Synchronized shock for unstable tachyarrhythmia with pulse.
Indications
- • Unstable AF, atrial flutter, SVT, VT with pulse — hypotension, ischemia, HF, altered mental status
Contraindications
- ⚠ Digoxin toxicity
- ⚠ Stable arrhythmia (medical management first)
Equipment
- • Defibrillator with sync mode
- • Sedation (midazolam / etomidate)
- • Airway kit
Positioning
- • As appropriate for the procedure and patient comfort.
Consent
- • Explain indication, benefits, alternatives
- • Explain risks & complications
- • Obtain written/verbal consent as per SOP
- • Document consent
Universal precautions
- • Hand hygiene
- • PPE — gloves, mask, eye protection
- • Aseptic technique
- • Sharps safety
- • Verify patient identity & site
Step-by-step (0/7)
Tap to complete
Confirm unstable arrhythmia.
Immediate complications
- ⚠ VF (if unsynchronized)
- ⚠ Post-shock hypotension
- ⚠ Thromboembolism (AF > 48h)
Delayed complications
- • Skin burn
Initial management
- • Immediate defibrillation if VF
Prevention
- • Anticoagulation if AF > 48h
- • Confirm sync
Post-procedure observation
- • Vitals q15min × 1h then hourly
Monitoring
- • Site inspection
- • Symptom review
Documentation
- • Procedure note
- • Consent
- • Findings
Patient instructions
- • Report pain, bleeding, fever, worsening symptoms
Related in WardRound
Educational bedside guide. Perform only under supervision until competent. Follow local SOPs and consent policy.
