If so, synchronised DC cardioversion is indicated.
Clearly stability/instability is a spectrum — if in doubt, give electricity.
Sedation should be administered by a doctor experienced and competent in the technique used.
Deliver a synchronised DC shock. The current recommendations for different tachyarrhythmias are:
- Initial synchronised shock at maximum defibrillator output rather than an escalating approach for atrial fibrillation (Resus Council UK advises that this is a reasonable strategy based on current data)
- Initial shock of 70-120J, with stepwise increases in electricity for subsequent shocks, for atrial flutter or supraventricular tachycardia
- Initial shock of 120-150J, with stepwise increases in electricity for subsequent shocks, for ventricular tachycardia
Question: You deliver three shocks to an unstable patient without success. What do you do next?
