| Indications |
Ventricular Fibrillation (VF)
Pulseless Ventricular Tachycardia (pVT) |
Supraventricular Tachycardia (SVT)
Atrial Fibrillation (AF) with rapid ventricular response
Atrial Flutter
Ventricular Tachycardia (VT) with a pulse |
| Synchronization |
Unsynchronized |
Synchronized (timed to R wave) |
| Patient Status |
Unresponsive, no pulse |
Conscious or sedated, with a pulse (though often unstable) |
| Urgency
|
Emergency – immediate intervention required |
Urgent, but typically not as immediately life-threatening as VF/pVT |
| Procedure |
Mode: Turn on the defibrillator and attach the defibrillator pads to the patient's chest, following the diagrams on the pads.
Energy: Charge the device based on the model available.
- Biphasic: 120-200 J (escalating if needed)
- Monophasic: 360 J
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Mode: Turn on the defibrillator and attach the defibrillator pads to the patient's chest, following the diagrams on the pads. Select synchronized mode. A synchronizing marker appears above each QRS complex on the telemetry display, indicating the synchronize feature is active.
Energy (initial): Charge the device based on the model available and to the device’s recommended energy level to maximize first shock success, varying from 50 to 200 joules. There are no guidelines for specific shock dose recommendations. In general, start at the lowest energy level (50 joules), and if the shock is unsuccessful, double the amount of energy used. In a refractory case, 200 joules could be used after just 3 shocks. |
| Sedation: Not applicable (patient is pulseless) |
Sedation: Conscious sedation (e.g., midazolam, etomidate) is typically required to minimize discomfort. |
| Monitoring: Continuous ECG monitoring |
Monitoring: Continuous ECG and SpO2 monitoring, blood pressure, airway assessment. |
| Timing: The discharge/shock button is pressed and the shock is delivered immediately. |
Timing: The discharge/shock button is pressed and held. The defibrillator does not release the shock immediately. Instead, it waits for the next R-wave to appear and delivers the shock at the time of the R-wave to avoid R-on-T phenomenon (delivery during refractory period). |
| Other Considerations |
- Cardiopulmonary Resuscitation (CPR) initiated immediately and continued until the defibrillator is ready.
- Emphasis on minimal interruptions to chest compressions.
- Post-resuscitation care, including airway management and targeted temperature management if indicated.
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- Anticoagulation may be required before cardioversion for certain arrhythmias (e.g., AF greater than 48 hours duration) to prevent thromboembolic events.
- Airway management and ventilatory support may be necessary during sedation.
- Close monitoring for rhythm changes and hemodynamic stability post-procedure.
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