With serious signs and symptoms related to the Tachycardia
If Ventricular rate is > 150/min , Prepare for Immediate Cardioversion
May give a brief trial of medication based on specific arrhythmias.
Immediat Cardioversion is generally not needed for rate < 150/min.
* Secure Airway
* Oxygen Saturation
* Suction Device
* IV Line
* Intubation Equipment
Premedicate whenever possible *
Effective regiments have included
a sedative (eg, Diazepam ,
Midazolam Barbiturates ,Etomidate ,
Ketamin , Methohexital) with or
without analgestic agent (eg ,
Fentanyl , Morphine , Meperidine).
Many experts recommend anasthesia.
PSVT / Atrial Flutter
- may start with 50 J
Treat Polymorphic VT (Irregular form and rate) - Like VF
Note possible need to Resynchronize after each Cardioversion
If delays synchronization occure and clinical conditions are critical ,
go to immediate unsynchronized shocks.
Steps for Synchronized Cardioversion
1. See electrical cardioversion algorhithm for Sedation.
2. Turn on defibrillator.
3. Attach monitor leads to the patient and ansure proper display
patient's rhythm.
4. Engage the synchronization mode by pressing the "sync"
control button.
5. Look for markers on the R waves indicating sync mode.
6. If necessary adjust R wave gain untill sync markers occur with
each QRS complex.
7. Select appropriat energy level.
8. Position conductor pads on patient (or apply gel to paddels).
9. Position paddles on patient (sternum-apex).
10.Announce to the team members: "Charging defibrillator - Stand Clear !"
11.Press "charge" button on apex paddle (right hand).
12.When the defibrillator is charge , begin the final "clearing chant" . State
firmly in a forceful voice before each shock.
13.Apply 25 lb pressure on both paddles.
14.Press the "discharge" buttons simultaneously.
15.Check the monitor. If Tachycardia persists , increase the joules
according to the electrical cardioversion algorhithm.
* Reset the sync mode after each synchronized cardioversion ,
Because most defibrillators default back to unsynchronized mode.
The default to unsynchronized mode is allow an immediate
defibrillation in the cardioversion produced VF.
Paramedic Neomi Zvi - Feb 2000
AHA ; ACLS ; 1994 ; 1-34 - 1-35