ACLS review: SVT part 7

Preparation

·         Airway: Establish appropriate airway management. Suction equipment on hand

·         B Breathing: Provide O2. Assess adequacy of ventilation.  Monitor oxygen saturation

·         C Circulation: IV access. Attach monitor leads and Combo pads

Technique

·         Premedicate whenever possible.

·         Engage sync mode before each attempt.

·         Look for sync markers on the R wave.

·         Set recommended joule setting

·         Press “charge” button, “clear” the patient, and press the “shock” button.

Synchronized cardioversion joule settings

·         SVT, Atrial flutter     50-100J  

·         Stable VT                100J    

·         Atrial fibrillation       120-200J 

·         Polymorphic VT      200J (unsynchronized) 

Note

Cardioversion with monophasic waveforms should begin at 200 J and increase in stepwise fashion if not successful.

Arrhythmias with a polymorphic QRS appearance (such as torsades de pointes) will usually not permit synchronization. Thus, if a patient has polymorphic VT, treat the rhythm as VF and deliver high-energy unsynchronized shocks

Technique

·         Observe for rhythm change on monitor.

·         Observe patient’s ABCs post procedure

Reviewed 2/28/16