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Do you guys do carotid massage on SVT? And how successful have you guys found your technique to be?
Do you guys do carotid massage on SVT? And how successful have you guys found your technique to be?
I do carotid massages, have the patient blow through a straw, and even bare down. I've never seen a vagal maneuver work.
If no bruit
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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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.
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.
3. Adenosine sucks for patients (per report). However, the risk of adenosine <<<<< cardizem in all but the most stable patients.
Does your massage work?
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.
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