![]() The recent EPIC trial found that anterior/lateral pad placement was more effective than anterior/posterior pad placement ( 34814700, □).Non-intubated patients: Dissociation with ketamine is generally an effective and safe strategy.Ketamine has a first-pass effect on the brain, so it may have a maximal effect about 1-2 minutes after administration – this is the optimal time to perform cardioversion. Ketamine dissociation is a solid option.Etomidate may be a good choice to achieve deep sedation briefly.Sedative regimen will vary depending on context (e.g., many patients may already be deeply sedated).Consequently, the mainstay of patient comfort is deep sedation. For example, no reasonable dose of opioid will make cardioversion comfortable. Intravenous magnesium should also be considered (more discussion of this below). ![]() Amiodarone may subsequently be continued until the patient has recovered from their critical illness (e.g., for 1-2 weeks).
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