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VSA Post Synchronized Cardioversion
Question# 964
If a patient falls VSA post synchronized cardioversion, are the shocks delivered during the cardioversions included in the 3 shocks required before performing a vector change/dual-sequential defibrilation? Therefore, performing the change on either the first or second rhythm check, depending on the number of cardioversion attempts?
Answer:
No. Prior synchronized cardioversion shocks are not counted toward the 3 shocked used to trigger a vector change or dual sequential defibrillation in a VF/pVT arrest.
Keep in mind, cardioversion shocks start at a lower energy, are synchronized, and target a different electrophysiologic problem. They don’t reflect failure of defibrillation in true VF/pVT. Having said that, it's reasonable to change the vectors if cardioversion failed using initial pad placement.
Once the patient becomes pulseless, the shock count effectively resets, and only defibrillation attempts delivered during the arrest are counted, meaning the first, second, and third shocks occur at successive rhythm checks during CPR cycles, with escalation (e.g., vector change or dual sequential defibrillation) considered after the third arrest shock.
As a final point, if the patient is already on the monitor and connected to the pads, and the rhythm is shockable (VF/pVT), there is no need to wait for 2 minutes of CPR before delivering a shock. Defibrillation should be performed immediately once ready, with CPR continued during charging and resumed immediately after the shock.
Keep in mind, cardioversion shocks start at a lower energy, are synchronized, and target a different electrophysiologic problem. They don’t reflect failure of defibrillation in true VF/pVT. Having said that, it's reasonable to change the vectors if cardioversion failed using initial pad placement.
Once the patient becomes pulseless, the shock count effectively resets, and only defibrillation attempts delivered during the arrest are counted, meaning the first, second, and third shocks occur at successive rhythm checks during CPR cycles, with escalation (e.g., vector change or dual sequential defibrillation) considered after the third arrest shock.
As a final point, if the patient is already on the monitor and connected to the pads, and the rhythm is shockable (VF/pVT), there is no need to wait for 2 minutes of CPR before delivering a shock. Defibrillation should be performed immediately once ready, with CPR continued during charging and resumed immediately after the shock.