Technique

(see algorithm opposite).

• The chances of maintaining sinus rhythm are increased in elective cardioversion if K+ >4.5mmol/l and plasma Mg2+ levels are normal.

• Prior to defibrillation, ensure self and onlookers are not in contact with patient or bed frame.

• To reduce the risk of superficial burns, replace gel/gelled pads after every 3 shocks.

• Consider resiting paddle position (e.g. anteroposterior) if defibrillation fails.

• The risk of intractable VF following defibrillation in a patient receiving digoxin is small unless the plasma digoxin levels are in the toxic range or the patient is hypovolaemic.

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