Book contents
- Frontmatter
- Contents
- Acknowledgments
- List of Contributors
- SECTION ONE OVERVIEW AND PRINCIPLES IN EMERGENCY ANALGESIA AND PROCEDURAL SEDATION
- SECTION TWO ANALGESIA FOR THE EMERGENCY PATIENT
- SECTION THREE PROCEDURAL SEDATION FOR THE EMERGENCY PATIENT
- 23 Patient Assessment and Preprocedure Considerations
- 24 Monitoring for Procedural Sedation
- 25 Pharmacology of Commonly Utilized Sedative Agents
- 26 Procedural Sedation for Pediatric Laceration Repair
- 27 Procedural Sedation for Pediatric Radiographic Imaging Studies
- 28 Procedural Sedation for Brief Pediatric Procedures: Foreign Body Removal, Lumbar Puncture, Bone Marrow Aspiration, Central Venous Catheter Placement
- 29 Procedural Sedation for Adult and Pediatric Orthopedic Fracture and Joint Reduction
- 30 Procedural Sedation for Electrical Cardioversion
- 31 Procedural Sedation for Brief Surgical Procedures: Abscess Incision and Debridement, Tube Thoracostomy, Nasogastric Tube Placement
- SECTION FOUR TOPICAL, LOCAL, AND REGIONAL ANESTHESIA APPROACH TO THE EMERGENCY PATIENT
- SECTION FIVE SPECIAL CONSIDERATIONS FOR EMERGENCY PROCEDURAL SEDATION AND ANALGESIA
- Index
- Plate section
- References
30 - Procedural Sedation for Electrical Cardioversion
from SECTION THREE - PROCEDURAL SEDATION FOR THE EMERGENCY PATIENT
Published online by Cambridge University Press: 03 December 2009
- Frontmatter
- Contents
- Acknowledgments
- List of Contributors
- SECTION ONE OVERVIEW AND PRINCIPLES IN EMERGENCY ANALGESIA AND PROCEDURAL SEDATION
- SECTION TWO ANALGESIA FOR THE EMERGENCY PATIENT
- SECTION THREE PROCEDURAL SEDATION FOR THE EMERGENCY PATIENT
- 23 Patient Assessment and Preprocedure Considerations
- 24 Monitoring for Procedural Sedation
- 25 Pharmacology of Commonly Utilized Sedative Agents
- 26 Procedural Sedation for Pediatric Laceration Repair
- 27 Procedural Sedation for Pediatric Radiographic Imaging Studies
- 28 Procedural Sedation for Brief Pediatric Procedures: Foreign Body Removal, Lumbar Puncture, Bone Marrow Aspiration, Central Venous Catheter Placement
- 29 Procedural Sedation for Adult and Pediatric Orthopedic Fracture and Joint Reduction
- 30 Procedural Sedation for Electrical Cardioversion
- 31 Procedural Sedation for Brief Surgical Procedures: Abscess Incision and Debridement, Tube Thoracostomy, Nasogastric Tube Placement
- SECTION FOUR TOPICAL, LOCAL, AND REGIONAL ANESTHESIA APPROACH TO THE EMERGENCY PATIENT
- SECTION FIVE SPECIAL CONSIDERATIONS FOR EMERGENCY PROCEDURAL SEDATION AND ANALGESIA
- Index
- Plate section
- References
Summary
SCOPE OF THE PROBLEM
The first use of electricity in resuscitation was described in 1774 by the Royal Humane Society in London for a near-drowned child. In the late nineteenth century, treatment of ventricular fibrillation was described in animals with the use of electricity. In 1947, successful termination of ventricular fibrillation was described using AC current in humans. In the 1960s, direct current cardioversion was described and this ultimately became the standard for modern-day cardioversion. Cardioversion techniques have been modified and developed during the past 50 years with different waveforms, amplitudes, and timing for delivering safe and effective cardioversion.
The ideal agents and methods to provide procedural sedation and analgesia (PSA) during the cardioversion procedure have been less well investigated. Few studies have evaluated the use of PSA in the emergency department (ED) for electrical cardioversion. Additionally, studies that have addressed this unique problem in the ED setting have been limited by small sample sizes. As a consequence, there is a large variation of clinical practice for PSA during ED cardioversion.
Despite a lack of a uniform approach to PSA during ED cardioversion, it is clear that electrical cardioversion as an ED-based procedure is becoming more commonplace. This is largely due to an aging population with elevated risk for arrhythmias.
The largest cohort of ED patients with stable arrhythmias that are candidates for cardioversion is the new-onset atrial fibrillation and flutter group. Atrial fibrillation is the most common arrhythmia seen in the ED and afflicts approximately 0.4% of the population.
- Type
- Chapter
- Information
- Emergency Sedation and Pain Management , pp. 190 - 194Publisher: Cambridge University PressPrint publication year: 2008