- Unstable patient with a tachydysrhythmia (rapid atrial fibrillation, supraventricular tachycardia, ventricular tachycardia)
- Patient is not pulseless (the pulseless patient requires un-synchronized cardioversion, i.e.,defibrillation)
- Ensure the patient is attached properly to a monitor/defibrillator capable of synchronized cardioversion.
- Have all equipment prepared for unsynchronized cardioversion/defibrillation if the patient fails synchronized cardioversion and the condition worsens.
- Consider the use of pain or sedating medications.
- Set energy selection to the appropriate setting.
- Set monitor/defibrillator to synchronized cardioversion mode.
- Make certain all personnel are clear of patient.
- Press and hold the shock button to cardiovert. Stay clear of the patient until you are certain the energy has been delivered. NOTE: It may take the monitor/defibrillator several cardiac cycles to “synchronize”, so there may a delay between activating the cardioversion and the actual delivery of energy.
- Note patient response and perform immediate unsynchronized cardioversion/defibrillation if the patient’s rhythm has deteriorated into pulseless ventricular tachycardia/ventricular fibrillation, following the procedure for Defibrillation-Manual.
- If the patient’s condition is unchanged, repeat steps 2 to 8 above, using escalating energy settings.
- Repeat until maximum setting or until efforts succeed. Consider discussion with medical control if cardioversion is unsuccessful after 2 attempts.
- Note procedure, response, and time in the patient care report (PCR).