Clinical Indications:


  • 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)




  1. Ensure the patient is attached properly to a monitor/defibrillator capable of synchronized cardioversion.
  2. Have all equipment prepared for unsynchronized cardioversion/defibrillation if the patient fails synchronized cardioversion and the condition worsens.
  3. Consider the use of pain or sedating medications.
  4. Set energy selection to the appropriate setting.
  5. Set monitor/defibrillator to synchronized cardioversion mode.
  6. Make certain all personnel are clear of patient.
  7. 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.
  8. 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.
  9. If the patient’s condition is unchanged, repeat steps 2 to 8 above, using escalating energy settings.
  10. Repeat until maximum setting or until efforts succeed. Consider discussion with medical control if cardioversion is unsuccessful after 2 attempts.
  11. Note procedure, response, and time in the patient care report (PCR).