"Cardioverting"

[firecall62]

Could someone please tell me what cardioverting is?

Thanks:D :cool:

[needlejockey]

In short it's changing someones heart rythm to a better one using either drugs or electricity.

Basically you're taking a (probably) concious person who has an unstable heart rythm and you give them medications to either change that rythm or make them just not care that you're going to shock the sh!t out of them.

[marie24]

(For some reason I can reply to posts but I can't post a new thread. I keep getting a error message so I'm posting this way.):
I'm currently a emt volunteer and will start taking the classes in a few months and go through the process to be a fdny emt. Although it will be a while before I have to take the test I'm out of shape so i have to start training now. Does anybody from this area know the details of what is required for the physical agility test? I could just work out to get in shape but I think it would be better to know the specifics of weights/running times that I need to get to.
thanks

[scvfd412]

I am curently in EMT-I class and we have covered that, this is what I've learned about "cardioverting"................

For testing purposes, call it synchronized cardioversion. First, determine if your patient is stable or unstable. The unstable patients have vital signs that are unstable. They may have a low blood pressure or complain of shortness of breath, chest pain or be confused. Once you get them on the monitor, you will notice the rhythm to be either too fast or too slow. The stable patient will have a change in their EKG but not be symptomatic. In the unstable patient, you opt for eletrical treatment first. If the rhythm is too fast, to slow it down, you cardiovert, if its too slow, to speed it up, you pace. After the electrical treatment and it's still not fixed, then you opt to medication. But medication is generally first for the stable patient.

[emsforlife69]

(For some reason I can reply to posts but I can't post a new thread. I keep getting a error message so I'm posting this way.):
I'm currently a emt volunteer and will start taking the classes in a few months and go through the process to be a fdny emt. Although it will be a while before I have to take the test I'm out of shape so i have to start training now. Does anybody from this area know the details of what is required for the physical agility test? I could just work out to get in shape but I think it would be better to know the specifics of weights/running times that I need to get to.
thanks


well first a pee test, next you will go into a room with a stair climber, you will wear a 25 pound vest and walk for a think 3 min. Its a bitch...I did it. Next some minor things, like pulling on a bar to measure grip, a hand cycle machine for endurence and the last thing is another bar, u pull using ur leg muscles it tests leg endurnce. Its not too bad but start a walking/running program in advance!

[emsforlife69]

Could someone please tell me what cardioverting is?

Thanks:D :cool:

One key point that eveyone is missing, is it send the electricy during the R wave, this way it dosent hit the realtive refractory perid of the cardiac cycle, If it did do this, sending electricy without knowing where the electrical current is flowing would kill the pt

[AZCEP43]

Technically, regardless of when the electricity is delivered, if it is effective it will eliminate all electrical activity in the myocardium. Thus resulting in a "dead" patient.

The hope is the intrinsic pacemakers will be able to reestablish control at a normal rate/rhythm. If this fails, the patient is still dead.

Cardioversion = synchronized defibrillation
Defibrillation = unsynchronized cardioversion

That should confuse you for a while.

[emsforlife69]

Technically, regardless of when the electricity is delivered, if it is effective it will eliminate all electrical activity in the myocardium.





Eliminating electrical activity in the mycardium? It has automaticity, stopping that process would result in asytole. What you mean is stopping various iritated foci, as with the SA node not being the dominat pacemaker

[AZCEP43]

Eliminating electrical activity in the mycardium? It has automaticity, stopping that process would result in asytole. What you mean is stopping various iritated foci, as with the SA node not being the dominat pacemaker

The purpose of cardioversion/defibrillation is to eliminate ALL electrical activity in the myocardium.

The property of automaticity is what allows us to perform this treatment and have the heart resume function following. When the energy is delivered effectively, you generate asystole for a short period. If you don't, you have not been effective with the treatment.

[marie24]

well first a pee test, next you will go into a room with a stair climber, you will wear a 25 pound vest and walk for a think 3 min. Its a bitch...I did it. Next some minor things, like pulling on a bar to measure grip, a hand cycle machine for endurence and the last thing is another bar, u pull using ur leg muscles it tests leg endurnce. Its not too bad but start a walking/running program in advance!

thanks for the info

[emtJon]

The purpose of cardioversion/defibrillation is to eliminate ALL electrical activity in the myocardium.

The property of automaticity is what allows us to perform this treatment and have the heart resume function following. When the energy is delivered effectively, you generate asystole for a short period. If you don't, you have not been effective with the treatment.

This is correct. emsforlife, when you cardiovert someone, whether electrically or medically, if it's done right there will be a short period of asystole following the treatment. It's actually kinda freaky the first few times, but I've yet to have a pt whose intrinsic pacemaker didn't resume on its own after a few seconds.

