SVT... carotid massage...

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pinipig523

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Do you guys do carotid massage on SVT? And how successful have you guys found your technique to be?

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Do you guys do carotid massage on SVT? And how successful have you guys found your technique to be?

If no bruit and hemodynamically stable, then yes I do...

...while I'm waiting for Adenocard, as it never seems to work (n = my experience).

Cheers!
-d


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I just finished a shift.

A lady w/ SVT. Became nauseous, then terminated in NSR.

I've had several terminate w/ nausea, several w/ IV. Both, I suspect, from vagal stimulation.

One previous experience w/ carotid massage.
 
My carotid massages used to suck before. Then I came across instructions on how to properly do one on Tintinalli last year. Since then, I think I've broken approximately 6 SVT with the carotid massage.

I think I'm about 30-40% with my SVT. Usually I try it on younger folk and those without a bruit.

I used to be 0% successful with carotid massages.

I was just wondering if others had similar experiences and if you have tips on improving the massage.
 
Are you that confident in your physical exam?

And, if so, what do you think the absence of an audible bruit represents?

HH

I am that confident in my exam; and I acknowledge that lack of bruit means little in terms of se/sp for carotid stenosis.

I should clarify, then: my earlier post in patients whom I feel are low risk for carotid stenosis.

Still never works, though... d=)

-d

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I am that confident in my exam; and I acknowledge that lack of bruit means little in terms of se/sp for carotid stenosis.

I should clarify, then: my earlier post in patients whom I feel are low risk for carotid stenosis.

Still never works, though... d=)

-d

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Do you actually massage or press down hard on the carotid?

I used to massage and it never worked.
 
I rarely get to use adenosine. It normally breaks as soon as I enter the room or as soon as I insert the needle. I can count on one hand the number of times I've actually gotten to break an SVT with adenosine.
 
Meh, I'll try vagal maneuvers in young people but with older people I go straight to the adenosine.

Adenosine sucks balls to the people that actually get it. Use Cardizem instead. Equal efficacy, less of that "I'm going to die" feeling.

Or don't. Just don't ever give me adenosine. Cardizem or electricity only.
 
I love the face-in-ice-water maneuver. As a medic, I have 75% success with an N of 10-12. Definitely agree with the dilt before adenosine though.
 
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Adenosine sucks balls to the people that actually get it. Use Cardizem instead. Equal efficacy, less of that "I'm going to die" feeling.

Or don't. Just don't ever give me adenosine. Cardizem or electricity only.

Yes.

My thoughts:

1. Listening for bruit is low-yield (like most auscultation). PMHx and age are must more important. Ultrasound is where it's at (in general, not so much here).

2. Vagals without direct pressure on the carotid seem to be benefit >>> risk, whereas direct carotid pressure seems risk > benefit.

3. Adenosine sucks for patients (per report). However, the risk of adenosine <<<<< cardizem in all but the most stable patients.

4. Etomidate, fentanyl, and electricity are good. Propofol (+/- neo), fentanyl, and electricity are better.

So, I don't see any reason to do carotid massage. Stable patient who you want to try some tricks on before meds? Then vagals that don't involve the carotid/stokes.

Unstable patient? Zap! (or adenosine for the "semi-stable")

HH
 
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What side do you usually try it on? I heard you should do it on the right side to avoid throwing plaque to the left (speech center) side of the brain.
 
What side do you usually try it on? I heard you should do it on the right side to avoid throwing plaque to the left (speech center) side of the brain.

If you think there's a risk of throwing a plaque, you don't do it at all. "Well, jury, I figured if I was going to give her a stroke, I may as well give her a right sided stroke instead"
 
3. Adenosine sucks for patients (per report). However, the risk of adenosine <<<<< cardizem in all but the most stable patients.

Bolus cardizem isn't any more risky than adenosine. Neither is the drip.
 
Nope, neither do any of the other vagal maneuvers I try.

Do you actually massage?

My thoughts on this:
1. Young person - fair game. I just have them look Lt, feel for the carotid. I have them take a deep breath and hold. While they are holding their breath, I push the carotid all the way into the vertebral bodies/transverse processes of their c spine. Hold it for 5 seconds... usually they will respond.

My success rate is about 35%, I can beat out the nurses drawing adenosine.

I used to "massage" the carotid - that was completely USELESS.
 
Do you actually massage?

My thoughts on this:
1. Young person - fair game. I just have them look Lt, feel for the carotid. I have them take a deep breath and hold. While they are holding their breath, I push the carotid all the way into the vertebral bodies/transverse processes of their c spine. Hold it for 5 seconds... usually they will respond.

My success rate is about 35%, I can beat out the nurses drawing adenosine.

I used to "massage" the carotid - that was completely USELESS.


Again: Why do it?

There are other vagal manuevers that are also not frequently successful (but with no risk -- admittedly, less successful)...why take risk at all? There equally safe therapies in the stable patient.

I really think this is a technique left over from the days of leeches.

HH
 
Again: Why do it?

There are other vagal manuevers that are also not frequently successful (but with no risk -- admittedly, less successful)...why take risk at all? There equally safe therapies in the stable patient.

I really think this is a technique left over from the days of leeches.

HH

What's the risk? SVT in a 27yo?
 
I'll try carotid massage if under 60yo (completely arbitrary and unscientific cutoff). My success rate is >50%. My odds improved greatly after a cards attending showed me the proper technique intern year.
 
BLUEBLAZER fibbed:

"I love the face-in-ice-water maneuver. As a medic, I have 75% success with an N of 10-12..."



No way.
 
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