Preparing the defibrillator
The first step in preparing the defibrillator is to ensure that it is set to deliver a synchronised shock. An unsynchronised shock could coincide with a T wave and cause ventricular fibrillation (VF). By avoiding the relative refractory period, the risk of inducing VF is minimised.
Select Start to begin.
You should ensure that you give a shock of the correct energy to your patient, preferably a biphasic shock unless only monophasic equipment is available:
For a broad-complex tachycardia or atrial fibrillation, start with a 120 - 150 J biphasic shock (200 J monophasic) and increase in increments if this fails.
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Atrial flutter and regular narrow-complex tachycardia will often be terminated by lower-energy shocks: start with 70 - 120 J biphasic (100 J monophasic).
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For patients who are in atrial fibrillation or atrial flutter, use anteroposterior self-adhesive pad positions when it is practicable to do so.
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When delivering the shock, press the shock button and keep it pressed until after the shock has occurred – there may be a slight delay before the shock is delivered. If further shocks are needed, reactivate the synchronisation switch before each shock if necessary.
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References
See chapter 11 of the ALS manual for further reading about the tachycardia algorithm.
The tachycardia algorithm
