Carotid massage urban legend

[ericdamiansean]

Anyone has heard that you can kill a normal person, with no heart problems with a carotid massage?

[Idiopathic]

I dont know, maybe no diagnosed (but still underlying?) heart problems. You can also break loose a carotid plaque or possibly cause an arrythmia, but not typically in a person with a totally normal heart (just perhaps in someone with an undiagnosed medical condition).

[ericdamiansean]

I was thinking of that too, but some people are taking it as a party joke..

I was taught to always do a unilateral massage, apparently a bilateral one may cause syncope

[getianshi]

Originally Posted by ericdamiansean

Anyone has heard that you can kill a normal person, with no heart problems with a carotid massage?

I dunno about that but I do remember during our clinical skills training being practiced on for the neck exam. After the preceptor and 4 other students grabbed my neck in every which way my heart rate dropped and I almost ended up on the floor.

Maybe you could kill someone but if that were the case the Chuck Norris move wouldn't be "death hold grip" it'd be "neck rub of death"

[ericdamiansean]

Originally Posted by getianshi

Maybe you could kill someone but if that were the case the Chuck Norris move wouldn't be "death hold grip" it'd be "neck rub of death"

That's the one where you turn the person's head to one side, and with your other hand, press real hard on the neck for about 15 seconds and it cuts off the blood supply and boom! You're on the floor

I saw this on Ripleys, some karate guy who chops on various points of the body and the person becomes paralysed..now, that's cool! Try using it on your more annoying mates

[SoCuteMD]

Originally Posted by Idiopathic

I dont know, maybe no diagnosed (but still underlying?) heart problems. You can also break loose a carotid plaque and cause an arrythmia, but not typically in a person with a totally normal heart (just perhaps in someone with an undiagnosed medical condition).

If you dislodge a carotid plaque it won't cause an arrhythmia, it will cause a stroke - especially in those small terminal vessels (perforated substance). In cardiophys we were told that's what could kill a person.

[Idiopathic]

Originally Posted by socuteMD

If you dislodge a carotid plaque it won't cause an arrhythmia, it will cause a stroke - especially in those small terminal vessels (perforated substance). In cardiophys we were told that's what could kill a person.

I meant to say stroke, obviously. Thanks for catching it.

[DropkickMurphy]

I've seen someone go briefly into asystole (10 seconds) from a CSM, but they spontaneously returned to a normal sinus rhythm very quickly. So, yes, you can technically get an arrhythmia, but it is due to the vagal stimulus, not fracturing the plaque.

[GregsAnatomy]

Originally Posted by ericdamiansean

Anyone has heard that you can kill a normal person, with no heart problems with a carotid massage?

This is one of the closely guarded secrets in osteopathic manipulation....

[ericdamiansean]

Originally Posted by Pegasus52082

This is one of the closely guarded secrets in osteopathic manipulation....

Mind sharing?

[neurodoc]

Although I've never seen anyone harmed during carotid massage (used to cause a vagal reflex to slow down an SVT), it makes sense not to "massage" both carotids at the same time, since to achieve the vagal stimulation only one caratid needs to me massaged, and if you massage both at the same time you do risk clamping down on the blood supply to the brain, causing syncope. There is a small risk of causing a stroke by massaging a stenotic carotid, but I've never seen that happen.

I have seen some disasters from chiropractic cervical manipulation, but not from OMT. The worst case I saw was a carpewnter in his early 30's who went to a local chiropractor complaining of neck pain. He was treated by the DC who "cracked" his neck and scheduled a follow-up visit the next day. The patient returned the next day and reported that the treatment helped his neck and shoulder pain a bit, but he had a wierd experience while driving home after the treatment. He informed the DC that on the way home he suddenly got very dizzy and nauseous, and he started seeing double. He had to stoip the car and throw up at the side of the road, and these symptoms passed. The DC told him he needed "another treatment." This was administered, the patient went home and went to bed. When he woke up in the morning, he told his wife he couldn't move the right side of his body. She called 911 and he was admitted to the hospital where I was rotating as Chief Resident on the Neuro service. I was called to evaluate him because his MRI showed a pontine stroke. He told me his story and I ordered an angiogram which showed a vertebral dissection...

I told his attending that I thought this guy's stroke was caused by the DC.

