Fire during cardioversion

Q: All of the following are true regarding electrical cardioversion except?

A) Oxygen saturation should be monitored
B) Intravenous access should be established
C) Cart for  advanced cardiac life support (ACLS) should be made available
D) Should be performed only by a physician
E) Supplemental oxygen (nasal cannula/venti-mask) should be transiently removed during application of shock


Answer: D

The objective of the above question is to point out the hazard of fire during electrical cardioversion. Any open access of oxygen like nasal cannula or venti-mask should be held for those seconds when a shock is applied for electrical cardioversion, so choice E is correct! The risk is higher if oxygen saturation > 50% and within 30 cm of the patient. Pausing the ventilator for few seconds while shock is applied has been mentioned but there is no concrete evidence to support this practice as ventilators usually have a closed circuit.

Electrical cardioversion can be performed by any person trained including nurses and midlevel providers.

#cardiology


Reference: 

1. ECRI Institute. Hazard report: using external defibrillators in oxygen-enriched atmospheres can cause fires. Health Devices 2005; 34: 423-425. 

2. American Heart Association Guidelines for CPR and ECC, 2005. Supplement to Circulation. 2005;112:IV-41.