Step by step guide for Synchronised DC Cardioversion - PowerPoint Presentation

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