Today our topic of discussion is General Instruction for Cardioversion.
General Instruction for Cardioversion
General Instructions
Prevent potential complications while using defibrillator such as:
- Burns to the patient
- Shock to operator/other personnel
- Fire/sparks
- Arrhythmias
- Ineffective shock.
Procedure
- Pre-defibrillation care (Preparation defibrillation)
- Explain procedure if patient is conscious
- Position in supine without any pillow for head
- Confirm ventricular tachycardia or ventricular fibrillation by checking patient’s clinical condition
- Ensure “synchronize” mode is off.
- Apply adequate gel to paddles and place on chest.
- Keep one paddle anteriorly at 2nd intercostals space right of sternum and another paddle laterally at 5th intercostals space to left of sternum at mid-axillary line or at cardiac apex. Ensure there is 10 cm distances between paddles
- Select energy setting according to patient’s weight, height and level of consciousness
- Check cardiac monitor, if life-threatening arrhythmia is still present, charge defibrillator
- Look around and ensure no one is in contact with patient or bed
- Loudly announce “stand clear/all clear” and alert other health team members
- Discontinue oxygen inhalation to prevent fire hazards
- Defibrillate by pressing discharge buttons on both paddles simultaneously.
- Apply 20 to 25 pounds (10-12 kg) of pressure on each paddle
- Reassess cardiac monitor to determine rhythm and subsequent action while paddles are still on chest If VF/VT is still present, reset and increase energy at 200-300 joules and deliver .
- If VF/VT is not revered, deliver 360 joules and reassess cardiac rhythm.
- When VF/VT persist, administer emergency drugs, e.g.
- Injection adrenaline and atropine and give CPR for one minute
- Repeat defibrillation at 360 joules for 3 times as ordered
- Discontinue procedure Clean and replace paddles for next use.
- The following steps are mandatory for defibrillation: A defibrillator is one part of standard emergency equipment available.
- There are many different models of defibrillators.
- The nurse should be familiar with the operation of the type of defibrillation that is used in the critical care unit.
- CPR should be in progress if the defibrillator is not immediately available
- The defibrillator should be turned on and the proper energy level should be selected
- Synchronizer switch is turned off
- Conductive material in the form of saline pads, electrode. gel or defibrillator gel pads are applied to the chest, where defibrillator paddals are placed.
- This helps to prevent burns.
- The paddels are placed on the chest wall at the third intercostal space to the right of the fifth intercostal space on the left mid-axillary line.
- The operator calls “all clear, to ensure that personnel are not touching the patient or bed at the time of discharge.
- The defibrillator is then discharged by depressing buttons on both paddles simultaneously.
Read more: