Modified positional valsalva
- 10ml syringe with plunger
- Two assistants - one to adjust head of bed and another to raise/lower legs.
- Position patient with legs flat and head of bed to 45°
- Have patient attempt to blow out plunger of 10ml syringe (or Valsalva around 40mmHg) for 15 seconds.
- Then quickly reposition patients head of bed to flat and have the other assistant raise legs to 45° for another 15 seconds.
- Return patient to head of bed at 45° and continue to monitor for resolution for 1 minute.
- Repeat if needed.
Carotid sinus massage
- Ideal duration of 15 seconds
- Auscultate to rule out bruits in carotid artery before performing
- Perform ONE side at a time
- Often successful with ice application to face
- Appelboam, A, et al. Randomised Evaluation of modified Valsalva Effectiveness in Re-entrant Tachycardias (REVERT) study. BMJ, 2014; 4(3):e004525.