# Sinus Tach maneuver name?



## nomofica (Mar 14, 2009)

There's a maneuver where the pt is asked to increase pressure via holding breath + pushing with core muscles as if they were "pinching one off", resulting in the slowing down of impulses from the sinoatrial node (and I'm guessing a more relaxed communication from the medulla oblongada and the SA node), therefore "pulling" themselves out of sinus tach, but for the life of me I can't remember the name of it...

I'm sure you guys can refresh my memory. Thanks, in advance.


----------



## Sasha (Mar 14, 2009)

Vagal manuevers?


----------



## nomofica (Mar 14, 2009)

Sasha said:


> Vagal manuevers?



Ahhh yes, Valsalva maneuver.

This is where I /facepalm myself.:blush:


----------



## AJ Hidell (Mar 14, 2009)

Be careful!


----------



## rhan101277 (Mar 14, 2009)

This maneuver didn't fix my sinus tach.


----------



## JPINFV (Mar 14, 2009)

^ 
So? A single case study doesn't invalidate an established treatment.


----------



## boingo (Mar 14, 2009)

Vagal maneuvers aren't done for sinus tach, they are done for svt.


----------



## VentMedic (Mar 14, 2009)

You have to treat the cause for sinus tach: fever, pain, anxiety, dehydration, drugs etc.


----------



## medic417 (Mar 14, 2009)

Do not just use vagal w/o precautions such as heart/lung sounds, check for bruits, establish IV, ekg 12 lead, etc.


----------



## AJ Hidell (Mar 14, 2009)

rhan101277 said:


> This maneuver didn't fix my sinus tach.


The facepalm?


----------



## medic417 (Mar 14, 2009)

medic417 said:


> Do not just use vagal w/o precautions such as heart/lung sounds, check for bruits, establish IV, ekg 12 lead, etc.



Also this is not a basic manuever.  It probably should not be used by many Paramedics that have not been educated what to look for prior to doing.


----------



## AJ Hidell (Mar 14, 2009)

Hmmm... I didn't notice that this was posted in the BLS Discussion forum.  It definitely should not be.


----------



## Sasha (Mar 14, 2009)

AJ Hidell said:


> Hmmm... I didn't notice that this was posted in the BLS Discussion forum.  It definitely should not be.



Maybe there's an EMT-V cert somewhere!


----------



## medic417 (Mar 14, 2009)

Sasha said:


> Maybe there's an EMT-V cert somewhere!



Don't suggest it some idiot somewhere will convince their state to start one.


----------



## firecoins (Mar 14, 2009)

medic417 said:


> Don't suggest it some idiot somewhere will convince their state to start one.



I am in an EMT-V certification class right now:sad:


----------



## Sasha (Mar 14, 2009)

firecoins said:


> I am in an EMT-V certification class right now:sad:



Accelerated or regular version?


----------



## medic417 (Mar 14, 2009)

Sasha said:


> Accelerated or regular version?



Vounteer or paid?


----------



## JPINFV (Mar 14, 2009)

/me remembers a discussion a few years ago on the other forum about the "EMT-J" level.


----------



## Sasha (Mar 14, 2009)

What did the J stand for?

By the way.. Off topic, but so is the thread! 



> Kirksville, MO- 2/25-3/1 (waitlisted)



I'm SO proud of you! You're almost in doctor school! :] Keep your fingers crossed and hope someone... I don't know.. decides they want to be a NASCAR driver instead!


----------



## JPINFV (Mar 14, 2009)

Sasha said:


> What did the J stand for?
> 
> By the way.. Off topic, but so is the thread!


EMT-Johnson



> I'm SO proud of you! You're almost in doctor school! :] Keep your fingers crossed and hope someone... I don't know.. decides they want to be a NASCAR driver instead!



Well, second deposit was due on Friday, so hopefully a lot of people withdrew their applications.


----------



## Airwaygoddess (Mar 14, 2009)

Valsalva Maneuver is for ALS only, as said before this requires the theory and a proper patient assessment and a cardiac monitor, and IV access.


----------



## PapaBear434 (Mar 14, 2009)

Airwaygoddess said:


> Valsalva Maneuver is for ALS only, as said before this requires the theory and a proper patient assessment and a cardiac monitor, and IV access.



