Page 247 - 2023 SMOG Digital

SYNCHRONIZED

CARDIOVERSION

CLINICAL INDICATIONS:
• Unstable patient with tachycardia-dysrhythmia noted on monitor/EKG.
• Patient who has failed conservative and/or chemical cardioversion.
• Patient not pulseless.
CONTRAINDICATIONS:
• None
PROCEDURE:
• Ensure patient attached to monitor/defibrillator with synchronized cardioversion capability.
• Time-permitting, ensure adequate IV/IO access present. Ensure that unsynchronized
cardioversion/defibrillation capabilities present in case patient degenerates into another dysrhythmia.
• Consider use of sedating medication (e.g., Midazolam 0.1mg/kg (5mg max dose) prior to delivery of shock.
Note: This step is not mandatory and should not delay appropriate management of emergent
condition.
• Set energy level to appropriate level. Usually starting at 50J-100J in adults or 0.5J/kg-1J/kg in children for
atrial/ventricular arrhythmias, respectively.
• Select Synchronized Cardioversion option. This should result in machine displaying “SYNC” as well as
tracking electrical activity (arrow or highlighted segment of EKG).
• Ensure all personnel clear of patient and pilots aware of cardioversion.
• Press and hold “Shock” button until energy delivered. (This may take several seconds for machine to
synchronize with cardiac cycle. Shock is not immediately delivered as in defibrillation.)
• If rhythm converts – monitor and treat as appropriate.
• If fails to convert – repeat steps 4-7 above using escalating energy levels. If patient degenerates, treat as
per appropriate protocol/CPR. Note: most machines require pushing the “SYNC” after each shock if
synchronized cardioversion to be repeated, failure to do so will result in delivery of an
unsynchronized shock.
• Document procedure, results, and vital signs on run sheet following mission.

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