Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content + • Rapid termination of tachycardia that is either unresponsive to medications or pacing interventions or is hemodynamically compromising, necessitating more urgent intervention. +++ Cardioversion + • Tachycardia, either supraventricular or ventricular, with regular ventricular response with mild to moderate hypotension.• Mechanisms of supraventricular tachycardia include the following:• Atrial reentry tachycardia.• Reciprocating tachycardia utilizing an accessory connection.• Atrial flutter.• Atrioventricular nodal reentry tachycardia. ++Table Graphic Jump Location|Download (.pdf)|Print• Cardioversion: Can be performed using medications, electrical pacing, or electrical direct current shock synchronized to QRS complex to correct an abnormal rapid cardiac rhythm.• Benefits of cardioversion are restoration of a sinus or slower rhythm, improving cardiac output and function, and decreasing the risk of thromboembolism, cardiac dysfunction, and sudden death associated with the tachycardia. +++ Defibrillation + • The most effective treatment for ventricular fibrillation and pulseless ventricular tachycardia (Table 7–1).• Its effectiveness diminishes rapidly over time; therefore, early defibrillation is recommended in patients who have suffered cardiac arrest.• Atrial fibrillation.• Supraventricular tachycardia with rapid conduction via an accessory connection.• Ventricular fibrillation.• Torsades de pointes. ++Table Graphic Jump Location|Download (.pdf)|Print• Defibrillation: Uses electrical energy delivered transthoracically, nonsynchronously, and in a random fashion during the cardiac cycle to correct a very rapid rhythm.++Table Graphic Jump LocationTable 7–1. Treating tachycardia.View Table||Download (.pdf)Table 7–1. Treating tachycardia.TachycardiaSpecific rhythmTreatmentNarrow QRS complexSinus tachycardiaTreat underlying causeNarrow QRS complexSupraventricular tachycardiaMedicationsVagal maneuversPacingCardioversionWide QRS complexVentricular tachycardiaSVT with aberrant conductionSVT with antegrade conduction over an accessory connectionMedicationsCardioversionPulseless rhythmVery rapid atrial or ventricular tachycardiaAtrial or ventricular fibrillationTorsades de pointesDefibrillation +++ Absolute + • A patient directive regarding resuscitation. +++ Relative + • Cardioversion of a rhythm known to be automatic in origin is not indicated.• Digoxin toxicity-induced arrhythmia.• With digoxin toxicity, there is a high incidence of post-cardioversion ventricular tachycardia and fibrillation.• Elective cardioversion of a hemodynamically stable patient with a known atrial thrombus; however, the likelihood of impending cardiovascular compromise can outweigh the risk of thromboembolism.• Repeated cardioversion of a rhythm where the predisposing cause is not eliminated. + • External defibrillator, either manual or semi-automated (Figure 7–1). + • Skin electrode patches, wires to connect to defibrillator.• Heart rhythm monitor.• Equipment to protect the airway as well as resuscitation medications to support blood pressure.• Do not delay cardioversion or defibrillation in a hemodynamically unstable patient while waiting for additional monitoring equipment or personnel. ++Figure 7–1.Graphic Jump LocationView Full Size||Download Slide (.ppt)Cardioverter/defibrillator. + • Chest wall lesions.• Neurologic complications.• Arrhythmia complications.• ... Your Access profile is currently affiliated with [InstitutionA] and is in the process of switching affiliations to [InstitutionB]. Please select how you would like to proceed. Keep the current affiliation with [InstitutionA] and continue with the Access profile sign in process Switch affiliation to [InstitutionB] and continue with the Access profile sign in process Get Free Access Through Your Institution Learn how to see if your library subscribes to McGraw Hill Medical products. Subscribe: Institutional or Individual Sign In Error: Incorrect UserName or Password Username Error: Please enter User Name Password Error: Please enter Password Sign in Forgot Password? Forgot Username? Download the Access App: iOS | Android Sign in via OpenAthens Sign in via Shibboleth You already have access! Please proceed to your institution's subscription. Create a free profile for additional features.