Standards Procedure (Skill)
Clinical Indications: Level: EMT-P only
Ø Unstable patient with a tachydysrhythmia (rapid atrial fibrillation, supraventricular tachycardia, ventricular tachycardia.)
Procedure:
a. Ensure the monitor in use has defibrillation /cardioversion capabilities and is correctly applied and working properly.
b. Have all equipment ready for unsynchronized cardioversion (defibrillation) if the patient fails to respond or condition worsens.
c. Consider the use of pain or sedation medications.
d. Explain the procedure to the patient and/or family members.
e. Set the energy selection to 50 joules.
f. Set the monitor to the synchronized cardioversion mode.
g. Verify that the machine is synching by visualization of the complexes.
h. Make certain that all personnel are clear.
i. Press the button to cardiovert and hold down. Stay clear of the patient until you are sure that the energy has been delivered. (It may take a short period of time between the activation of the button and the delivery of the energy to the patient.)
j. Note the patient’s response and be able to immediately deliver a defibrillation if the patient’s condition deteriorates to that of a pulseless ventricular tachycardia or a ventricular fibrillation.
k. If the patient’s condition is unchanged after the initial cardiversion, repeat steps above but increase joules to 100, 200, then 300 successively. Reassesses between each deliver of cardioversion.
l. If the patient has not improved with the cardioversion, contact medical control.
m. Note the procedure, response, and time on the ACR.
Certification Requirements:
Successfully complete an annual skill evaluation including the indications, contraindications, technique, and possible complications of the procedure.