Page 220 - 2026 SMOG

CARDIAC DEFIBRILLATION
Clinical Indications
• Patient who is in pulseless cardiac arrest with either ventricular fibrillation or ventricular
tachycardia seen on monitor
Contraindications
• None
Procedure
1. Ensure the patient is attached to a monitor/defibrillator. If paddles are used, ensure that they
are several centimeters away from the monitor leads to prevent arcing. Use pediatric paddles
as indicated. If unavailable and pads are used, place in the anterior/posterior position for
pediatric patients.
2. Set the energy level to the appropriate level. Start 200J adult (biphasic) or 360J adult
(monophasic), or 2J/kg pediatric.
3. Press the “charge” button 30 seconds prior to the end of compressions. This maneuver
minimizes the time between compressions and defibrillation. Compressions should continue
until the end of the cycle
4. Ensure all personnel are clear of the patient and that pilots are aware of cardioversion
5. Press and hold the “shock” button until energy is delivered
6. If rhythm converts, treat as per post-resuscitation protocol
7. Following shock delivery, immediately begin/return to CPR for 2min before checking for
a pulse
8. If the pediatric patient fails to convert, repeat steps 2–7 above using escalating energy levels
**Document procedure, results, and vital signs**

AUTOMATED EXTERNAL DEFIBRILLATOR (AED)
1. Turn on the power to the machine and follow the prompts to attach the pads to the patient and
the machine
2. Ensure no one is touching/moving the patient and press the “Analyze” or equivalent button.
(If not present, the machine will automatically check the rhythm at dedicated time intervals.
A vocal warning will tell you when this is occurring)
3. If a shock is advised, press the button to deliver a shock and return to CPR for 2min.
4. After analysis, if subsequent shocks are advised, repeat steps 2–3 up to 3 shocks, until further
care arrives or until no further shocks are advised. If no shock is advised at any time,
CHECK PULSE. Continue CPR if no pulse. If pulse present, place patient in recovery position
and transport.
**Document procedure, results, and vital signs.**

212 • PROCEDURES