Vagal maneuvers: Difference between revisions
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==Carotid sinus massage== | ==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> | *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> | ||
| Line 7: | Line 4: | ||
*Perform ONE side at a time | *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> | *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== | ==Pediatrics== | ||
*Often successful with ice application to face | *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== | ==See Also== | ||
*[[SVT]] | *[[SVT]] | ||
==External Links== | |||
*https://www.medmastery.com/magazine/modified-valsalva-maneuver-video-review | |||
==References== | ==References== | ||
<references/> | <references/> | ||
[[Category:Cardiology]] | [[Category:Cardiology]] | ||
[[Category:Procedures]] | |||
Latest revision as of 16:38, 13 May 2021
Carotid sinus massage
- Ideal duration of 15 seconds[1]
- 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[2]
Reverse valsalva
- First described in a 2020 case series from France by Gaudart, et al.[3]
- 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
External Links
References
- ↑ Appelboam, A, et al. Randomised Evaluation of modified Valsalva Effectiveness in Re-entrant Tachycardias (REVERT) study. BMJ, 2014; 4(3):e004525.
- ↑ Lacerda, GC, et al. Complications related to carotid sinus massage in 502 ambulatory patients. Arq Bras Cardiol, 2009; 92(2)
- ↑ 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.