Page 222 - 2026 SMOG

SYNCHRONIZED CARDIOVERSION
Clinical Indications
• Unstable patient with tachycardia, dysrhythmia noted on monitor/EKG
• Patient who has failed conservative and/or chemical cardioversion
• Pulse present
Contraindications
• None
Procedure
1. Ensure the patient is attached to a monitor/defibrillator with synchronized cardioversion
capability.
2. Time-permitting, ensure adequate IV/IO access is present. Ensure that unsynchronized
cardioversion/defibrillation capabilities are present in case the patient degenerates into another
dysrhythmia.
3. Consider use of sedating medication (e.g., Midazolam 0.5–2mg q5min) prior to delivery
of shock.
Note: This step is not mandatory and should not delay the appropriate management of an
emergent condition.
4. Set energy level IAW appropriate ALS/PALS Protocol
5. Select the Synchronized Cardioversion option. This should result in the machine displaying
“SYNC” as well as tracking electrical activity (arrow or highlighted segment of EKG)
6. Ensure all personnel are clear of the patient and that pilots are aware of cardioversion
7. Press and hold the “Shock” button until energy is delivered (this may take several seconds for
the machine to synchronize with the cardiac cycle. Shock is not immediately delivered as in
defibrillation)
8. If rhythm converts, monitor and treat as appropriate
9. If it fails to convert, repeat steps 4–7 above using escalating energy levels. If the patient
degenerates, treat as per appropriate ALS/PALS protocol.
Note: Most machines require pushing the “SYNC” after each shock if synchronized
cardioversion is to be repeated; failure to do so will result in delivery of an
unsynchronized shock.
**Document procedure, results, and vital signs.**

214 • PROCEDURES