Synchronized and Unsynchronized
Electrical Cardioversion

It is essential that ACLS Providers know the indications for electrical cardioversion and receive proper training using their equipment before attempting to perform this risky procedure. Only experts should manage synchronized electrical cardioversion of a stable patient.

Synchronized Electrical Cardioversion

As part of the Secondary ABCDs the following mnemonic directs preparations for synchronized electrical cardioversion of unstable tachycardia with circulatory compromise due to the fast rate (do not delay shocking if seriously unstable):

Oh Say It Isn't So

Mnemonic Preparation
Oh O2 Saturation monitor
Say Suctioning equipment
It IV line
Isn't Intubation equipment
So Sedation and possibly analgesics

Synchronized Electrical Cardioversion *Energy Levels:

The initial synchronized shock is 100J monophasic (50J for SVT/A-Flutter) with increasing energy, i.e., 200J, 300J, 360J, if successive shocks are needed.

Unsynchronized Electrical Cardioversion

Give unsynchronized shocks at VF/PVT *energy levels without delay for unstable tachycardia with critical circulatory compromise due to the fast rate. Also give unsynchronized shocks if you cannot synchronize, or if polymorphic VT is present.

If VF/PVT develops, immediately defibrillate at *360J per the VF/PVT Algorithm.

*Or biphasic equivalent