Nick

He told me his story

[BackTalk]

The incidence of stroke following cervical spine manipulation is actually very low. Yes, it can happen but I have found that Neuro's like to blow this out of proportion. If this was such an epidemic then why aren't we seeing daily reports on the news of people stroking out at the hands of a chiropractor?

[PlasticMan]

How delicate can the carotids be? I've heard of some plaque being able to break loose, etc. If anyone has done jui-jitsu or grappling, we apply blood chokes(pressure to both carotids) ALL the time. Everytime you train, it's very likely you'll apply chokes to others and/r be choked yourself. I've never seen or heard of anyone having problems from being choked during training. It's not a gentle choke either, sometimes the guy will be struggling and you'll have your legs wrapped around his neck (triangle choke) trying to squeeze the life out of him before he'll tap. Once you apply good pressure to both carotids though, if the guy doesn't tap, should only take 8 seconds or so to knock him out. But you have to get both carotids; if you only apply pressure to one, it may tire him, but he won't get choked out.

[Chronic Student]

I think that were talking about people who are fifty plus and with atherosclerotic risk factors having plaque dislodged. Not younger, healthy atheletes.

-Mike

[PlasticMan]

Originally Posted by Chronic Student

I think that were talking about people who are fifty plus and with atherosclerotic risk factors having plaque dislodged. Not younger, healthy atheletes.

-Mike

We got some old people that roll around with us too. One guy that started training a couple months ago is 57 years old! Is it safe for people this old to start training and get choked?

[Mr. McDuck]

I broke my damn foot at Arnold's a few years ago trying a flying triangle choke. Stupid showboating.

[caffeinefree08]

I'm not really sure that chokes were exactly what we meant by vigorous carotid sinus massage - but just in case, I am willing to try that out at my next judo practice to see how effective it is.

[FutureNavyDOc]

Originally Posted by PlasticMan

We got some old people that roll around with us too. One guy that started training a couple months ago is 57 years old! Is it safe for people this old to start training and get choked?

I can't help but wonder about whether or not it is worth it for people of that age to occupy a spot in a med school class. I have no doubts about their ability to become great doctors, but if they start med school at say 50, they graduate at 54, finish a 3 year FP residency at 57, best case scenario they practice until 70 and have 13 years of practice.

As opposed to someone who like myself went straight from college to med school, I'll graduate at 25, if I do a 3 year residency I'm done at 28/29 (summer birthday) and even if I retire at 60 I will have 31 years in practice, more than likely I will work until 65 or so putting me at around 36 years.

With the supposed shortage in physicians over the coming decades, is it necessarily a good idea to accept someone who is already halfway to the century mark and has at best 13-15 years to practice over someone who is under 30 and will have at least double that time?


Thoughts???

[Mr. McDuck]

Erm. He's talking about "rolling", i.e., practicing jui-jitsu--not attending medical school.

[Shodddy18]

you have to listen for a carotid bruit before doing massage, because if they have a plaque, you could break part of it off and cause a stroke, or dammage the intima and cause a clot to start. This is why nurses are not allowed to do carotid massage... its out of their scope of practice because I guess their not trained to detect a bruit!

[FutureNavyDOc]

Originally Posted by Billy Shears

Erm. He's talking about "rolling", i.e., practicing jui-jitsu--not attending medical school.

My bad, but I know at DMU there is a 51 year old in the 1st year class. I thought someone had her beat for life experience coming in to Med school.

[ericdamiansean]

Originally Posted by FutureNavyDOc

With the supposed shortage in physicians over the coming decades, is it necessarily a good idea to accept someone who is already halfway to the century mark and has at best 13-15 years to practice over someone who is under 30 and will have at least double that time?


Thoughts???

This is a matter of whether you want quality or quantity. Yes, there may be a shortage but then again, you don't want substandard people providing healthcare

[neurodoc]

Originally Posted by BackTalk

The incidence of stroke following cervical spine manipulation is actually very low. Yes, it can happen but I have found that Neuro's like to blow this out of proportion. If this was such an epidemic then why aren't we seeing daily reports on the news of people stroking out at the hands of a chiropractor?

Well, I've seen it happen THREE TIMES, and I reported what I consider to have been the most egregious case. I'm sure it's occurence "very low," but that is small consolation to the three young and previously vigorous patients who suffered devastating strokes after having their necks "cracked."

