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