analgesia before cardioversion

brownbook · Jul 10, 2013

I don't know if NCLEX tries to test students on ACLS protocol? I would not think so? Sedating before cardioversion depends a lot on how stable the patient is.

When your are studying for, taking, ACLS there is kind of the assumption that you are dealing with patients who are doing their darnedest to die on you. Even then you consider or give sedation if there is time.

I would assume for NCLEX maybe you are dealing with a more stable patient who walks into your ER, or is on your med/surg floor, talking to you, normal BP, normal mentation, but has a heart rate over 150, not from pain, dehydration, fever, etc. Then you have time to sedate prior to cardioverting.

MunoRN, RN · Jul 10, 2013

It's always good form, when possible, to give analgesia and sedation prior to a shock, whether it be elective or emergent. In emergent cardioversions however it may frequently not be possible.

There's an interesting argument to be had as to whether or not patients should get versed and analgesia when they are premedicated for a cardioversion, or does the amnesic properties of versed mean that it doesn't matter if the patient experiences pain since they won't remember experiencing pain. Some Docs argue that if they aren't going to remember it anyway, it doesn't matter how much they suffer with the shock. It's sort of like if a tree falls in the woods and no one is there to here it.... If a patient has pain but then has no recollection of having pain, did they really have pain?

Susie2310 · Jul 11, 2013

There's an interesting argument to be had as to whether or not patients should get versed and analgesia when they are premedicated for a cardioversion, or does the amnesic properties of versed mean that it doesn't matter if the patient experiences pain since they won't remember experiencing pain. Some Docs argue that if they aren't going to remember it anyway, it doesn't matter how much they suffer with the shock. It's sort of like if a tree falls in the woods and no one is there to here it.... If a patient has pain but then has no recollection of having pain, did they really have pain?

I find this philosophical argument that you say some doctors are having, very disturbing and unethical. What is important, surely, is avoiding causing unnecessary human suffering. Just because the patient doesn't remember experiencing pain doesn't mean the patient isn't experiencing pain or didn't experience pain. Patients trust doctors to act to prevent their suffering, not to conjecture that if they can't remember their pain their pain doesn't matter.

CharleeFoxtrot, BSN, RN · Jul 11, 2013

I have to agree to not give pain management provided the patient isn't emergent is unethical! When I was a Paramedic the few times I did it in the field I was lucky enough to have time to premedicate the patient. My spouse had to be cardioverted last week after he went into A-Fib (ideopathic as he has no risk factors or prior issues) and I would have had a hairy fit if they didn't give him pain management. Poor guy had to be shocked twice and had the outlines of the patches burned into his skin. The good news is the versed did its magic and he has no memory of it.

mrnewman · Jul 11, 2013

thanks alot for the explanation. I never see a cardioversion in my life, I am imaging is really painful, but thee rational on my practice question said no narcotic analgesic used before cardioversion, I am wondering if a non-narcotic "weak" pain meds will be good enough to relieve the severe pain. or the rational of question is wrong?

nrsang97, BSN, RN · Jul 11, 2013

I have seen someone shocked without sedation or pain meds and it was absolutely awful. He was in V-Tach and needed cardioversion, but the MD refused to give pain meds. The screams from that pt were just terrible. He felt like every bone in his chest was broken.

I feel it is unethical to not give anything unless the pt is very unstable.

Biffbradford · Jul 11, 2013

The EP docs will usually give Versed before a non-emergent ICU cardioversion. When all is done, the RN has the options of PRN pain meds that are always available (Fentanyl or Morphine).

Altra, BSN, RN · Jul 11, 2013

Have assisted with many cardioversions - both with meds given and without. Have not seen the "terrible" scenario some of you are describing. If there is time to prudently medicate, fine ... with the understanding that introducing sedatives/narcotics into the scenario brings with it changes in necessary post-cardioversion monitoring.

I also think that some sense of perspective is necessary here. IMHO, cardioversion falls into the category of other interventions like surgical procedures, orthopedic reductions, suturing, etc. -- it's gonna hurt -- but it is without question necessary.

SwansonRN · Jul 11, 2013

I hear it feels like a kick in the chest by a wild stallion. If its not absolutely emergent * must be done right now or the patient will code * it's your job to advocate for meds.

StayLost, BSN, RN · Jul 12, 2013

Ive been a CCU nurse for years and different institutions. In my experience the most common medication used for cardioversion is about 5ml of diprivan rapid IVP right before the shock is delivered. The EP doc with push the diprivan, checks to make sure the pt is totally out while the nurse charges the defibrillator. The magnitude/pain of the shock wakes the patient right up, usually remembering nothing.

If the patient is hypotensive, will use versed. But always some sort of sedation.

applewhitern, BSN, RN · Jul 12, 2013

I took the OP's question to mean cardioversion as an elective procedure, such as cardioverting atrial fib to (hopefully) sinus~ not cardioversion in the instance of v-fib. Yes, we would give pain/sedation meds prior, if it is elective. If it is emergency cardioversion, such as the patient is in v-fib, then no, you wouldn't have time to pre-medicate.