Sincerely,

Nick

[DropkickMurphy]

Originally Posted by Pegasus52082

This is one of the closely guarded secrets in osteopathic manipulation....

Ah yes, the fabled Dim mok. Not many people know that A.T. Still was also a 8th degree black belt in ninjitsu.

[DropkickMurphy]

Originally Posted by neurodoc

Well, I've seen it happen THREE TIMES, and I reported what I consider to have been the most egregious case. I'm sure it's occurence "very low," but that is small consolation to the three young and previously vigorous patients who suffered devastating strokes after having their necks "cracked."

Sincerely,

Nick

Are you sure that those cases were embolic strokes from plaque and not due to damage to or occlusion of the vertebrals?

*EDIT: Guess I should have noticed you're a practicing neurologist......still, I have seen two strokes due to neck "cracking" and both were due to problems with the vertebral arteries- one being an occlusion of one due to a partial dissection following "traction" and the other a "pinching off" of the vertebral due to a displaced vertebra.

[ilovestewie]

Originally Posted by FutureNavyDOc

With the supposed shortage in physicians over the coming decades, is it necessarily a good idea to accept someone who is already halfway to the century mark and has at best 13-15 years to practice over someone who is under 30 and will have at least double that time?


Thoughts???

Its better than letting an idiot in who doesnt have any reading comprehension skills to figure out the conversation wasnt about an older person in med school.

[FutureNavyDOc]

Originally Posted by ericdamiansean

This is a matter of whether you want quality or quantity. Yes, there may be a shortage but then again, you don't want substandard people providing healthcare

Good point, but can you really tell how good of a doc someone is going ot be from a 30 min interview? With the ridiculous pace of DO schools popping up it seems the obvious answer for many is quantity.


Stewie lover,
Good to see you've had your weekly helping of bitter soup. I apologize for not being up on the current lingo of martial arts. I also made the mistake of thinking this was a thread about Medical school and clinical rotations, but clearly it is about jui-jitsu and making assumptions about people you've never met because they don't read every single post on a chat thread.

[PlasticMan]

Originally Posted by FutureNavyDOc

Good point, but can you really tell how good of a doc someone is going ot be from a 30 min interview? With the ridiculous pace of DO schools popping up it seems the obvious answer for many is quantity.


Stewie lover,
Good to see you've had your weekly helping of bitter soup. I apologize for not being up on the current lingo of martial arts. I also made the mistake of thinking this was a thread about Medical school and clinical rotations, but clearly it is about jui-jitsu and making assumptions about people you've never met because they don't read every single post on a chat thread.

Yes, I meant grappling. "Rolling" refers to sparring for grappling. In any case, in regard to the older med school student thing, we got a couple of guys in my class that are up there in age as part of the emigre physician program; one guy from India said he graduated medical school over there in 1973!

[Rendar5]

Originally Posted by Billy Shears

I broke my damn foot at Arnold's a few years ago trying a flying triangle choke. Stupid showboating.

Flying?!?! is that like jumping at the other guy crotch first to start the hold?

[enanareina]

The way one of my professors explained this was as follows: if you do an improper carotid massage bilaterally, you compress the carotid sinus; if you compress it too much, the pressure recorded by the sinus increases, sending a signal to the brain that pressure is too high and needs to drop--NOW. According to this prof, if you press "just right" on both carotid sinuses, you can essentially vasovagal the person to death.

Emedicine has an interesting article on a related topic: http://www.emedicine.com/med/topic299.htm Pubmed has a very few case studies of reports of "carotid sinus death", including this one: http://www.ncbi.nlm.nih.gov/entrez/q...=pubmed_docsum

So if I had to hazard a guess, I'd say this could be a mechanism for death in a young, healthy person with their neck maneuvered in the wrong way. It could also be a myth--who knows?

[PlasticMan]

Originally Posted by Rendar5

Flying?!?! is that like jumping at the other guy crotch first to start the hold?

Yes. Example vid: http://www.youtube.com/watch?v=Ipb899h3w54

[tupac_don]

Originally Posted by FutureNavyDOc

I can't help but wonder about whether or not it is worth it for people of that age to occupy a spot in a med school class. I have no doubts about their ability to become great doctors, but if they start med school at say 50, they graduate at 54, finish a 3 year FP residency at 57, best case scenario they practice until 70 and have 13 years of practice.

