ELECTRICAL CARDIOVERSION

Cardioversion is the delivery of energy that is synchronized to the QRS complex, whereas defibrillation is non-synchronized delivery of energy, i.e. the shock is delivered randomly during the cardiac cycle (Table 10.18). In the patient who has had a cardiac arrest and is not responding to repeated defibrillation, a difficult decision is when to stop resuscitation and defibrilla-tion efforts. This depends on the patient, the circumstances of the arrest and how long the patient has had a non-perfusing cardiac rhythm. In general, if a patient arrests in hospital and resuscitation has not resulted in a perfusing cardiac rhythm after 30 minutes, then further attempts are unlikely to be successful. The prognosis is poorer in patients who arrest outside hospital. There are exceptions: resuscitation is continued for longer in a hypothermic patient.

Indications

■ Elective cardioversion

■ atrial tachyarrhythmias

■ Emergency cardioversion

■ atrial tachyarrhythmias causing haemodynamic compromise, e.g. hypotension, pulmonary oedema

■ ventricular tachycardia (VT)

■ ventricular fibrillation (VF).

Contraindications

■ Digitalis toxicity (relative contraindication) - induction of ventricular arrhythmias by cardioversion is more likely

Table 10.18 Energy levels for biphasic defibrillators

Arrhythmia

Initial shock energy (J)

Broad-complex tachycardia

120-150

Atrial flutter and narrow-complex tachycardia

70-120

Atrial fibrillation

120-150

Ventricular arrhythmias

150-200

■ Atrial fibrillation with onset more than 24 hours previously (due to risk of embolism) unless patient has high-risk symptoms and signs (p. 420).

Ebook Essentials of Kumar and Clark's Clinical Medicine, 5e

1. Ethics and communication

Ethics and communication

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Infectious diseases

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Liver, biliary tract and pancreatic disease
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SYMPTOMS AND SIGNS OF LIVER DISEASE
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Renal disease
INVESTIGATION OF RENAL DISEASE
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NEPHROTIC SYNDROME
URINARY TRACT INFECTION
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TESTICULAR TUMOUR
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COMMON PRESENTING SYMPTOMS OF HEART DISEASE
INVESTIGATIONS IN CARDIAC DISEASE
CARDIAC ARRHYTHMIAS
HEART FAILURE
ISCHAEMIC HEART DISEASE
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TUBERCULOSISnd
DIFFUSE DISEASES OF THE LUNG PARENCHYMA
OCCUPATIONAL LUNG DISEASE
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Intensive care medicine

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Drug therapy, poisoning, and alcohol misuse

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Endocrine disease
PITUITARY HYPERSECRETION SYNDROMES
THE THYROID AXIS
MALE REPRODUCTION AND SEX
FEMALE REPRODUCTION AND SEX
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DISORDERS OF CALCIUM METABOLISM
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ENDOCRINOLOGY OF BLOOD PRESSURE CONTROL
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DIABETES MELLITUS
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COMPLICATIONS OF DIABETES
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HYPOGLYCAEMIA IN THE NON - DIABETIC
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