View source for Vagal maneuvers

==Carotid sinus massage==
*Ideal duration of 15 seconds<ref>Appelboam, A, et al. Randomised Evaluation of modified Valsalva Effectiveness in Re-entrant Tachycardias (REVERT) study. BMJ, 2014; 4(3):e004525.</ref>
*Auscultate to rule out bruits in carotid artery before performing
*Perform ONE side at a time
*Perform with caution in elderly patients and those with a history of cardiovascular or neurologic events, though the complication rate is low<ref>Lacerda, GC, et al. Complications related to carotid sinus massage in 502 ambulatory patients. Arq Bras Cardiol, 2009; 92(2)</ref>

==Reverse valsalva==
*First described in a 2020 case series from France by Gaudart, et al.<ref>Gaudart P, Cazes N, Simon K, Larger D, Deharo JC. The reverse vagal manoeuvre: A new tool for treatment of supraventricular tachycardia? Am J Emerg Med. 2021 Mar;41:66-69. doi: 10.1016/j.ajem.2020.12.061. Epub 2020 Dec 26. PMID: 33387931.</ref>
*Initial data scant but promising with 10/11 cardioverting to normal sinus rhythm, including 4 who had failed the modified Valsalva maneuver

===Set-up===
*No assistant or items necessary

===Procedure===
#Have the patient exhale completely in a sitting position
#Pinch nose and close mouth tightly
#Attempt to inhale against resistance for 10 seconds

==Pediatrics==
*Often successful with ice or ice-water application to face for at least 10 seconds (physiologically similar to mammalian diving reflex, and works best in infants up to 6 months of age)

==See Also==
*[[SVT]]

==External Links==
*https://www.medmastery.com/magazine/modified-valsalva-maneuver-video-review

==References==
<references/>
[[Category:Cardiology]]
[[Category:Procedures]]