Aww...  I wanted to cause someone's heart and BP to drop to dangerous levels tonight...  

You medics never let us have ANY fun!


----------



## Jon (Mar 14, 2009)

medic417 said:


> Do not just use vagal w/o precautions such as heart/lung sounds, check for bruits, establish IV, ekg 12 lead, etc.


If we are having the patient do the valsalva maneuver, why are we checking for bruits? Don't we only worry about that for carotid sinus massage?

And thread moved to ALS forum, as Vagal maneuvers are usually in the ALS level of care.


----------



## medic417 (Mar 14, 2009)

Jon said:


> If we are having the patient do the valsalva maneuver, why are we checking for bruits? Don't we only worry about that for carotid sinus massage?
> 
> And thread moved to ALS forum, as Vagal maneuvers are usually in the ALS level of care.



Note I stated vagal which includes both valsalva and carotid.  But it is good practice to listen for bruits as part of any complete exam.


----------



## nomofica (Mar 18, 2009)

Hahaha, thanks for the posts (and moving of the thread), guys.

Valsalva didn't "treat" my sinus tach stint a while back, either. Responding ALS did have me ECG'd and IV'd, but I don't recall anything beyond that. I was a bit drunk at the time... :blush:

Well, no more Jagerbombs at the night clubs for me...!


----------



## mycrofft (Mar 19, 2009)

*Toxscreen too.*

Have the pt cough deeply a few times.
Unless you know they are at risk for aneurysm or have active TB.....


----------



## Melbourne MICA (Mar 19, 2009)

*The big V*

Are some of you guys allowed to do carotid sinus massage? 

MM


----------



## medic417 (Mar 19, 2009)

Melbourne MICA said:


> Are some of you guys allowed to do carotid sinus massage?
> 
> MM



Yes it is one of the vagal manuevers we are allowed.


----------



## fma08 (Mar 19, 2009)

boingo said:


> Vagal maneuvers aren't done for sinus tach, they are done for svt.



Which could be a sinus tach (not trying to bust any b***s here) h34r:


----------



## Melbourne MICA (Mar 19, 2009)

*SInus Tachy*



fma08 said:


> Which could be a sinus tach (not trying to bust any b***s here) h34r:



Sorry it doesn't work like that. 

Sinus Tachycardia is a normal cardiac response to demand upon the myocardium designed to balance cardiac output to tissue perfusion needs when load is increased and oxygen consumption from the tissies rises. It is also works to assist in removal of the by priducts of metabolism, principally carbon dioxide. 

Sinus tachycardia is generated from the sinus node by stimulation of pacemaker cells by the sympathetic nervous system and follows the normal conduction pathway through to the ventricles. 

It may also be artifically induced such as through drug stimulation (like a strong coffee, meth amphets etc) and occur as a byproduct of abnormal events going on in the body like infection eg. With artifical stimulation the tachycardia will persist until the source of the stimulation is removed or metabolised.

There is only one type of Sinus Tachycardia.

Super ventricular tachycardia's only comparison to sinus tach is that they are fast - >100min.  (please note "they are" - plural)

"Super Ventricular" describes the site/s of origin which are above the ventricles; in the atria or at or about the AV node region. 

Alternately of course as you would be aware "ventricular tachycardia" describes an impulse generated in the ventricles. 

But SVT has an "abberrant" (abnormal) conduction pathway - typically it is generated through a "re-entry circuit" pathway. SVT's may also reflect  abnormal tissues, electrolyte imbalance, artifical stimulation or other unusual triggers for their origin. 

And SVT is class of arrhythmias. (Scientists love to have everything neatly packaged into their own little boxes).

There are a number of "SVT's" such as Atrial Fibrillation, Atrial tachycardia, Junctional tachycardia and others . How they are described or called specifies features of their point/s of origin, their rate, characteristics or duration. eg "Atrial" "Fibrillation" - origin is in the atria, its main characteristic is to cause fibrillation (chaotic contraction) of the atria. (Does that make sense?)

So under the arbitrary arrangements used by the cardiology community to classify all electrical impulses generated in the heart "Sinus Tachycardia" is simply an impluse that is fast, that being greater than 100 beats per minute and generated in the sinus node.

