Cardioversion

Revision of 08/2026 removed the need to call Med Control for Sedation prior to Cardioversion. Provides standing order for Midazolam.

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. Prepare are Synchronized cardioversion 

• A-fibrillation/A-flutter Perform synchronized cardioversion at 200 joules.

• Narrow Complex tachycardia 100 joules

• Monomorphic VT 100 joules

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.