion of a life-threatening condition to premedicate the patient! 4. Set monitor/defibrillator to the appropriate energy based on the manufacturer’s recommendations.

☐

☐

☐

☐

☐

☐

☐

☐

 Zoll – 75 J, 120 J, 150 J, 200 J, 200 J, 200 J  Physio – 50-100 J, 150 J, 200 J, 200 J, 200 J  Philips – 50-100 J, 150 J, 200 J, 200 J, 200 J

5. Set monitor/defibrillator to synchronized cardioversion mode  Note that some ventricular tachyarrhythmias may not synchronize  Torsades de Pointes can be cardioverted asynchronously (defibrillated)

☐

☐

6. Make certain all personnel are clear of patient or any wet or metal items the patient may be touching. 7. Press the button to cardiovert. Stay clear of the patient until you are certain the energy has been delivered.  Note that the monitor may not discharge immediately. Some devices require several cycles prior to discharge. Some devices also require the provider to hold the Shock button until these cycles are complete. Know your equipment and use your head. 8. Note patient response and perform immediate unsynchronized cardioversion (defibrillation) if the patient’s rhythm has deteriorated into pulseless VT or VF.

☐

☐

☐

☐

☐

☐

9. If the patient’s condition is unchanged, repeat steps 2 to 8 above.

☐

☐

10. Consider drug therapy if the patient’s condition has not improved after cardioversion. Refer to the appropriate protocol.

☐

☐

11. Note procedure, response, and time in the patient care report (PCR).

☐

☐

118

EMR

EMT

AEMT

Paramedic

Extended