NORTH COAST EMERGENCY MEDICAL SERVICES Policy # 5335

POLICIES AND PROCEDURES

Subject: Medical Direction

Cardioversion-Conscious Patient Protocol

Associated Policies: 02/08/98

  1. Indications:
  1. Inadequate cardiac output and signs of poor perfusion associated with tachycardia not due to hypovolemia, or primary respiratory insufficiency.
  1. Therapeutic Effects:
  1. Rapid termination of cardiac dysrhythmias associated with inadequate cardiac output.
  2. Synchronized cardioversion is designed to deliver a shock at the peak of the R wave avoiding the vulnerable relative refractory period.
  3. Synchronization may reduce the energy required to end the dysrhythmia.
  1. Contraindications:
  1. Absolute: Supraventricular tachycardia due to hypovolemic shock.
  2. Relative: Suspected digitalis toxicity.
  1. Adverse Effects:
  1. Erythema or irritation of skin will occur, particularly if good conductive medium and skin contact are not achieved.
  2. Muscle cramps and pain.
  3. Ventricular fibrillation and asystole.
  1. Equipment:
  1. monitor/ defibrillator with synchronizer and adult and pediatric paddles or adapters available.
  2. Defibrillation pads or equivalent.
  1. Procedure:
  1. Start IV prior to procedure if possible.
  2. Attach monitor and select lead that gives upright QRS complex. Determine rhythm.
  3. In responsive patients and with IV access available. Consider need for anesthesia.
  4. Turn synchronizer switch to "on" position. Set the energy level as prescribed by protocol.
  5. Verify that the monitor is detecting the R waves.
  6. Charge capacitor.
  7. Place defibrillation pads.
  8. Apply paddles to chest as for defibrillation.
  9. Assure that all personnel are clear, depress and hold firing buttons until defibrillator delivers the shock.
  10. If no shock is delivered increase the amplitude of the R wave and retry or turn off synchronizer switch and deliver the shock unsynchronized.
  11. If synchronization fails to convert the rhythm, increase output for subsequent shocks.
  12. If patient is cardioverted into or progresses to ventricular fibrillation, turn off synchronizer and defibrillate.
  1. Special Instructions:
  1. Cardioversion is rarely indicated in children. Dose for pediatric patients start at 0.5 J/kg. If rhythm persists double the dose.
  2. The energy requirements for adults are based on the type of dysrhythmia being treated.