[LasVegasEMS]

The purpose of cardioversion/defibrillation is to eliminate ALL electrical activity in the myocardium.

The property of automaticity is what allows us to perform this treatment and have the heart resume function following. When the energy is delivered effectively, you generate asystole for a short period. If you don't, you have not been effective with the treatment.

Actually you're both partially right. The goal with electricity is to cause depolarization of all the cardiac cells in the heart, in hopes that the hearts automaticity will pick back up into a rythm that is more favorable. However, emsforlife69 is correct in that the timing of the shock is extremely important. The difference between synchronized cardioversion and defibrillation is the timing. When you cardiovert someone, the monitor is using all its little processors to time your shock just right so it will hit right after the R wave but before the T wave when you decide to press the shock button. This is because if you decide to cardiovert someone without synchronizing the rythm, you may end up with the R on T phenomenon and put them into an even worse rythm then they started with, such as V-fib or "permenant" asystole. When you defibrillate someone, they are so far gone down the cardiac drain, anything will help them so you just shock them as soon and as fatg as possible, regardless of timing.

[LasVegasEMS]

The purpose of cardioversion/defibrillation is to eliminate ALL electrical activity in the myocardium.

The property of automaticity is what allows us to perform this treatment and have the heart resume function following. When the energy is delivered effectively, you generate asystole for a short period. If you don't, you have not been effective with the treatment.

Actually you're both partially right. The goal with electricity is to cause depolarization of all the cardiac cells in the heart, in hopes that the hearts automaticity will pick back up into a rythm that is more favorable. However, emsforlife69 is correct in that the timing of the shock is extremely important. The difference between synchronized cardioversion and defibrillation is the timing. When you cardiovert someone, the monitor is using all its little processors to time your shock just right so it will hit right after the R wave but before the T wave when you decide to press the shock button. This is because if you decide to cardiovert someone without synchronizing the rythm, you may end up with the R on T phenomenon and put them into an even worse rythm then they started with, such as V-fib or "permenant" asystole. When you defibrillate someone, they are so far gone down the cardiac drain, anything will help them so you just shock them as soon and as fatg as possible, regardless of timing.

[LasVegasEMS]

The purpose of cardioversion/defibrillation is to eliminate ALL electrical activity in the myocardium.

The property of automaticity is what allows us to perform this treatment and have the heart resume function following. When the energy is delivered effectively, you generate asystole for a short period. If you don't, you have not been effective with the treatment.

Actually you're both partially right. The goal with electricity is to cause depolarization of all the cardiac cells in the heart, in hopes that the hearts automaticity will pick back up into a rythm that is more favorable. However, emsforlife69 is correct in that the timing of the shock is extremely important. The difference between synchronized cardioversion and defibrillation is the timing. When you cardiovert someone, the monitor is using all its little processors to time your shock just right so it will hit right after the R wave but before the T wave when you decide to press the shock button. This is because if you decide to cardiovert someone without synchronizing the rythm, you may end up with the R on T phenomenon and put them into an even worse rythm then they started with, such as V-fib or "permenant" asystole. When you defibrillate someone, they are so far gone down the cardiac drain, anything will help them so you just shock them as soon and as fatg as possible, regardless of timing.

[AZCEP43]

The timing of the shock differentiates "synchronized" from "unsynchronized", nothing more.

Even when the energy is delivered at the peak of the R-wave, the intended effect is to eliminate all electrical activity. Thus allowing the intrinsic pacemakers to resume activity, hopefully at a slower rate.

Most texts, and providers, will tie cardioversion to synchronized, and leave defibrillation to mean unsynchronized. Semantics aside, the desired effect is the same.

[FF162718]

One final note to some of the other posts, regarding the differences between cardioversion & defibrillation:
True - Card. / Defib. both hope to cause depolarization for the entire myocarium, hopefully allowing the intrinsic pacemaker to "take control". This may be a little too advanced for the original question, though.
The difference between them is not limited to "syncronization" to the "R"wave of the QRS complex. It is also the amount of electricity delivered to the patient. Cardioversion will typically deliver much less electricity than standard defibrillation, unless the patient's unstable / tachycardic dysrhythmia will not respond to the lower Joule setting. You may eventually be delivering a "defibrillatin" dose, though. However, you should still be "synchronizing" the timimg of the delivery.

**** To sum this up: Essentially, cardioversion is the same thing as defibrillation, but with proper timing and decreased electriciy. ****

[firespec35]

Ok short answer- "better medicine through edison" :)

Come on!!! Someone had to say it :)

[ALSfirefighter]

Cardioversion also meets a little teeth gritting on the part of the medic delivering it. 1. Because you hope it corrects the problem, not make it into a problem that is easier to attempt to treat (asystole) and 2. because you know what the poor bastard lying on the stretcher is going to get. :)