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Defibrillate, Cardiovert and Pace

Step by step on the monitor: pads, joules, sync, charge, capture.

How to Defibrillate, Cardiovert and Pace

• Synced to the R wave with cardioversion • When pacing, after electrical capture occurs, increase electrical current by 10-15% to ensure capture does not fail • Ensure everyone is cleared prior to defibrillation and cardioversion • After defibrillation, immediately resume CPR for another 2 minutes / 5 cycles

Defibrillation

The shockable rhythms are Ventricular fibrillation and Pulseless Ventricular tachycardia.

Ventricular Fibrillation Rocuronium Bromide, CC0, via Wikimedia Commons
Ventricular Tachycardia Rocuronium Bromide, CC0, via Wikimedia Commons

• Ensure pads are placed in an anterior posterior location, placing the heart between them. This allows the electrical current to pass directly through the heart. • Turn the defibrillator on by turning the knob to "Defib"

The defibrillator controls Photograph from the course material

• Select the joules (amount of energy) for the defibrillation (You will be asking your provider this, however, it is typically between 120-200J for biphasic) • Press Charge • Once charged, the orange button will light up. At that point, say "Everyone clear." Once everyone is cleared, press and hold the button to deliver the defibrillation.

Cardioversion

Cardioversion will be used in rhythms such as SVT and ventricular tachycardia with a pulse to convert these abnormal rhythms back to normal sinus rhythm. • Ensure pads are placed in an anterior posterior location, placing the heart between them. This allows the electrical current to pass directly through the heart. • Turn the defibrillator on by turning the knob to "Defib" • Press the sync button (These will ensure the delivery of the electrical current occurs on the R wave)

Pressing sync before a cardioversion Photograph from the course material

• Once synced, you should see markers/spikes/arrows above each R wave

Synced: a marker above every R wave Photograph from the course material

• Select the joules (amount of energy) for the cardioversion (You will be asking your provider this, however, it is typically between 100-200J for biphasic) • Press Charge • Do one last check to ensure you are still synced by looking for those cardioversion markers above each R wave. • Once charged, the orange button will light up. At that point, say "Everyone clear." Once everyone is cleared, press and hold the button to deliver the cardioversion.

Pacing

Besides the pads being placed, for pacing, ensure the 3 Lead ecg from the monitor/defibrillator are also connected to the patient. The pads provide the electrical current to stimulate the heart, while with the 3 lead ecg, you will be able to see if there is electrical capture. • Turn the knob to "pacer" • Determine what the desired heart rate is (Ask your provider) and set it

Setting the pacing rate Photograph from the course material

• Begin increasing the electrical output until there is electrical capture (electricity is causing a contraction)

Increasing the output until capture Photograph from the course material

• Electrical capture is evident when there is a QRS following each pacer marker (as shown by the arrows)

Electrical capture Photograph from the course material

• After there is electrical capture, increase the electrical current by another 10-15% to ensure electrical capture does not fail. THEN, also manually check the heart rate to ensure a heart rate is produced (this is called mechanical capture).

Updated 30 Aug 2026

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