{"id":478,"date":"2020-08-07T16:31:26","date_gmt":"2020-08-07T16:31:26","guid":{"rendered":"https:\/\/www.proacls.com\/wiki\/?p=478"},"modified":"2020-08-11T18:19:36","modified_gmt":"2020-08-11T18:19:36","slug":"synchronized-cardioversion","status":"publish","type":"post","link":"https:\/\/www.proacls.com\/wiki\/acls\/synchronized-cardioversion\/","title":{"rendered":"Synchronized Cardioversion"},"content":{"rendered":"<h2>What is Synchronized Cardioversion?<\/h2>\n<p>Synchronized cardioversion is a treatment technique that uses a sensor to deliver a shock that is synchronized with a peak in the QRS complex.<\/p>\n<p>Defibrillators can deliver two types of shocks \u2013 synchronized and unsynchronized. Unsynchronized shocks refer to a shock that is delivered immediately after the healthcare professional pushes the shock button. This means that the shock is not delivered precisely in the cardiac cycle; in other words, unsynchronized shocks are more random.<\/p>\n<p>However, when a healthcare provider uses synchronized cardioversion, after pushing the shock button, that shock may not be delivered immediately. Instead, the shock delivery will be synced with the peak of the R wave in the patient&#8217;s QRS complex.<\/p>\n<p>Synchronization avoids the delivery of a shock during cardiac repolarization, which is represented on the surface ECG as the T wave. This is a period of vulnerability in which a shock can precipitate <a href=\"https:\/\/www.proacls.com\/training\/video\/ventricular-fibrillation\">VFib<\/a>.<\/p>\n<p>Synchronized cardioversion uses a lower energy level than normal defibrillation. These low-energy shocks must always be delivered as synchronized shocks to avoid precipitating VFib.<\/p>\n<h2>When is Synchronized Cardioversion Used?<\/h2>\n<p>Synchronized cardioversion is recommended in some <a href=\"https:\/\/www.proacls.com\/wiki\/category\/acls-algorithms\/\">ACLS algorithms<\/a>, such as unstable tachycardia, particularly when a persistent tachyarrhythmia is causing the following to occur:<\/p>\n<ul>\n<li>Hypotension<\/li>\n<li>Acutely altered mental state<\/li>\n<li>Signs of shock<\/li>\n<li>Ischemic chest discomfort<\/li>\n<li>Acute heart failure<\/li>\n<\/ul>\n<h2>Synchronized Cardioversion Technique<\/h2>\n<p>Synchronized cardioversion is the recommended treatment for patients who have a symptomatic, unstable reentry <a href=\"https:\/\/www.proacls.com\/training\/video\/supraventricular-tachycardia\">SVT<\/a> or V-tach with pulses. Synchronized cardioversion is also routinely used to treat unstable atrial flutter and unstable atrial fibrillation.<\/p>\n<p>Cardioversion may not be effective when treating junctional tachycardia or ectopic or multifocal atrial tachycardia, as these rhythms have an automatic focus arising from cells that are spontaneously depolarizing at a rapid rate. In these scenarios, the delivery of a shock typically cannot stop these rhythms. In fact, it may actually increase the rate of the tachyarrhythmia.<\/p>\n<p>When performing synchronized cardioversion, the shocks are administered through either adhesive electrodes or handheld paddles. Healthcare providers must place the defibrillator\/monitor in synchronized mode, which is designed to deliver energy just after the R wave of the QRS complex.<\/p>\n<h3>Synchronized Cardioversion Steps<\/h3>\n<p>ACLS providers should be aware that they may have to modify these steps for the specific device they\u2019ll be using.<\/p>\n<ol>\n<li>Sedate conscious patients unless they are unstable or rapidly deteriorating.<\/li>\n<li>Turn on the monophasic or biphasic defibrillator.<\/li>\n<li>Attach the monitor leads to the patient. Remember lead placement with this \u2013 <em>white to right, red to ribs, what&#8217;s left over to the left shoulder<\/em>. You should also ensure that the patient&#8217;s rhythm is displayed properly. Then position the adhesive electrode or conductor pads on the patient.<\/li>\n<li>Engage the synchronization mode by pressing the sync control button.<\/li>\n<li>Look for markers on the R wave which indicate the sync mode.<\/li>\n<li>Adjust the monitor, if necessary, until the sync markers occur with each R wave.<\/li>\n<li>Choose the appropriate energy level and deliver monophasic synchronized shocks in the following sequence:<br \/>\na. If treating unstable atrial fibrillation, the initial dose is 200 J.<br \/>\nb. If treating unstable monomorphic V-tach, the initial dose is 100 J.<br \/>\nc. If treating another unstable SVT or atrial flutter, the initial dose is 50 to 100 J.<br \/>\nd. If treating unstable polymorphic V-tach, you should treat it as VFib and deliver a high-energy shock.<\/li>\n<li>Make an announcement to the team members that you\u2019re charging the defibrillator and tell everyone to stand clear.<\/li>\n<li>Press the charge button.<\/li>\n<li>Make sure the patient is clear once more after the defibrillator is charged.<\/li>\n<li>Press the shock button.<\/li>\n<li>Check the monitor. If tachycardia continues to persist, you should increase the energy level according to the Electrical Cardioversion Algorithm.<\/li>\n<li>Activate the sync mode. This should be done after each synchronized shock. Be aware that many defibrillators will default back to the unsynchronized mode after delivery of a synchronized shock. This default allows for an immediate shock if your cardioversion efforts produce VFib in the patient.<\/li>\n<\/ol>\n","protected":false},"excerpt":{"rendered":"<p>What is Synchronized Cardioversion? Synchronized cardioversion is a treatment technique that uses a sensor to deliver a shock that is synchronized with a peak in the QRS complex. Defibrillators can deliver two types of shocks \u2013 synchronized and unsynchronized. Unsynchronized shocks refer to a shock that is delivered immediately after the healthcare professional pushes the [&hellip;]<\/p>\n","protected":false},"author":2,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"jetpack_post_was_ever_published":false,"_jetpack_newsletter_access":"","_jetpack_dont_email_post_to_subs":false,"_jetpack_newsletter_tier_id":0,"_jetpack_memberships_contains_paywalled_content":false,"_jetpack_memberships_contains_paid_content":false,"footnotes":"","jetpack_publicize_message":"","jetpack_publicize_feature_enabled":true,"jetpack_social_post_already_shared":true,"jetpack_social_options":{"image_generator_settings":{"template":"highway","default_image_id":0,"font":"","enabled":false},"version":2}},"categories":[16],"tags":[],"class_list":["post-478","post","type-post","status-publish","format-standard","hentry","category-acls"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.5 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Synchronized Cardioversion - ACLS Wiki<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/www.proacls.com\/wiki\/acls\/synchronized-cardioversion\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Synchronized Cardioversion - ACLS Wiki\" \/>\n<meta property=\"og:description\" content=\"What is Synchronized Cardioversion? Synchronized cardioversion is a treatment technique that uses a sensor to deliver a shock that is synchronized with a peak in the QRS complex. Defibrillators can deliver two types of shocks \u2013 synchronized and unsynchronized. 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