Defibrillation
(Redirected from Unsynchronized cardioversion)
See critical care quick reference for defibrillation settings (joules) by weight.
Background
- Unsynchronized shock
Indications
It is important to note that the procedure and indications differ between defibrillation and cardioversion
Defibrillation (Unsynchronized Cardioversion)
Synchronized Cardioversion
- Supraventricular tachycardia (SVT)
- Atrial fibrillation
- Atrial flutter
- Ventricular tachycardia with a pulse
Contraindications
- None
Equipment Needed
- Automated External Defibrillator (AED)
- Defibrillator
Procedure
- Apply pads or paddles
- Paddles may be slightly quicker but pads are viewed to be safer[1]
- Larger pads reduce transthoracic impedance[2]
- “Adult” size in adults
- “Adult” size (8 to 10 cm) for children >10 kg (> approximately 1 year)[3]
- “Infant” size for infants <10 kg
- 4 accepted pad positions: anterolateral, anteroposterior, anterior-left infrascapular, and anterior-right-infrascapular
- Anteroposterior position performs slightly better[4]
- Biphasic setting
Complications
- Defibrillator Refractory VF
- Consider apply 2 defibrillators and delivering double sequential external shocks[9][10]
- Consider esmolol bolus 500 mcg/kg IVP over 30 seconds followed by drip of 50 mcg/kg/min if ROSC obtained [11]
- Consider stellate ganglion nerve block
See Also
- ACLS (Main)
- PALS (Main)
- Synchronized cardioversion
- Tachycardia (Wide)
- Adult pulseless arrest
- In-Training Exam Review
External Links
References
- ↑ Benedikte H, et al. Time and safety in defibrillation with paddles versus pads: A comparative study of two defibrillation regimes. Resuscitation. 2013; 84(11):e141–e142.
- ↑ Connell PN, et al. Transthoracic impedance to defibrillator discharge. Effect of electrode size and electrode-chest wall interface. J Electrocardiol. 1973; 6:313–M.
- ↑ Atkins DL, et al. Pediatric defibrillation: current flow is improved by using “adult” electrode paddles. Pediatrics. 1994; 94:90–93.
- ↑ Krasteva V, et al. Transthoracic impedance study with large self-adhesive electrodes in two conventional positions for defibrillation. Physiol Meas. 2006; 27:1009–1022.
- ↑ Neumar RW, et al. 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science. Part 8: Adult Advanced Cardiovascular Life Support. Circulation. 2010; 122: S729-S767.
- ↑ Kleinman ME, et al. 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science. Part 14: Pediatric Advanced Life Support. Circulation. 2010; 122: S876-S908.
- ↑ Mittal S, Ayati S, Stein KM, et al. Comparison of a novel rectilinear biphasic waveform with a damped sine wave monophasic waveform for transthoracic ventricular defibrillation. ZOLL Investigators. J Am Coll Cardiol. 1999;34(5):1595-1601. doi:10.1016/s0735-1097(99)00363-0
- ↑ Schneider T, Martens PR, Paschen H, et al. Multicenter, randomized, controlled trial of 150-J biphasic shocks compared with 200- to 360-J monophasic shocks in the resuscitation of out-of-hospital cardiac arrest victims. Optimized Response to Cardiac Arrest (ORCA) Investigators. Circulation. 2000;102(15):1780-1787. doi:10.1161/01.cir.102.15.1780
- ↑ Hoch DH, et al. Double sequential external shocks for refractory ventricular fibrillation. J Am Coll Cardiol. 1994; 23(5):1141-5.
- ↑ Cabanas JG, et al. Double Sequential External Defibrillation in Out-of-Hospital Refractory Ventricular Fibrillation: A Report of Ten Cases. Prehosp Emerg Care. 2015; 19(1):126-130.
- ↑ Driver BE, Debaty G, Plummer DW, et al. Use of esmolol after failure of standard cardiopulmonary resuscitation to treat patients with ventricular fibrillation. Resuscitation. 2014; 85(10):1337-1341.