Procedural Skills for Medical Students

Electrical Cardioversion/Defibrillation

Objectives:

  1. Learners should be able to verbalize which cardiac rhythms indicate synchronized cardioversion and defibrillation and the considerations for each.
  2. Learners should be able to demonstrate the correct placement of patient electrodes and pads on HPS.
  3. Learners should be able to perform synchronized cardioversion and defibrillation using the defibrillator on the HPS.

Material to review prior to lab: Video on Cardioversion and Video on Defibrillation

Indications:

1.  Cardioversion: Atrial fibrillation, atrial flutter, hemodynamically stable VT unresponsive to pharmacologic therapy, hemodynamically unstable VT with a pulse, hemodynamically unstable SVT, and Wolfe-Parkinson White syndrome unresponsive to pharmacologic therapy.

Contraindications:

  1. Cardioversion contraindications: absent pulse, severely unstable patient needing resuscitation, severe electrolyte disturbances, digitalis toxicity, left atrial or atrial appendage thrombus, and left ventricular mural thrombus.

Equipment: HPS, defibrillator & pads, patient electrodes

Instructional Procedure & Endpoints:

  1. Learners will be oriented to trainer and equipment in ASTEC.
  2. ASTEC staff will demonstrate safe use of defibrillator for defibrillation and synchronized cardioversion.
  3. Learners will demonstrate correct placement of defibrillator pads.
  4. Learners will correctly identify and treat (cardioversion or defibrillation) 2 out of 3 abnormal cardiac rhythms.

References:

Fish, J. (2011). Electricl cardioversion. In J.L. Pfenninger, & G.C. Fowler (Eds.), Procedures for Primary Care, 3rd Ed (1438-1442). Philadelphia: Elsevier Mosby.

Guidant. (2007). Cardioversion defib. Boston Scientific. Retrieved from http://www.youtube.com/watch?v=C8GH4s2RWQ4

Warmbier, E. (2009). Introduction to simulation part III. Broward College. Retrieved from http://www.youtube.com/watch?v=KVUF79PNeT4

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