As opposed to someone who like myself went straight from college to med school, I'll graduate at 25, if I do a 3 year residency I'm done at 28/29 (summer birthday) and even if I retire at 60 I will have 31 years in practice, more than likely I will work until 65 or so putting me at around 36 years.

With the supposed shortage in physicians over the coming decades, is it necessarily a good idea to accept someone who is already halfway to the century mark and has at best 13-15 years to practice over someone who is under 30 and will have at least double that time?


Thoughts???

I see your point and it's a very valid one. However, you gotta understand, that yea this guy is 50 when he starts med. But who knows, he might work till he is 80. Also how many people do you think who are young, don't finish med, for whatever reason, (drop out, never finish residency, decide it's not for them, change careers). I think there is a lot more of those than people who are 50+ who drop out. People in their 50's are more motivated than your typical younger individual and know exactly what they are getting themselves into. I think the percentage of people in med schools who are 50 and up is very small, so having a 1 guy out of 200 people in the class, big deal, that's ok. Even having them work for 13 years is not a bad thing.

Is it better to have younger people, absolutely, but you are not talking about half the class being over 50, at best you are talking about 20 of these individuals, maybe in the whole nation, being accepted to med school. Not a big deal.

[stretch210]

As mentioned before this is for vagal reflex. I was taught one thing that you should ALWAYS do with a carotid massage. ONLY massage one side at a time, healthy or not. This was already mentioned and this is absolutely correct! A complication is always possible...but you have to weigh the options and consequences (as with everything).

As far as using it with a patient with heart problems. This is actually what it would be used for the majority of the time. Unfortunately that most likely means artherosclerotic plaque has been built up. There are other techniques to cause a vagal reflex that are less effective, or I should say don't get the desired affect as often. Let me give a scenario. If you're on a hike in the mountains and you come across some person who seems to be having a cardiac infarct there is very little you can do. You don't have medicine, you don't have a d-fib if you need one, you don't have anything but some water and your hands. In order to cause the vagal reflex a carotid massage may be your only option. And probably the best option because it works the most often to slow down Cardiac output.

Another scenario: you are in the emergency department as a 3rd year med student and a patient comes in with signs of a cardiac infarct. There are 10 people standing around with a doc barking out orders, but none have been given to you and as far as you know everything has been taken care of. This is when I would use another technique for vagal reflex as opposed to the carotid massage. For one, I will be doing something to help them, and for another they are receiving other proven medical attention. Maybe I will do a bilateral eye pressure or stimulate T1 - T5 via pressure. This not only often comforts the patient because hands are actually touching them instead of sticking them with needles, but can be an effective way of decreasing HR by 10-15 bpm.

[ericdamiansean]

Originally Posted by enanareina

It could also be a myth--who knows?

A question for the Mythbusters?

[ericdamiansean]

Originally Posted by FutureNavyDOc

Good point, but can you really tell how good of a doc someone is going ot be from a 30 min interview? With the ridiculous pace of DO schools popping up it seems the obvious answer for many is quantity.

Actually, my school has thought of a plan to include selected students for the interview process, it's currently being tested out for the pharmacy students.

Perhaps, students are able to tell amongst themselves who are the ones who should be weeded out, but this can be open to abuse ie. a male student interviewer might let in the hot females and vice versa

But from personal experience, all my juniors whom I thought would be kicked out by the end of MS1, were kicked out..some just looked like thugs

[zenman]

Originally Posted by DropkickMurphy

Ah yes, the fabled Dim mok. Not many people know that A.T. Still was also a 8th degree black belt in ninjitsu.

It also doesn't take much of a slap in the carotids to drop one's pressure.
We did it a lot in Hapkido. Some people just stand there with a glazed look in their eyes while you can just push them over, others drop like a rock. It's a good thing to teach your kids if kidnapped...just keep trying to slap the perv in the neck.

[FutureNavyDOc]

Originally Posted by ericdamiansean

Actually, my school has thought of a plan to include selected students for the interview process, it's currently being tested out for the pharmacy students.

