Summative Synchronized Cardioversion

Student name *

Evaluator name *

Skill Steps *

Verbalizes/demonstrates appropriate infection control precautions

Applies 3-lead ECG electrodes

Identifies the rhythm requiring synchronized cardioversion

Applies Quick-Combo pads

Justifies need for IV access and considers sedation

Depresses SYNC button and confirms sense markers on QRS complexes

Selects energy setting on defibrillator (Narrow/Wide, regular 100J, Narrow/Wide irregular 200J)

Charges defibrillator

Clears the patient and presses and holds SHOCK button

Observes patient and ECG rhythm

Required

Critical Criteria

Failure to deliver a shock in a timely manner

Failure to press SYNC prior to shock delivery

Failure to verify rhythm before delivering each shock

Failure to ensure the safety of self and others [verbalizes “All clear” and observes]

Inability to deliver DC shock [does not use machine properly]

Evaluator Comments

Was the student able to successfully perform this skill? *

Yes

Submit

Never submit passwords through Google Forms.

This form was created inside of Paramedic Institute. Report Abuse