FIELD REFERENCE
Full criteria & treatment guidance
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. Pediatric cardioversion requires base contact and an order. PR-095 includes child-sized pad guidance by age and estimated weight as well as manufacturer restrictions. Confirm the exact pad/monitor compatibility and manufacturer age/weight limits; the source wording still requires clinical/device review and is not resolved by a universal cutoff in this draft. 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.
Learn the controls on your actual monitor
- OCEMS PR-095 governs clinical selection and treatment. Use training for the exact monitor model and its current operating instructions to identify synchronization controls and confirm the markers.
- ZOLL’s linked lesson is for X Series. Stryker’s linked lesson is for LIFEPAK 35. Control sequences from another monitor model should not be substituted. These links do not establish any agency’s equipment inventory.
- Open the manufacturer lesson below. The original OCEMS procedure and treatment guidance remain available in this page’s full-document section.
X Series: Synchronized Cardioversion (English), published by zollmedical ↗
LIFEPAK 35: Synchronized Cardioversion, manufacturer training ↗
VISUAL FIELD REFERENCE
Synchronize → clear → shock → reassess
Adult & pediatric · ALS
After confirming the indication and preparing the patient and pads. Recheck synchronization before each shock.
Verify R-wave markers
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.
Select energy and clear personnel
Set the defibrillator to the manufacturer’s recommended cardioversion energy. Clear all personnel from patient contact, charge, and deliver the synchronized shock.
Reassess after the shock
Reassess vital signs, rhythm, and signs or symptoms of cardiac ischemia or poor perfusion.
- 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.
Selected checkpoints; read the complete guide for criteria, exclusions, doses, and ongoing care. PR-095
UNDERSTAND THE CARE
Why synchronization is an active verification step
The monitor must identify the appropriate part of the cardiac cycle for synchronized delivery. Turning on a mode is not the same as confirming that its markers track the R waves correctly. Inspect the tracing and markers after adjusting leads or gain and again before each shock, following the actual device instructions.
Applying the guidance
Clinical eligibility comes from the local procedure and condition order, while the manufacturer defines the controls and energy recommendations for the monitor in use. Keep those roles separate. After delivery, reassess pulse, rhythm, pressure and ischemic or poor-perfusion symptoms. Record each attempt and obtain further direction when required.
Putting it together
Teaching example: a repeat shock is being prepared after the rhythm persists. Recheck the displayed synchronization markers and current patient state before delivery rather than relying on the first setup.
Diagram text & teaching checkpoints
- Patient
- Unstable tachycardia with a pulse.
- Monitor
- Correct device, pads and mode.
- Synchronization
- Markers align with R waves before each shock.
- Response
- Pulse, rhythm, pressure and symptoms.
Sources for this explanation
Original OCMedic teaching synthesis of the references below. Educational expansion updated ; this is not a new independent clinical-review date. Source-specific dates and limitations remain in the full guidance.
Use a spoken check before a repeat attempt
For a team practice scenario, assign separate observations: one clinician states the patient’s pulse and unstable findings, one checks that synchronization markers track the R waves, and the operator confirms the selected energy and that everyone is clear. This is a communication aid for applying PR-095, not a substitute for device training or the procedure.
Repeat the same checks if another synchronized attempt is required. A prior successful setup does not establish that the current tracing is being sensed appropriately. Use the actual monitor model’s instructions to locate synchronization controls and understand its behavior after a shock; the linked manufacturer lessons demonstrate specific models rather than a universal control sequence.
After delivery, report rhythm and clinical perfusion separately. Persistence of tachycardia with ongoing instability is different from a changed rhythm with poor perfusion. Record the number of attempts and obtain further direction as the procedure requires. For a child, the base contact and order belong before pediatric cardioversion; the adult pathway should not be read as permission to skip that requirement.
Sources: PR-095