Protocol: Cardioversion (Synchronized)

Original Effective Date: 01/01/2001 | Revised Date: 01/01/2002

ALS PROTOCOL

PROCEDURE:

  1. Typical Indications (with unstable signs/symptoms)

    1. Ventricular Tachycardia
    2. Paroxysmal Supraventricular Tachycardia
    3. Atrial Fibrillation
    4. Atrial Flutter

  2. Relative Contraindications

    1. Digoxin Toxicity (if cardioversion is necessary, use lowest possible energy setting (10-20j)
    2. Permanent pacemaker (avoid placing paddle near the pacemaker generator (may cause permanent malfunction)

  3. Sedation

    1. Consider sedation if cardioversion is indicated, patient is very lucid and circumstances will allow for small time delay. For amnesic effects, administer Diazepam 5 mg slow IVP approximately 1 minute prior to cardioversion.

  4. Cardioversion energy settings in unstable rhythms:

    RhythmInitialSubsequent
    1. Paroxysmal Supraventricular Tachycardia50-100j200j, 300j, 360j
    2. Ventricular Tachycardia100j200j, 300j, 360j
    3. Atrial Fibrillation50-100j200j, 300j, 360j
    4. Atrial Flutter50-100j200j, 300j, 360j

SPECIAL CONSIDERATIONS/NOTES/PRECAUTIONS:
  1. Effective regimens have included a sedative such as Diazepam, with or without analgesic agents.
  2. Note possible need to resynchronize after each cardioversion.
  3. If delays in synchronization occur and clinical condition is critical, go immediately to unsynchronized shocks.
  4. Treat polymorphic ventricular tachycardia (irregular form and rate) like ventricular fibrillation: see V-Fib/V-Tach protocol.
  5. Paroxysmal supraventricular tachycardia and atrial fibrillation often respond to lower energy levels (start with 50j).

Protocol based on AHA Guidelines 2000

back to home page