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58 Cards in this Set
- Front
- Back
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What is this this algorithm for?
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SYNCHRONIZED electrical cardioversion of unstable tachycardia with circulatory compromise caused by the fast heartbeat
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If the patient is seriously unstable, what do you do?
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Shock immediatley
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What types of cardioversion are there?
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Synchronized, unsynchronized, and chemical
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What is cardioversion?
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Changing one heart rhythm into another...usually a bad one to a good one
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What is synchronized cardioversion?
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Changing a bad heart rhythm to a good one by shocking the heart at a specific place in the heart cycle
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What is another word for synchronized cardioversion?
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Countershock
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What is synchronized cardioversion used for?
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Any irregular heart rhythm except ventricular fibrillation, and ventricular tachycardia without a pulse
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In what part of the heart cycle does synchronized cardioversion shock?
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Around ten miliseconds after the peak of the "R" wave
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What does shocking at this part of the heart cycle avoid?
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The vulnerable relative refractory period of the ventricles
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What are some benefits of using synchronized cardioversion?
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It may reduce the energy needed to stop the irregular heart rhythm, and may also lessen the chance of causing another irregular heart rhythm
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How do you know where the shock will occur in the heart cycle?
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There should be a marker on the "R" wave
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If the marker does not appear on the "R" wave, what should you do?
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Use another lead
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What do you do to get ready to use synchronized cardioversion?
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Oxygen Saturation Monitor (Pulse Ox)
Suctioning Equipment IV Intubation Equipment Sedation and maybe analgesics |
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What is the mnemonic for getting ready to use synchronized cardioversion?
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Oh
Say It Isn't So |
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What does "Oh Say It Isn't So" stand for?
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Oh - Oxygen Saturation Monitor (Pulse Ox)
Say - Suctioning Equipment It - IV Isn't - Intubation Equipment So - Sedation and maybe analgesics |
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After you get ready for synchronized cardioversion, what do you do?
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Cardiovert!
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What do you use to cardiovert?
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A monophasic or biphasic defibrillator
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What is a monophasic defibrillator?
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The main defibrillator used in hospitals that gives a single pulse of electricity that goes ONE WAY in between the two pads
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How much energy should be used for the first shock when using a monophasic defibrillator?
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100 Joules
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If more shocks are needed when using a monophasic defibrillator, what should you do?
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Increase the energy used
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If additional shocks are needed when using a monophasic defibrillator, how much energy should you use?
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200, 300, and 360 Joules
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If a patient has supraventricular tachycardia or atrial flutter, how much energy should be used for the first shock when using a monophasic defibrillator?
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50 Joules
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What is a biphasic defibrillator?
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Defibrillation that delivers an electrical pulse in two directions...from one pad to the other and then back again
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What is an advantage of using a biphasic defibrillator?
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It lessens what it takes to correct an irregular heart rhythm, and therefore saves more lives
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What are the steps of synchronized cardioversion?
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1. Use sedation if necessary
2. Turn on the defibrillator 3. Put the leads on the patient, and make sure the rhythm on the defibrillator is correct 4. Enlarge the synchronization mode by pressing the "sync" button 5. Look for markers on "R" waves that indicate sync mode 6. If necessary, adjust monitor gain until sync markers happen with every "R" wave 7. Use appropriate energy level 8. Put pads on patient 9. Put pads/paddles on patient 10. Yell "Clear"! 11. Press "Charge" button 12. When the defibrillator is charged, make sure no one is touching the patient and yell "I'm clear, you're clear, everyone is clear" 13. Apply 25 psi pressure if using paddles 14. Press the "shock" button 15. Check the patient's heart rhythm, and if irregular rhythm not corrected continue to shock according to the algorithm 16. Reset sync mode after every synchronized cardioversion |
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What is the saying for applying a three lead?
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"White to right, red to ribs, what's left over the left shoulder"
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If you use paddles, what do you do before you put them on the patient?
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Put gel on the paddles
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Where do you put the pads or paddles on the patient?
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On the sternum, and on the apex of the heart?
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What is the apex of the heart?
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The "point" of the heart that goes down, forward, and to the left at the fifth intercostal space, left midclavicular line
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Where is the charge button on the defibrillator?
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On the monitor or and/or on the right paddle (Apex paddle)
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What is the first step in synchronized cardioversion?
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1. Use sedation if necessary
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What is the second step in synchronized cardioversion?
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2. Turn on the defibrillator
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What is the third step in synchronized cardioversion?
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3. Put the leads on the patient, and make sure the rhythm on the defibrillator is correct
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What is the fourth step in synchronized cardioversion?
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4. Enlarge the synchronization mode by pressing the "sync" button
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What is the fifth step in synchronized cardioversion?
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5. Look for markers on "R" waves that indicate sync mode
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What is the sixth step in synchronized cardioversion?
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6. If necessary, adjust monitor gain until sync markers happen with every "R" wave
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What is the seventh step in synchronized cardioversion?
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7. Use appropriate energy level
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What is the eighth step in synchronized cardioversion?
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8. Put pads on patient
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What is the ninth step in synchronized cardioversion?
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9. Put pads/paddles on patient
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What is the tenth step in synchronized cardioversion?
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10. Yell "Clear"!
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What is the eleventh step in synchronized cardioversion?
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11. Press "Charge" button
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What is the twelfth step in synchronized cardioversion?
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12. When the defibrillator is charged, make sure no one is touching the patient and yell "I'm clear, you're clear, everyone is clear"
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What is the thirteenth step in synchronized cardioversion?
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13. Apply 25 psi pressure if using paddles
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What is the fourteenth step in synchronized cardioversion?
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14. Press the "shock" button
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What is the fifteenth step in synchronized cardioversion?
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15. Check the patient's heart rhythm, and if irregular rhythm not corrected continue to shock according to the algorithm
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What is the sixteenth step in synchronized cardioversion?
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16. Reset sync mode after every synchronized cardioversion
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What is the synchronized cardioversion protocol for?
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Synchronized cardioversion of unstable tachycardia with signs and/or symptoms of shock (That is caused byt the tachycardia)?
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What is synchronized cardioversion?
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???
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1. What is the mnemonic used to get ready for cardioversion?
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Oh Say It Isn't So
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2. What does it mean?
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Oh = Oxygen Saturation
Say = Suctioning Equipment It = IV Equipment Isn't = Intubation Equipment So = Sedation (And maybe anelgesics) |
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3. How much energy should you use for the first synchronized shock?
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100J (Monophasic)
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4. What if it is supraventricular tachycardia or atrial flutter?
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50J (Monophasic)
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5. If more shocks are needed, what should you do?
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Give them with increasing energy (200J, 300J, 360J for example).
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7. If a patient is seriously unstable, how long should you wait to cardiovert?
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You should not wait, use synchronized cardioversion immediately?
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When should you use unsynchronized electrical cardioversion?
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When there is unstable tachycardia with signs and/or symptoms of shock (Caused by the tachycardia), or if you cannot synchronize, or if polymorphic VT is present.
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If unstable tachycardia with signs and/or symptoms of shock (Caused by the tachycardia)what energy level should you give unsynchronized shock?
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At VF/PVT energy levels without delay.
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10. What do you do if ventricular fibrillation or pulseless ventricular tachycardia develops?
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Defibrillate immediately at 360J (Or it's biphasic equal) per the ventricular fibrillation/pulseless ventricular tachycardia protocol.
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11. What is the whole purpose of the "Oh Say It Isn't So" mnemonic?
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To remind what to do before you use synchronized cardioversion. In other words, you should get the equipment out to check the patient's oxygen level, use suction, start an IV, intubate, and sedate.
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