Effective Strategies for DC Cardioversion in Cardiac Arrest Management
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EDucateEM
February 2024
Cardiac Arrest
DC Cardioversion
14/02/2024
COLIN MUNRO
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DC Cardioversion
Aims
1.
Understand the indications
2.
Know how to prepare
3.
Know use the defib
for cardioversion
4.
Post cardioversion care
1. Understand the
Indications
Intervene so peri-arrest arrhythmias don’t
progress
Patient with adverse or life-threatening features
•
Shock (Systolic<90mmHg)
•
Syncope
•
Myocardial ischaemia
•
Severe
heart failure
2. Know how to prepare
▪
Environment?
▪
Monitoring?
▪
Equipment?
▪
Personnel?
▪
Patient?
3. Know use the defib
for cardioversion*
•
*Cardioversion
not
defibrillator
•
Pad placement
with
monitoring leads
•
Get out of AED mode
•
Sync button
•
Energy selection (ALS book)
•
Atrial Flutter/SVT – Start at 70-120J
•
Pulsed VT – Start at 120-150J
•
Atrial Fibrillation – Start at highest
energy output (360J)
•
NHST policy – 200, 300, 360J
•
Safe use of defib
•
Need to hold down shock button
4. Post cardioversion care
•
Success?
•
Further attempts at increasing energy
•
Change pad position
•
Amiodarone + further shocks
•
Cardiology input
•
Repeat ECG
•
Observation (cardiovascular stability and recovery from sedation).
•
Disposition
•
CCU
DC Cardioverison Summary
▪
Life threatening features
▪
Preparation is key
▪
Defib set-up
▪
Post cardioversion care
Understanding the indications for DC cardioversion, preparing the environment and equipment, knowledge of defibrillator use, and post-cardioversion care are crucial steps in managing cardiac arrest cases. This educational material provides a comprehensive guide on when to intervene, how to prepare, proper defib use, and post-care considerations for successful outcomes in cardioversion procedures.
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Presentation Transcript
EDucateEM February 2024 Cardiac Arrest DC Cardioversion 14/02/2024 COLIN MUNRO
DC Cardioversion Aims 1. Understand the indications 2. Know how to prepare 3. Know use the defib for cardioversion 4. Post cardioversion care
1. Understand the Indications Intervene so peri-arrest arrhythmias don t progress Patient with adverse or life-threatening features Shock (Systolic<90mmHg) Syncope Myocardial ischaemia Severe heart failure
2. Know how to prepare Environment? Monitoring? Equipment? Personnel? Patient?
3. Know use the defib for cardioversion* *Cardioversion not defibrillator Pad placement with monitoring leads Get out of AED mode Sync button Energy selection (ALS book) Atrial Flutter/SVT Start at 70-120J Pulsed VT Start at 120-150J Atrial Fibrillation Start at highest energy output (360J) NHST policy 200, 300, 360J Safe use of defib Need to hold down shock button
4. Post cardioversion care Success? Further attempts at increasing energy Change pad position Amiodarone + further shocks Cardiology input Repeat ECG Observation (cardiovascular stability and recovery from sedation). Disposition CCU
DC Cardioverison Summary Life threatening features Preparation is key Defib set-up Post cardioversion care
