CARDIOVERSION (Synchronized)

Indications: 
Unstable tachycardia (altered LOC, dizziness, chest pain, hypotension).

Energy Levels: 100 J, 200 J, 300 J, 360 J.

Application: 
Use handheld paddles or remote adhesive pads.
Always use a conducting gel with paddles. 
For conscious patients explain the procedure and use a medication for sedation. 
Consider 2.5–5.0 mg of midazolam (Versed) or 5 mg diazepam (Valium).

Methods: 
Place defibrillator in synchronized (sync) mode.
Charge to appropriate level. 
Say, “I’m going to shock on three. 
One, I’m clear; two, you’re clear; three, everybody’s clear.” 
Perform visual sweep and press shock button. 
Reassess and treat according to appropriate algorithm.

Precautions: 
Reactivation of sync mode is required after each attempted cardioversion. Defibrillators default to unsynchronized mode. 
Place paddles and pads several inches away from an implanted pacemaker.

Sync mode delivers energy just after the R wave to avoid stimulation during the refractory, or vulnerable, period.