Apply pads
Anterior-Posterior placement is preferred  but may not be as important as previously thought and most studies are for atrial fibrillation or flutter 
Avoid placing in close proximity to implanted devices if possible 
Select appropriate energy (Joules)
Ensure machine is "synced" before each discharge
Most machines show an indicator (arrow or dot) above each beat if appropriately<unk> 
Ensure R or S wave is bigger than T wave
Machine may read T wave as depolarization and shock during an actual repolarization phase
May induce shock on T and subsequent VT/VF
Move leads to avoid this
Give sedation, if indicated
All awake and hemodynamically stable patients
Ensure safety of environment prior to<unk> 
Nobody touching patient
Nobody touching equipment that is touching patient
Consider removing supplemental oxygen
Cardiovert
Hold 'Shock' button until shock discharged
Shock delayed until peak of QRS complex in<unk>  (keep holding button down)
Repeat PRN
May require escalating energy
Anterior-Posterior placement is preferred  but may not be as important as previously thought and most studies are for atrial fibrillation or flutter 
Avoid placing in close proximity to implanted devices if possible 
Avoid placing in close proximity to implanted devices if possible 
Most machines show an indicator (arrow or dot) above each beat if appropriately<unk> 
Machine may read T wave as depolarization and shock during an actual repolarization phase
May induce shock on T and subsequent VT/VF
Move leads to avoid this
All awake and hemodynamically stable patients
Nobody touching patient
Nobody touching equipment that is touching patient
Consider removing supplemental oxygen
Hold 'Shock' button until shock discharged
Shock delayed until peak of QRS complex in<unk>  (keep holding button down)
Shock delayed until peak of QRS complex in<unk>  (keep holding button down)
May require escalating energy
Initial recommendations:
Tachycardia with pulse
Narrow regular (SVT): 50-100 J
Narrow irregular (A fib, A flutter)
Biphasic: 120-200 J (may start as low as 50 - 100 J for A flutter)
Monophasic: 200 J
Wide regular (VT with pulse): 100 J
Wide irregular: defibrilate (NOT<unk> 
Narrow regular (SVT): 50-100 J
Narrow irregular (A fib, A flutter)
Biphasic: 120-200 J (may start as low as 50 - 100 J for A flutter)
Monophasic: 200 J
Wide regular (VT with pulse): 100 J
Wide irregular: defibrilate (NOT<unk> 
Biphasic: 120-200 J (may start as low as 50 - 100 J for A flutter)
Monophasic: 200 J
Synchronized cardioversion
Defibrillation
Transcutaneous pacing
Transvenous pacing
Vagal maneuvers
Double simultaneous external defibrillation
Resuscitative endovascular balloon occlusion of the aorta
Pericardiocentesis