# SVT to NSR



## medic5740 (Nov 25, 2012)

Well, I'm just passing along an interesting method of resolving SVT.  It was somewhat unusual.  Called to a clinic to help a patient with a "quivery" feeling.  The heart rate was between 150 and 160.  The patient had lots of other issues in her history, including liver disease and varices in the esophagus and in the intestines.  The normal Valsalva maneuver was not possible due to the concern for internal bleeding.  The rate was borderline SVT, and since no cause was easily determined, it was classified PSVT, but it had continued for an hour prior to EMS.  SPO2 was 93.  SPCO2 was 26. BG was normal, Hemoglobin was within normal limits, no blood in the urine.  IV established. 12-lead obtained with monitor verifying SVT.  The patient was asked to scootch (sp) over from the cllnic bed to the ambulance cot.  The patient grunted twice during this move to the cot.  We watched the heart rate resolve to NSR after the second grunt.  This was not taught as part of ACLS that I am aware of.  Of course we transported the patient for follow up care and further diagnosis, but I had never heard of a grunt resolving SVT before, had you?


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## Aidey (Nov 25, 2012)

How old was the patient?

It likely wasn't the grunt that did it, it was the inadvertent performance of the Valsalva's maneuver.


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## medic417 (Nov 25, 2012)

You will find anything that causes exertion or provides a significant sense of relief can inadvertently cause a vagal response.   
I've seen them convert while they are urinating, when they fart, when the ambulance driver hit a big bump. Really doesn't take much for some people.


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## medic5740 (Nov 25, 2012)

*More info*

The female patient was in her 60s.


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## medic5740 (Nov 25, 2012)

*Thanks Medic417*

Having not ever had someone convert without the chemical solution, I found this interesting.  Thanks, Medic417.  Anyone else have an unusual conversion?


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## EMSrush (Nov 25, 2012)

Aidey said:


> How old was the patient?
> 
> It likely wasn't the grunt that did it, it was the inadvertent performance of the Valsalva's maneuver.



This. 

I had an SVT patient vomit, which accomplished the same thing, but a bit messier.


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## NYMedic828 (Nov 25, 2012)

Fluid bolus converts people too on occasion. Baroreceptive reflex or something like that.


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## socalmedic (Nov 25, 2012)

medic417 said:


> ...when they fart...



I have had a fart resolve svt. it was quite entertaining.


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## Medic Tim (Nov 25, 2012)

socalmedic said:


> I have had a fart resolve svt. it was quite entertaining.



Yours or theirs? Lol


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## medic417 (Nov 25, 2012)

Medic Tim said:


> Yours or theirs? Lol



You know probably won't matter if they laugh hard about it.


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## VFlutter (Nov 25, 2012)

Aidey said:


> Valsalva's maneuver.



+1 The grunt probably made her bare down


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## Hunter (Nov 25, 2012)

I don't think it was the grunt but the effort from sliding over from the bed to the stretcher.


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## socalmedic (Nov 25, 2012)

Medic Tim said:


> Yours or theirs? Lol



Theirs, but either probably either would have worked.


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