Cardioversion vs defibrillation–performing the procedures
Learn how to perform both of these procedures and make the right choice about which is required, and when.
Explore the difference between cardioversion and defibrillation, and learn how to shock someone back to life! In this video, from our Emergency Procedures Masterclass course, you'll discover how to perform both of these procedures and be able to differentiate when each is required.
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[00:00:00] Let's start by learning how to perform cardioversion. Here's a patient I recently treated. He was 57 years old, he had palpitations, he had a normal blood pressure, he didn't have any chest pain or shortness of breath, but he was really uncomfortable. We assessed him to have atrial fibrillation with rapid ventricular response and we confirmed it with an EKG. You can see that there are no P waves and the rate is pretty fast and irregular.
[00:00:30] Let's cardiovert him. After consenting the patient for sedation and cardioversion, place your pads and connect to the machine. Next, administer the sedative and wait until it takes effect. Since you're performing cardioversion, press the sync button, then select the energy level and charge the machine. I recommend at least 100 joules in a biphasic machine for all rhythms. Depending on the size of the patient, I may just go up to 200 joules of biphasic energy.
[00:01:00] Once charged, make sure no one is touching the patient. As soon as everyone is clear, press the shock button. You'll see a brief contraction of the patient's chest wall muscles. And at this point, look at the monitor and see if you have terminated the dysrhythmia. After the cardioversion, the EKG is repeated and shows successful cardioversion to normal sinus rhythm. Because we used the short-acting
[00:01:30] sedative, etomidate, our patient was awake and asymptomatic and ready for discharge within minutes of the cardioversion. Now, let's look at the case that needs defibrillation. For defibrillation, there's no need for sedation, since the patient is unconscious and CPR is likely being performed. So, select the highest energy and charge the machine. Once it's charged, make sure no one is touching the patient. This is the only time the CPR
[00:02:00] is briefly stopped and as soon as everyone is clear, press the shock button. You'll see a brief contraction of the patient's chest wall muscles. Using the latest guidelines, continue CPR for two minutes, before checking the rhythm again.