Vagal maneuvers: Difference between revisions
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*Auscultate to rule out bruits in carotid artery before performing | *Auscultate to rule out bruits in carotid artery before performing | ||
*Perform ONE side at a time | *Perform ONE side at a time | ||
*Perform with caution in elderly patients and those with a history of cardiovascular or neurologic events, though the complication rate is low<ref>Lacerda, GC, et al. Complications related to carotid sinus massage in 502 ambulatory patients. Arq Bras Cardiol, 2009; 92(2)</ref> | |||
==Pediatrics== | ==Pediatrics== | ||
Revision as of 16:35, 14 February 2019
Modified positional valsalva
Modified positional valsalva
Set-up
- 10ml syringe with plunger
- Two assistants - one to adjust head of bed and another to raise/lower legs.
Steps
- Position patient with legs flat and head of bed to 45°
- Have patient attempt to blow out plunger of 10ml syringe (or Valsalva around 40mmHg) for 15 seconds
- Quickly reposition patient's head of bed to flat and have the other assistant raise legs to 45° for another 15 seconds
- Return head of bed to 45° and continue to monitor for resolution for 1 minute
- Repeat if needed
Carotid sinus massage
- Ideal duration of 15 seconds[1]
- Auscultate to rule out bruits in carotid artery before performing
- Perform ONE side at a time
- Perform with caution in elderly patients and those with a history of cardiovascular or neurologic events, though the complication rate is low[2]
Pediatrics
- Often successful with ice application to face