For this procedure, ECG monitoring and all the essential equipment for managing CPR must be available. Once the patient has been attached to the monitor and the trace is on screen, the 'synch' button must be activated. To verify this, the ECG should display bright synchronising signals/marks over the R waves. This ensures that the shock is triggered to take place on the R wave and not the T wave, as this might induce VF (Bennett 2002). Prior to the shock, the operator must check that only the R waves are synchronised. If the complexes are small, increase the amplitude. Operators need to be aware of the delay between the time the discharge buttons were depressed and the actual shock; this is because the defibrillator is detecting a shockable R wave. Hence the paddles must remain pressed firmly on the patient's chest and buttons depressed until the shock has been delivered. Some defibrillators default to unsyn-chronised mode after each shock. In others the 'synch' button must be switched off.
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