II. Indications

III. Precautions

  1. Do not perform Retinal massage for Vagal Maneuver
  2. Do not delay definitive management (e.g. electrical cardioversion) in unstable SVT

IV. Techniques

  1. Carotid massage
    1. See Carotid Sinus Massage
    2. Perform only on one side
  2. Ice placed on face
    1. Avoid covering nose or mouth
    2. Leave ice in place for 15 seconds and then remove
  3. Other techniques
    1. Blow into device
    2. Bear down (as if trying to a pass a Bowel Movement)
    3. Child held upside down (toddlers, home management)
    4. Valsalva Maneuver (especially with lying supine with passive leg raise)
      1. Patient starts seated and blows into a manometer attempting to sustain 40 mmHg for 15 seconds
      2. Then immediately layed supine and passive leg raise
      3. Appelboam (2015) Lancet 384(10005):1747-53 +PMID:26314489 [PubMed]

V. Protocol: Approach

  1. May repeat Vagal Maneuver 2-3 times for 15 seconds per attempt with 30 seconds between maneuvers
  2. Do not delay definitive management in Unstable Patients

VI. References

  1. Claudius, Behar and Bar-Cohen in Herbert (2014) EM:Rap 14(5): 7-8

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