1	The Basics of Synchronized Cardioversion Steps and Procedures
2	Definition Synchronized Cardioversion A controlled form of defibrillation for patients who still have organized cardiac activity with a pulse.
3	Indications Unstable - Perfusing Ventricular Tachycardia SVT Atrial Fibrillation (with a rapid ventricular response) 2:1 Atrial Flutter
4	Procedure Similar to Defibrillation Sedate conscious patients if at all possible Press the “sync” button Confirm synchronization on monitor (R wave is detected) Charge to appropriate energy level. Adults in SVT or A. Flutter – 50 J Adults in VT or A. Fib – 100 J Children 0.5 J/kg
5	Procedure (cont’d) Clear patient Depress the shock button and hold until countershock is delivered. Evaluate patient’s ECG
6	Confirm Captured R Wave!
7	If patient doesn’t convert… Press “sync” button again Repeat steps of synchronized cardioversion by increasing energy as follows. Adult –> 100 J, 200 J, 300 J, 360 J. Child –> 1 J/kg, 2 J/kg, 4 J/kg *** Remember to press “sync” button every time before delivering the countershock
8	It the patient goes into VF… Press “sync” button to stop R wave synchronization and proceed with defibrillation at 200 J (or manufacture’s recommendations.)
9	If the patient converts to… Asystole or PEA Go to Pulseless Arrest Algorithm Bradycardia Go to Bradycardia Algorithm Normal organized rhythm with a pulse Monitor V/S Administer antidysrhythmic loading bolus if required and maintenance IV drip ie Amiodarone or Lidocaine
10	Consider sedation with… Valium® (diazepam) Versed® (midazolam) Ativan® (lorazepam) etomidate ketamine
11	Lifepak 12 Monitor/Defibrillator Defib/Cardioversion Controls
12	Questions ???