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: Adults

  1. Valsalva Maneuver (especially with lying supine with passive leg raise)
    1. Patient starts seated and blows into a 10 ml syringe or a manometer attempting to sustain 40 mmHg for 15-30 seconds
    2. Patient then immediately layed supine with passive leg raise
    3. Author's preferred method in PSVT
    4. Appelboam (2015) Lancet 384(10005):1747-53 +PMID:26314489 [PubMed]
  2. Other techniques
    1. Blow into device (e.g. straw or 10 ml syringe) for 15 to 30 seconds
    2. Bear down (as if trying to a pass a Bowel Movement)
    3. Carotid massage for 5 to 10 seconds
      1. See Carotid Sinus Massage
      2. Perform only on one side

V. Techniques: Children

  1. Child held upside down (toddlers, home management)
  2. Bag of ice placed on face (children)
    1. Avoid covering nose or mouth
    2. Leave ice in place for 15 to 30 seconds and then remove

VI. Protocol: Approach

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

VII. References

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

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