Select correct paddles- adult, pediatric or internal. Checks that defibrillator is in asynchronous mode. Places one paddle at the heart's Apex just left of the nipple in midaxillary line. Place the other paddle just below the right clavicle to the right of the sternum, applying 25 lbs. Wait until indicator stops flashing to indicate fully charged.
Checks rhythm immediately before discharge.
Depress both buttons simultaneously and maintain pressure until electrical current delivered. If first defibrillation unsuccessful, immediately charge paddles to 300 joules and repeat steps 2 through 9. If second defibrillation unsuccessful, immediately charge paddles to 360 joules and repeat steps 2 through 9. If third attempt is unsuccessful, continue CPR, initiate ACLS protocols, intubate and obtain IV access. Assess patient status and precipitating factors to prevent further decompensation of patient.