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Cardioversion |
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INTRODUCTION:
Synchronised Cardioversion:
INDICATIONS:
- Atrial fibrillation
- Atrial flutter
- Atrial tachycardia
- Supraventricular tachycardias
Unsynchronised Cardioversion/Defibrillation:
INDICATIONS:
- Ventricular tachycardia - compromising
- Ventricular fibrillation
Both compromising causing loss of consciousness.
STANDARDS:
* Management and care of cardioversion procedure is to be undertaken by:
- Medical officers of either ICU or CCU.
- Registered nurses who have been accredited for the emergency care protocol or FLEC
(First Line Emergency Care) accredited by the Richmond Health Service.
* In emergency situations registered nurses only who are FLEC accredited may defibrillate
in a cardiac arrest.
* Procedure should be carried out by authorised medical personnel.
* Should be done under close monitoring continuous ECG and recording facilities.
R : 49.1
* Cardioversion requires an anaesthetist and anaesthetic agents, laerdel bag and oxygen
equipment to maintain airway with induced unconsciousness.
* The defibrillator should be checked prior to use and the emergency trolley should
also be checked and placed in patients room.
* Ensure patient has been on NBM for 4-6 hours prior to elective cardioversion.
* Ensure patient has an IV cannula.
* Ensure a recent 12 lead ECG is available and recording of a baseline observation.
* Patient should have procedure explained to them by medical officer and a consent
form signed.
* All cardioversion being elective are to be attended in ICU or CCU.
OUTCOMES:
The procedure will be terminated either by a successful reversion to sinus rhythm
or when the medical officer determines that cardioversion will not revert the rhythm.
SPECIAL
CONSIDERATIONS:
In elective cardioversion the delivery of a synchronised external electrical impulse
via the chest wall in order to revert an arrhythmia to sinus rhythm. The current
is delivered at a pre-determined point in the cardiac cycle (the peak of the R wave)
so as to avoid discharging during the relative refractory stage of the cycle (the end of
the T wave), as this may result in the development of ventricular fibrillation.
EQUIPMENT:
Defibrillator with a synchronising button
Emergency trolley with emergency drugs; lignocaine atropine and adrenaline
Intubation equipment
Oxygen mask, laerdel bag - Guedels airway
Hudson mask
Monitor and continuous recording facilities
R : 49.2
PRE PROCEDURE:
PATIENT PREPARATION:
* Baseline observations - BP pulse and ECG for post procedure comparison.
* Be aware of the patients serum K+ level or whether the patient has been digitalised.
Notify medical officer.
NB:
Digitalis is usually discontinued 24-36 hours prior cardioversion; its presence may
result in an increased risk of cardioversion induced arrhythmias.
* Ensure patient IV access.
* The patient is connected to the monitoring function of the defibrillator baseline
rhythm recorded, Lead selected for recording, Lead II.
PROCEDURE:
*
The anaesthetic agents are chosen by the Anaesthetist; short acting general anaesthetics.
The patient will require recovery nursing care.
* Once the patient is anaesthetised get gel pad interface or defibrillator pads are
applied to the chest. The correct positions are to the right of the upper sternum
for the sternal pad and paddle and between the left midclavicular line and the left
mid axillary line for the apical pad and paddle.
* Place defibrillator paddles over the gel or defibrillator pads apply 10-12kg of
weight; charge machine to the joule level selected by the medical officer. Commencement
at 50-150j increasing to 300-360j.
* Ensure bed is clear; no one is in contact.
* Press the discharge buttons and maintain pressure on the paddles for one second
following electrical discharge.
POST PROCEDURE:
* The procedure will be terminated either by a successful reversion to sinus rhythm
or when the medical officer determines that cardioversion will not revert the rhythm.
* Ensure the patients airway is patent.
* Patient nursed in the left lateral position until fully conscious. Oxygen administration
c/- hudson mask.
* BP record immediately post procedure at 5 minute intervals for 15 minutes then 15
minute intervals for 2 hours.
* A 12 lead ECG is recorded within _ an hour of the procedure.
R : 49.3
* Documentation should include:
- pre and post procedure ECG
- pre and post procedure rhythm strip
- pre and post procedure observations
- the number of shocks and joules used
- the condition of the skin following cardioversion
REF:
TEDH; Push protocol/policies, Oct 18, 1993
R : 49.4
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