Which of the following is an indication for synchronized cardioversion?

• A. Ventricular tachycardia with inadequate perfusion
• B. Supraventricular tachycardia with inadequate perfusion
• C. Ventricular tachycardia with adequate perfusion, but refractory to drug therapy
• D. All of the above

Answer: (D)

Synchronized cardioversion is used for tachyarrhythmias with a pulse when the rhythm is causing instability or isn’t controlled by medications. Ventricular tachycardia with inadequate perfusion is unstable, so delivering a synchronized shock helps restore a perfusing rhythm quickly. Supraventricular tachycardia with inadequate perfusion is another unstable scenario where rapid conversion is needed to improve perfusion. If ventricular tachycardia has adequate perfusion but remains uncontrolled despite drug therapy, synchronized cardioversion is still an appropriate next step to terminate the rhythm. Because each of these situations fits the use of a synchronized, timed shock, all of the above is the best answer. (If there were no pulse, defibrillation—unsynchronized—would be used instead.)