Synchronized cardioversion is a procedure where the defibrillator is synchronized with the QRS complex.
Prevents shock during cardiac repolarization, avoiding ventricular fibrillation.
Can be performed urgently or electively.
Preparation
Clean and dry the patient's skin.
Shave or clip hair for better contact.
Use adhesive electrode pads or paddles.
Pad/Paddle Placement
Anterior Placement:
Right pad: Just to the right of the sternum, below the clavicle, at 2nd or 3rd intercostal space.
Lateral pad: Below left nipple, medial to anterior axillary line, at 5th or 6th intercostal space.
Anterior-Posterior Placement (for large chest cavity or breasts):
Use only adhesive pads.
Anterior pad: Left of sternum, 3rd or 4th intercostal space.
Posterior pad: Left of spine, below left scapula.
Heart is sandwiched between pads.
Equipment Setup
Attach defibrillation cables to the defibrillator.
Use conducting material (gel sheet or liquid) between paddles and chest, if using paddles.
Patient Care
Provide IV analgesia and sedation if possible.
Ensure monitor shows a clear rhythm.
Procedure Steps
Synchronization:
Activate sync by pressing the button.
Confirm synchronization with monitor (peak of QRS complex should brighten).
Energy Level Selection:
Biphasic machine: 100-120 joules for atrial fibrillation, 50 joules for other supraventricular tachycardia, 100 joules for monomorphic ventricular tachycardia.
Monophasic machine: 200 joules for atrial fibrillation, 100 joules for other supraventricular tachycardia or monomorphic ventricular tachycardia.
Charging and Delivery:
Press charge button.
Announce "all clear" and ensure no one is touching patient or bed.
Deliver shock using machine button (for pads) or paddles.
Post-Shock
Check monitor for conversion to sinus rhythm.
If no conversion, administer additional shock:
Increase energy to 200 joules (biphasic) or 360 joules (monophasic).