Electrical Cardioversion Algorithm

Question 1

What is electrocardioversion indicated for?

Answer 1

Serious signs and symptoms related to tachycardia. Asses for a pulse and the rhythm and proceed with cardioversion if patient is unstable.

Question 2

Consider immediate cardioversion if the ventricular rate is…

Answer 2

> 150 and the pt. is symptomatic

May consider a brief trial of medication for specific arrhythmias

Question 3

When is immediate cardioversion generally not needed?

Answer 3

HR <150

Question 4

What equipment should you have available during cardioversion?

Answer 4

O2 sat
Suction
IV
Intubation equipment
Premedications

Question 5

What would you use for premedication if needed?

Answer 5

Verseed
Valium
Etomidate
Consider in addition with MS or Fentynal

Question 6

How many joules for a fib?

Answer 6

120-200j, increase if needed

Question 7

How many joules for Stable monomorphic VT

Answer 7

100j, increase if needed

Question 8

How many joules for SVT or a flutter?

Answer 8

50-100j increase if needed

Question 9

How do you sync the monitor for cardioversion of tachycardia with a pulse?

Answer 9

1. Connect pads and select “paddles” lead
2. Do not place pads over a pacemaker
3. Press “sync”
4. Look for capture on R waves
5. Press “charge”
6. Clear the patient and press and hold “shock” until shock is delivered
7. If additional shock is indicated reset “sync” mode