By Martin Grant Student no 40077467 Cardioversion is defined as a synchronised direct current DC discharge and does not apply to ventricular defibrillation or to the pharmacologic reversion of arrhythmias ID: 510062
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Slide1
Step by step guide for Synchronised DC Cardioversion
By: Martin GrantStudent no. 40077467Slide2
Cardioversion is defined as a “synchronised direct current (DC) discharge, and … does not apply to ventricular defibrillation or to the pharmacologic reversion of arrhythmias
.”It is synchronised to give electrical discharge at the point of the Q or R wave in the ECG cycle. The reason to synchronise this is to prevent a shock occurring during repolarisation of ventricles in the T wave, which can lead to Ventricular Fibrillation.
What is Cardioversion?
1Slide3
The ECG
Left shows the various waves throughout the ECG and explains what each deflection means from the isoelectric line.
Right shows another ECG but with colour demonstrates the duration of each different segment.
Fig 1
Fig 2Slide4
Based on advanced cardiac life support (ACLS) guidelines, any patient with narrow or wide QRS complex tachycardia (ventricular rate >150) who is unstable (for example,
chest pain, pulmonary oedema, lightheaded, hypotension) should be immediately treated with synchronized electrical cardioversion.
Indications
2Slide5
Supraventricular tachycardia due to re-entry
Atrial fibrillationAtrial flutterAtrial tachycardiaMonomorphic VT with pulses
Contraindications
D
igoxin
toxicity–associated
tachycardiaSinus tachycardia caused by various clinical conditionsMultifocal atrial tachycardia
Also recommended in the following:Slide6
Midaxillary line
Important body landmarks
Right Sternal edge
Intercostal spacesSlide7
First of all, the appropriate equipment must be organised:IV accessAirway management equipment
Sedative drugs (midazolam and fentanyl)Cardioversion monitoring device
ProcedureSlide8
Place patient onto bed Remove upper garments
Apply heart tracing leadsStep 1
Conduction strips
Points of application
Leads: Red, Amber, Green (Traffic lights)Slide9
Turn the Cardioversion machine on
Step 2
Twist green nozzle clockwise to activate
OffSlide10
Place on the pads
Step 3
Pads and connection for machine
First pad: 2
nd
or 3
rd
intercostal space, Right Sternal edge
Second pad: 4
th
or 5
th
Intercostal space ,
Midaxillary line
Anterolateral pad positioningSlide11
Check heart tracing is being picked up
Step 4Slide12
Press Sync to locate R waves
Step 5
R waves indicated by arrowsSlide13
Set the voltage as per guidelines on the condition presenting with the patient
Step 6Slide14
WARN EVERYBODY AROUND THE BED YOU ARE ABOUT TO PRESS CHARGE AND SHOCK
Everyone should step back from the patient and the bedStep 7Slide15
Press ChargeThen Shock
Step 8Slide16
Watch the monitor and see if the Rhythm has returned to normal
If not, this may need to be repeatedBelow is a before and after ECG from a patient in AAH with Supraventricular tachycardia resolved using Synchronised DC Cardioversion
Step 9Slide17
Pre-Cardioversion ECGSlide18
Post-Cardioversion ECGSlide19
Synchronised cardioversion when practiced correctly can be a very effective way to correct tachycardia’s.ACLS guidelines should be followed for when it should be used and at which voltage.
Always check for the contraindications prior to the procedure.Follow the steps above for the correct way to perform the procedure safely and effectively.
ConclusionSlide20
Lown
B. Defibrillation and cardioversion. Cardiovasc Res. Aug 1 2002;55(2):220-4.
[Guideline] Part 5: Electrical Therapies. Automated External Defibrillators, Defibrillation, Cardioversion, and Pacing.
Circulation
. 2005;112:IV-35-IV-46.
Figures
http
://hyperphysics.phy-astr.gsu.edu/hbase/biology/imgbio/ecg.gif
References