Perhaps, students are able to tell amongst themselves who are the ones who should be weeded out, but this can be open to abuse ie. a male student interviewer might let in the hot females and vice versa

But from personal experience, all my juniors whom I thought would be kicked out by the end of MS1, were kicked out..some just looked like thugs

DMU has that in place already. 3 interviewers; a clinician, a prof and a current student. All get equal vote and more often than not the student pulls more weight in the discussion.

I would say for the most part the students can smell a rat a lot better than the other 2.

I don't believe the hot girl getting in with a male interviewer is much of a problem, at least not in any cases I have heard of.

[ericdamiansean]

Originally Posted by FutureNavyDOc

DMU has that in place already. 3 interviewers; a clinician, a prof and a current student. All get equal vote and more often than not the student pulls more weight in the discussion.

I would say for the most part the students can smell a rat a lot better than the other 2.

I don't believe the hot girl getting in with a male interviewer is much of a problem, at least not in any cases I have heard of.

How about having a computer and checking out the interviewee's myspace/ friendster profile(without their knowledge)? Does that tell you how someone is really like?

[FutureNavyDOc]

Originally Posted by ericdamiansean

How about having a computer and checking out the interviewee's myspace/ friendster profile(without their knowledge)? Does that tell you how someone is really like?

You bet it does! Don't forget facebook and eHarmony.com. If they're not compatible with me according to my EHarmony Dr Phill report, they are sooo not in.

[ericdamiansean]

Originally Posted by FutureNavyDOc

You bet it does! Don't forget facebook and eHarmony.com. If they're not compatible with me according to my EHarmony Dr Phill report, they are sooo not in.

Exactly..people can cheat and lie their way through in an interview, but what you put up on your pages and blogs tell hell alot more about yourself!

But does this violate any right? If word gets out that he/she was not accepted because of "clashes of online and real life personality," will this be grounds for a law suit?

[FutureNavyDOc]

Originally Posted by ericdamiansean

Exactly..people can cheat and lie their way through in an interview, but what you put up on your pages and blogs tell hell alot more about yourself!

But does this violate any right? If word gets out that he/she was not accepted because of "clashes of online and real life personality," will this be grounds for a law suit?

I hope you know I was kidding. At least I've never facebooked a potential interviewee. Usually when i interview I don't even know who I'm interviewing until I get the folders about a half hour before the interview.

[latinfridley]

Originally Posted by ericdamiansean

Anyone has heard that you can kill a normal person, with no heart problems with a carotid massage?

I ran into a doc the other day who told me about a patient on whom he was palpating their carotid and ended up stroking out and dying.
So, it can happen.

[ericdamiansean]

Originally Posted by latinfridley

I ran into a doc the other day who told me about a patient on whom he was palpating their carotid and ended up stroking out and dying.
So, it can happen.

Must be an old guy? Or like the other posters said, someone with a carotid plaque

[HooahDOc]

Originally Posted by PlasticMan

How delicate can the carotids be? I've heard of some plaque being able to break loose, etc. If anyone has done jui-jitsu or grappling, we apply blood chokes(pressure to both carotids) ALL the time. Everytime you train, it's very likely you'll apply chokes to others and/r be choked yourself. I've never seen or heard of anyone having problems from being choked during training. It's not a gentle choke either, sometimes the guy will be struggling and you'll have your legs wrapped around his neck (triangle choke) trying to squeeze the life out of him before he'll tap. Once you apply good pressure to both carotids though, if the guy doesn't tap, should only take 8 seconds or so to knock him out. But you have to get both carotids; if you only apply pressure to one, it may tire him, but he won't get choked out.

I ran a ring at a submission grappling tournament once where one of the fighters actually choked out his opponent; dude was too stubborn to tap out. It was a lot quicker than 8 seconds. I was watching the match, someone asked me a question and I answered, turned back and the dude was limp. The guy was totally useless afterwards, almost in a stupor for several minutes.

[ericdamiansean]

Originally Posted by HooahDOc

I ran a ring at a submission grappling tournament once where one of the fighters actually choked out his opponent; dude was too stubborn to tap out. It was a lot quicker than 8 seconds. I was watching the match, someone asked me a question and I answered, turned back and the dude was limp. The guy was totally useless afterwards, almost in a stupor for several minutes.

Can you tell us how you do a choke?