Cardioversion without ECG leads

This is not my primary area of expertise, but if you wanted a synchronized cardioversion you would need the ECG leads *from the defibrillator* on the patient. (The bedside monitor might help you make a decision about initiating cardioversion, but it won't allow the defibrillator to sync.) Wuzzie (above) is right to point out that some pads incorporate a 3-wire ECG.

Correct, such as the new zoll defibrillators. But for most other like the phillips heartstart and likepacks I gguess you so need to connect the limp leads

Current zoll, Phillip's, and life pack monitors do not require 3 lead cables in order to sync. We have a pair of paddles for one of our Phillip's MRXs (we don't use the and I'm not sure who bought them, but I digress) but even with that you can sync without 3 leads. in face we don't connect the 3 leads unless we are going to place, as we prefer the much larger screen on the ordinary CR monitors. All that the monitor is aiming for is the peak of the R wave to discharge in order to avoid applying electricity after the first 1/3 of the st segment causing fibrillation from electrical excitation during partial repolarization.

The belief of needing 3 leads to sync is way old and any group still using those monitors desperately needs to modernize.