II. Indications
III. Precautions
- Do not perform Retinal massage for Vagal Maneuver
- Do not delay definitive management (e.g. electrical cardioversion) in unstable SVT
IV. Techniques: Adults
-
Valsalva Maneuver (especially with lying supine with passive leg raise)
- Patient starts seated and blows into a 10 ml syringe or a manometer attempting to sustain 40 mmHg for 15-30 seconds
- Patient then immediately layed supine with passive leg raise
- Author's preferred method in PSVT
- Appelboam (2015) Lancet 384(10005):1747-53 +PMID:26314489 [PubMed]
- Other techniques
- Blow into device (e.g. straw or 10 ml syringe) for 15 to 30 seconds
- Bear down (as if trying to a pass a Bowel Movement)
- Carotid massage for 5 to 10 seconds
- See Carotid Sinus Massage
- Perform only on one side
V. Techniques: Children
- Child held upside down (toddlers, home management)
- Bag of ice placed on face (children)
- Avoid covering nose or mouth
- Leave ice in place for 15 to 30 seconds and then remove
VI. Protocol: Approach
- May repeat Vagal Maneuver 2-3 times for 15-30 seconds per attempt with 30 seconds between maneuvers
- Do not delay definitive management in Unstable Patients
VII. References
- Claudius, Behar and Bar-Cohen in Herbert (2014) EM:Rap 14(5): 7-8