Attach therapy electrodes. Either anterior-posterior or anterior-lateral positioning may be used. Synchronized cardioversion may be performed with therapy electrodes alone, however limb leads are strongly suggested.
Enable synchronized mode: press the “Sync” button on the monitor. Observe the display screen and confirm the flagging symbol (a downward-pointing triangle) appears above each QRS complex.
Select the appropriate energy level using the “Energy Select” buttons.
Charge the monitor/defibrillator and clear the patient.
Push and holdthe shock button until the energy is delivered. There will be a slight delay as the monitor attempts to time the shock with a detected R wave.
Reassess the patient and re-evaluate required treatment options, including supportive care or energy escalation.
If the patient deteriorates to ventricular fibrillation or unstable polymorphic ventricular tachycardia:
Confirm synchronization is off (push “Sync” button again if necessary) and that flags have disappeared. Verify patient pulses; if no pulse, begin chest compressions.
Reset the energy level to 200 J.
Charge the monitor.
Clear the patient and deliver the shock.
Recommended initial energy levels:
Unstable atrial fibrillation with rapid ventricular response: 200 J.
Unstable monomorphic ventricular tachycardia: 100 J.
Unstable supraventricular tachycardia or atrial flutter: 100 J.
If several synchronized shocks have been delivered and the rhythm fails to convert, consider switching pad placement: if the therapy electrodes were anterior-lateral, place them anteriorly-posteriorly (or vice versa) and attempt to cardiovert again at the last energy level used.