Sections View Full Chapter Figures Tables Videos 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 LocationFavorite Table | 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 LocationFavorite Table | 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|Favorite 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|Favorite Figure|Download Slide (.ppt)Cardioverter/defibrillator. + • Chest wall ... GET ACCESS TO THIS RESOURCE Sign In Username Error: Please enter User Name Password Error: Please enter Password Forgot Username? Forgot Password? Sign in via OpenAthens Sign in via Shibboleth Get Free Access Through Your Institution Contact your institution's library to ask if they subscribe to McGraw-Hill Medical Products. Access My Subscription GET ACCESS TO THIS RESOURCE Subscription Options Pay Per View Timed Access to all of AccessPediatrics 24 Hour $34.95 (USD) Buy Now 48 Hour $54.95 (USD) Buy Now Best Value AccessPediatrics Full Site: One-Year Individual Subscription $595 USD Buy Now View All Subscription Options