Page 215 - Critical Care Nursing Demystified

200 CRITICAL CARE NURSING DeMYSTIFIED

If there is no time on it, it assumes the patient is in ventricular fibrillation so a
shock is delivered. It is also programmed to fire like a pacemaker if the heart
rate becomes bradycardic or tachycardic. Care of the patient is not unlike care
after placement of a permanent pacemaker.

Cardioversion
7 A cardioversion is different from a defibrillation because
• It can be elective if the patent is in a nonthreatening rhythm.

• It is usually started at a lower energy level for depolarization.
• It is synchronized into the patient’s heartbeat.

H ? How to Do It—Preparing the

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1. Explain to the patient what will occur. .
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2. Prepare the defibrillator by pressing the synch button and recording a rhythm
ibrillat
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will fire.
3. Attach the defibrillator pads/paddles in the anterior to posterior position OR
under the right clavicle and apex of the heart.
4. Prepare and check the functioning of suctioning equipment.
5. Prepare and check the functioning of oxygen equipment and a BVM.
6. Make sure the patient has a patent IV.
7. Administer the preordered sedative to the patient.
8. Call “all clear?”
9. Depress the paddles firmly against the chest. The machine will hold the charge
until it senses the R wave, so there is a delay in the shock delivered.
10. Administer the shock and observe and record the rhythm.
11. Monitor and record the vital signs.