Recognize an unstable tachycardia, verify synchronization on the R wave, deliver the manufacturer-recommended energy, and reassess.
Draft OCEMS source summary · Updated 2026-09-16
Synchronization safety checks
Confirm that synchronization markers align with the R wave before each synchronized shock.
Pediatric synchronized cardioversion requires base-hospital contact and an order under PR-095.
If synchronization does not function, disengage sync mode and defibrillate at the manufacturer’s recommended defibrillation energy.
Confirm the indication
Use synchronized cardioversion for supraventricular tachycardia or ventricular tachycardia with severe signs or symptoms of poor perfusion or cardiac ischemia.
Explain the procedure if the patient is conscious and assist ventilation when needed.
Prepare & synchronize
Apply pads to the anterior chest or in an anterior-posterior position. For pediatric patients, obtain base contact and an order, use manufacturer-directed pediatric pad restrictions, and use anterior-posterior placement when the chest is too small to safely accommodate the pads.
Activate synchronized or cardioversion mode. Adjust gain or leads so the monitor marks each QRS complex, and verify synchronization on the R wave before proceeding.
Set the defibrillator to the manufacturer’s recommended cardioversion energy. Clear all personnel from patient contact, charge, and deliver the synchronized shock.
Reassess & escalate
Reassess vital signs, rhythm, and signs or symptoms of cardiac ischemia or poor perfusion.
If the rhythm does not convert and unstable tachycardia continues, repeat one synchronized cardioversion shock at the manufacturer’s recommended energy.
Document the number of cardioversion and defibrillation attempts. If there is no conversion or further direction is needed, contact the base hospital.