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 in seated for 3 minutes before maneuver
- Patient then blows into manometer or a 10 ml syringe tip ("try to force the plunger to move with breath")
- Attempt 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
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Related Studies
| Concepts | Disease or Syndrome (T047) |
| ICD10 | R00.1 |
| SnomedCT | 123330009, 29894000 |
| English | Vagal bradycardia (disorder), bradyarrhythmia vagal autonomic bradycardia, Vagal autonomic bradycardia (diagnosis), Vagal bradycardia, Vagal autonomic bradycardia, Vagal autonomic bradycardia (disorder), Vagal bradycardia -RETIRED- |
| Spanish | bradicardia vagal - RETIRADO -, bradicardia vagal - RETIRADO - (concepto no activo), bradicardia autonómica vagal (trastorno), bradicardia autonómica vagal, bradicardia vagal |
Ontology: Vagal stimulation (C1293903)
| Concepts | Diagnostic Procedure (T060) |
| SnomedCT | 128968000 |
| Spanish | prueba de provocación con estimulación vagal, estimulación vagal, prueba de provocación con estimulación vagal (procedimiento) |
| English | Vagal stimulation physiologic challenge, vagal stimulation, Vagal stimulation physiologic challenge (procedure), Vagal stimulation |
