Super Ventricular Tachycardia (SVT)

[Ridryder 911]

In my PC III class we was taught to do this only if the patient was 50 and we felt and listened to the carotids. We was also not allowed to use SVT we had to tell the difference between atrial tachycardia and junctional tachycardia.

The reason of < 50 is possible plaque build up and possible dislodgement while performing CSM. Different literature and standards advise of different ages; again the main concern is dislodging a clot. SVT ( albeit a true generic term) is more commonly used for those rhythms above the general range of atrial tach, and definitely not to be misconceived of nodal (high, medium, low) or junctional rhythms. Although, there is evidence that it is originating from the above the ventricles.

p.s. I do know why and whom taught this... :wink:

R/r 911

[brock8024]

The reason of < 50 is possible plaque build up and possible dislodgement while performing CSM. Different literature and standards advise of different ages; again the main concern is dislodging a clot. SVT ( albeit a true generic term) is more commonly used for those rhythms above the general range of atrial tach, and definitely not to be misconceived of nodal (high, medium, low) or junctional rhythms. Although, there is evidence that it is originating from the above the ventricles.

p.s. I do know why and whom taught this... :wink:

R/r 911

I know you know who taught this. He is one of my favorite teachers.

[Doczilla]

Well, if you're afraid to do CSM and the patient won't comply enough for valsalva...

...you could always perform a digital rectal sweep. It's an effective vagal maneuver without the drawbacks of the other methods. Of course, it has its own drawbacks. And some medical directors might frown on this.

:twisted:

'zilla

[Ridryder 911]

Well, if you're afraid to do CSM and the patient won't comply enough for valsalva...

...you could always perform a digital rectal sweep. It's an effective vagal maneuver without the drawbacks of the other methods. Of course, it has its own drawbacks. And some medical directors might frown on this.

:twisted:

'zilla

I always thought that was funny that has always been placed in the ECC criteria, usually followed by an asterisk * . Ironically, I have never sen that performed in the 30 yrs, I have been doing this...lol

The other technique, I have seen to be successful as well is the mammalian diving reflex, which you place the patient face in ice water...

R/r 911

[ERDoc]

I always thought that was funny that has always been placed in the ECC criteria, usually followed by an asterisk * . Ironically, I have never sen that performed in the 30 yrs, I have been doing this...lol

The other technique, I have seen to be successful as well is the mammalian diving reflex, which you place the patient face in ice water...

R/r 911

Yeah, I tried the ice bath once. The pt expressed how much he loved it with several rounds of four letter words. Had him bear down too. That was a good laugh for his family. Nothing like seeing an overweight, 50 something year old guy on his back, knees drawn up trying to push out a baby. I'm glad this guy had a good sense of humor otherwise it would have been much worse. Even ended up doing a carotid massage with no change. Had to do it chemically (though I admit I did not try the rectal method).

[fiznat]

very good replies everyone... just to add my two cents... I typically don't do it... i stick with the bear down method of vagal maneuvers. and just as a piece of trivia... heart transplant patients don't respond to vagal maneuvers, as the vagus nerve doesn't innervate the heart

Hey Brett, didnt know you were on here!

...Nerd!!

-Foster

[Crankyemt]

Not often that I can justify Pharmacologically Slowing a rate!!! Get my patients to blow out the plunger on a 20ml syringe... Valslva ...