Synchronized Cardioversion

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Synchronized Cardioversion

• Synchronized cardioversion is a LOW ENERGY shock that uses a sensor to deliver electricity that is synchronized with the peak of R-wave. 
• Synchronization avoids the delivery of LOW ENERGY shock during cardiac repolarization (T-wave). If the shock occurs on T-wave, there is a high likelihood that the shock can precipitate Ventricular Fibrillation.
• The most common indications for synchronized cardioversion are unstable tachyarrhythmias with palpable pulse.

Step 1. Prepare the patient.

• Sedate conscious patients unless they are unstable or rapidly deteriorating.
• Ensure that airway equipment and oxygen devices are within arm’s reach.

 
Step 2. Prepare the defibrillator.

• Turn on the defibrillator.
• Attach the monitor leads to the patient. 
• Ensure that the patient’s rhythm is displayed properly. 
• Position the conductor pads on the patient in an anterior–lateral or anterior–posterior position.

Step 3. Activate the synchronization mode.

• Engage the synchronization mode by pressing the sync control button.
• Look for markers on the R wave which indicate the sync mode.
• Adjust the monitor, if necessary, until the sync markers occur with each R wave.
• Synchronization allows the shock to be provided safely away from the T wave, avoiding the R-on-T phenomenon. 

Step 4. Select energy level.

• The recommended energy levels used to perform synchronized cardioversion vary from 50 to 200 joules.
• Choose the appropriate energy level according to ACLS guidelines.

Step 5. Shock the patient.

• Make an announcement to the team members that you’re charging the defibrillator and shout out "clear" for everyone to stand clear.
• Press the charge button.
• Make sure the patient is clear once more after the defibrillator is charged.
• Press the shock button.

Step 6. Repeat the shock with increased energy.

• Check the monitor and vital signs. 
• If tachycardia persists, increase energy level according to ACLS guidelines.
• Press the sync button again to activate sync mode before charging.
• Note that many defibrillators will default back to unsynchronized mode after a synchronized shock; this default allows for an immediate defibrillation if your cardioversion efforts produce Ventricular Fibrillation in the patient.