Procedures | DC Cardioversion

Question 1

Full outline of Cardioversion Station delivery?

Answer 1

Establish
- Introduction
- Confirm VT on ECG and appropriateness of DCCV

Explore & Educate

• Confirm time of onset and if this is first episode
• PC | HPC | PMH | DH
• Explain diagnosis
• Informed consent (Nature, Indication, Benefits, Risks/Complications, alternatives)

[Procedure]
- Suggest checklist
- Ensure 2 doctors and a nurse
- Full monitoring - Pulse ox, BP, 3 lead ECG, wave cap
- Rescue equipment - O2, airway adjuncts, suction, emergency drugs
- Defibrillator - sync, energy 120J - 150J
- Confirm adequate sedation (Ketamine/Propofol 0.5-1 mg/kg)
- Deliver shock and reassess

Exit

• Observe until GCS 15/15, normal observations
• Review post-cardioversion ECG
• Admission to Cardiology
• Answer Q’s and ICE

Question 2

How many people needed for cardioversion?

Answer 2

3 people.
2 doctors and 1 nurse.
* Sedationist
* Operator
* Monitor/Runner

Question 3

What is the main airway consideration in emergency cardioversion?

Answer 3

Patient likely not fasted so higher aspiration risk.

Question 4

What is the main anaesthetic concern regarding circulation in conditions requiring cardioversion?

Answer 4

Decreased cardiac output leds to increased circulation time and this should be kept in mind when titrating drugs.

Question 5

What does the sync function of the defibrillator ensure?

Answer 5

That shock is delivered with the peak of the R wave.

Question 6

What are the indications for cardioversion?

Answer 6

Haemodynamic instability associated with the following pulsed rhythms:

• SVT
• Atrial Flutter
• AF
• VT

Question 7

What are the energy levels used for cardioverting?

Answer 7

70-120 J (biphasic) - SVT and Atrial Flutter

120-150 J (biphasic) - Broad Complex Tachy/AF

Question 8

What is the option should cardioversion fail?

Answer 8

If cardioversion unsuccessful after 3 synchronised shocks, give amiodarone IV 300 mg over 10-20 minutes and repeat shock.

Follow up with 900 mg amiodarone over 24 hours.

Question 9

What is the access consideration for amiodarone?

Answer 9

Central vein ideal as drug can cause thrombophlebitis when given peripherally, however peripheral can be used in urgent/emergency situation.