Cardioversion

1. Indications:

a. Ventricular tachycardia

b. Supraventricular tachycardia

c. Atrial fibrillation/flutter with rapid ventricular rate

AND

d. Patient in distress with chest pain, respiratory distress, hypotension, or altered mental status.

2. Mandatory interventions:

a. Cardiac monitoring

b. IV access

c. Oxygen

3. Contact Medical Control:

a. Administer MIDAZOLAM (Versed) 5 mg IV for sedation.

i. Option: KETAMINE 1 mg/kg IV

b. Administer FENTANYL 50 - 100 mcg IV for pain.

c. Perform synchronized cardioversion at at   appropriate joules. (See Table Below)

Synchronized cardioversion

Atrial fibrillation: 200 J

Atrial flutter: 200 J

Narrow complex tachycardia: 100 J

Monomorphic VT: 100 J

Poloymorphic VT: unsynchronized, high-energy shock (defibrillation)

4. Monitor for rhythm changes and repeat 12 lead EKG.   If patient deteriorates to ventricular fibrillation, turn off “synchronized” mode and immediately defibrillate at 360 joules (or equivalent biphasic energy).

5. Notify Medical Control of results and patient condition.