Modified positional valsalva
- 10ml syringe with plunger
- Two assistants - one to adjust head of bed and another to raise/lower legs.
- 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
- 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
- Often successful with ice or ice-water application to face for at least 10 seconds (physiologically similar to mammalian diving reflex, and works best in infants up to 6 months of age)
- Appelboam, A, et al. Randomised Evaluation of modified Valsalva Effectiveness in Re-entrant Tachycardias (REVERT) study. BMJ, 2014; 4(3):e004525.
- Lacerda, GC, et al. Complications related to carotid sinus massage in 502 ambulatory patients. Arq Bras Cardiol, 2009; 92(2)