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Writer's pictureThe Resuscitation Coach
Oct 1, 20213 min read

Defibrillation, Cardioversion & TCP

Updated: Oct 18, 2021


We have uploaded our next video on the ACLS Made Easy Series. In this video, we are discussing & demonstrating Defibrillation, Synchronised Cardioversion, and TCP.


⚠️In medical emergencies when patients suddenly deteriorate, the Crash Cart is one of the first items that we will grab and bring to the patient's bedside. On the Crash Cart/Ambulance we have our defib which is one of the most important pieces of equipment as it has lots of life-saving potential if we know how to use the device quickly and effectively.


So do not wait until you have an emergency to figure out how to use the device. As professional healthcare providers, the Defib with the Crash Cart should be the first piece of equipment you should familiarize yourself with when joining a new facility.


Pads are the most commonly used device these days in hospitals and EMS as they are quick to use, provide improved shock delivery if placed correctly, and also increases safety for the healthcare providers. Another benefit of the Pads is that they provide you with ECG monitoring without attaching your ECG leads.


So where do we place the Multifunction Pads? Always follow the diagram on the pads. Typically we use the Anterior-Posterior or Anterior- Apex. Usually it's easier to use the Anterior- Apex position but the Anterior-Posterior position is preferred.

With the Anterior -Apex position one pad is placed below the clavicle while the other is placed on the left side just below the pectoral muscle or just underneath the breast in female patients.

With the Anterior-Posterior placement, the one pad is positioned Anteriorly, low chest in front of the heart while the second pad is placed posteriorly behind the heart in between the Scapula.


Always use the diagrams on the pads as your reference.

Other options available that are rarely used these days are the paddles. Some device manufacturers do not even supply paddles anymore to the defibs and it can be ordered as an optional accessory.


Another option when the patient's chest is open is to make use of the internal paddles that can be connected to your defibrillator.


Defibrillation: Delivering an electrical shock to the heart to completely depolarise the heart, and if there is enough high-energy phosphates in the Myocardium, hopefully, the hearts automaticity kicks in and we have a normal perfusing rhythm


What rhythms to defibrillate: VP and Pulseless VT


⚠️REMEMBER: For every minute we delay defibrillation, chances of success for the patient diminishes by 7-10% per minute. So we should be quick.


Energy Selection: Follow the recommendation from the manufacturer:

•360J (Monophasic)

•120J- 150J 200J (Zoll Biphasic)

•150J (Phillips Smart Biphasic)

•200J- 300J- 360J (LifePak 15)

Cardioversion delivers a shock on TOP of the peak of the ‘R’ Wave

Rhythms to Cardiovert: Supra Ventricular Tachycardia (SVT); Atrial Fibrillation (AF); Atrial Flutter; Ventricular Tachycardia with a pulse.


Energy Selection for Cardiovert: Follow the recommendation from the manufacturer but usually 100J- 150J- 200J. Might start at 50J for SVT and Atrial Flutter.


Usually, if the patient is stable, has no serious signs & symptoms, and has Normal Blood Pressure, we start with medications.


If the patient is unstable, then we will use Synchronise Cardioversion.


Synchronize Cardioversion can also be used on stable patients if the medication options did not convert the rhythm. Expert consultation is advised.


Transcutaneous Pacing (TCP): Delivering electrical energy (mA) to cause Cardiac Contraction


We use TCP on Symptomatic Bradycardia unresponsive to Atropine.


⚠️With TCP ensure to attach the pads and ECG leads. The pads will only deliver the electrical impulses while the ECG leads will provide you with ECG monitoring.


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