Steps to perform cardioversion in emergency

Posted by Doctor Tran Hai Ha - Emergency Department - Vinmec Times City International Hospital

Extrathoracic shock uses high-energy DC energy delivered over a very short period of time to depolarize most of the heart muscle cells at the same time to restore a normal heart rhythm.

Cardioversion is a form of electric shock, the electrical impulse hitting the R wave of the QRS complex (synchronized with the R wave) does not hit other stages (the phase of the heart muscle is very vulnerable to attack). especially T waves) to avoid causing ventricular fibrillation due to electric shock.
Indications for synchronous cardioversion:
Tachyarrhythmias causing hemodynamic instability, myocardial ischemia, congestive heart failure Ventricular tachycardia, atrial fibrillation, atrial flutter with rapid ventricular rate, causing symptoms of prolonged discomfort for the patient, hemodynamic instability Supraventricular tachycardia with wide or narrow QRS with hemodynamic instability Cases that need to be weighed against the benefit of electric shock:
Atrial fibrillation, no atrial flutter symptomatic, atrial fibrillation with slow ventricular response Sinus node insufficiency syndrome, pathology of the cardiac conduction system Electric shock machine: can use single phase or biphasic (monophasic - biphasic), effective biphasic shock higher than single-phase shock because the current will sweep through the heart once more in the opposite direction after passing through the heart for the first time.
In open heart surgery, an electric shock plate can be used directly on the heart to shock the rhythm or defibrillation. However, in this case, the energy level will be lower.

If electroconvulsive shock is planned, the patient should be fasted for 6-8 hours before the procedure to avoid aspiration pneumonia.
A short general anesthetic (Fentanyl, Midazolam, Propofol) is required because the electroshock procedure can cause pain in the patient. Need to arrange equipment and staff for anesthesia - emergency resuscitation for patients.
Location of electrodes: there are 2 commonly used ways to place the electrode plate: Anterior-posterior position (STERNUM plate in the 3-4 intercostal space close to the left breastbone, APEX plate below the left shoulder blade), Anterior-lateral position (STERNUM plate in the 2nd intercostal space close to the right breastbone, APEX plate in the 5-6 intercostal space at the apex of the heart) Lift the two electrode plates out of the socket, rub the conductive cream evenly. surface of electrode plate Use appropriate electrode plate (Adult: diameter 10-13 cm, Children > 10 kg: diameter 8 cm, Children < 10 kg: diameter 4.5 cm) Place 2 plates pole on the patient's chest to observe the ECG on the screen, select the lead with the best R wave (press the LEAD button to change the lead, press the SENS button to change the amplitude of the ECG) Turn on the sync button Set the electric shock energy level depending on the case (table below) Press the CHARGE button on the meter or on the handle of the electrode, the CHARGE lamp will flash and short beep continuously, when the energy level is fully charged, the light will light up. continuous and long beeps. Firmly press the 2 electrode plates to the patient's chest Shout loudly to keep everyone away from the patient Simultaneously press the 2 DISCHARGE buttons on the 2 electrode handles Recheck the ECG on the mornitor after each shock if the shock fails with energy level gradually increasing depending on each case Energy level of emergency electric shock (Biphasic)

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