(Ditto your remarks about not telling you to suck eggs). It's just matter of definition which is to say clarity, precision and consistency in the way such things are talked about.

MM


----------



## Melbourne MICA (Mar 20, 2009)

*Whoah*



medic417 said:


> Yes it is one of the vagal manuevers we are allowed.



What's the complication/SE rate and when are you allowed to perform it?

We use the Valsalva, or rather our pts do, for SVT's. As far as Rx goes our guideline changed recently. Evidence seemed to point to a very low rate of serious deterioration of SVT pts pre-hospital so an ambit restriction of > 30mins from hospital or prolonged extrication time were placed on using meds - in our case Verapamil/Aromine. If the pts pegging out in front of you we still treat of course incl Dc reversion of course but for a standard pt with SVT we just manage symptomatically.

Our medicos never considered carotid sinus massage in our guidleine - To dangerous with poor overall success rates.

How long have you had the procedure in you guidelines?

MM


----------



## AJ Hidell (Mar 20, 2009)

Melbourne MICA said:


> How long have you had the procedure in you guidelines?


CSM has been in my local guidelines for about thirty-three years.


----------



## bonedog (Mar 20, 2009)

I like to bolus the pt with 250, get their legs up and have them blow into 6 feet of O2 tubing, with instructions to "blow up a balloon". Works great I hardly ever use adenosine. 
If unstable DC.


----------



## JROD (Mar 20, 2009)

Melbourne MICA said:


> Sorry it doesn't work like that.
> 
> Sinus Tachycardia is a normal cardiac response to demand upon the myocardium designed to balance cardiac output to tissue perfusion needs when load is increased and oxygen consumption from the tissies rises. It is also works to assist in removal of the by priducts of metabolism, principally carbon dioxide.
> 
> ...


Actually, if we are getting technical, Sinus Tach is a form of SupraVentricular Tachycardia. The term supraventricular implies that it is originating somewhere other than the ventricles (i.e the atria or AV node). Types of SVT can include: sinus tach, a-fib, a-flutter, junctional tach, etc. We use the term SVT becuase we don't know exactly where the rhythm is originating from other than somewhere above the ventricles. Thats the way I was always taught, please correct me if I'm wrong.


----------



## Melbourne MICA (Mar 20, 2009)

*Svt*

You're right of course in the broadest possible sense of the definition. Sinus tachys can of course be arrhythmic as well but for the purposes of the context and practice relative to Mx of "SVT" ie the bad ones treated with the valsalva  - you could'nt really say you would use it to "revert" a sinus tachy - (though I appreciate vagal activation will reduce the rate of a sinus tachy). Cardiologists love to get us confused  - or maybe it's just me.

I appreciate the clarification and stand corrected.

MM


----------



## bonedog (Mar 20, 2009)

Cardioversion of Sinus Tach is like using benzo's to treat cardiac siezures.


----------



## piranah (Mar 20, 2009)

sinus tach- above 100 BPM, regular, narrow complex
SVT- rate above 150 regular w/ possibly indecernible P wave,narrow complex QRS..


----------



## Ridryder911 (Mar 20, 2009)

Vagal maneuvers work well if one knows how to do it properly. I worked with a Cardiologist that NEVER used Adenocard or any med.'s, cardioversion. I personally witnessed several cardioversions of SVT with CSM. Problem is most (including physicians) do not properly perform the procedure correctly. 

Mammalian diving reflex is another excellent technique, that works well. 

R/r 911


----------



## piranah (Mar 20, 2009)

the old freezing cold coke from the fridge chug....or bucket full of ice water for the kids..


----------



## Sasha (Mar 20, 2009)

> the old freezing cold coke from the fridge chug....



I think the hospital staff would have a coronary if we had a patient chug some soda.. After they finished handing you your bum, that is!


----------



## piranah (Mar 20, 2009)

not really they find it funny and interesting....if they are stable...why not its better then pumping them full of adenosine....its the mammilian diving reflex like rid said...dunk pedi's face in ice real quik and it works well....


----------



## tydek07 (Mar 20, 2009)

Melbourne MICA said:


> Are some of you guys allowed to do carotid sinus massage?
> 
> MM



We are told to not do that anymore here. We are to go with the valsalva maneuver. B)


----------



## Ridryder911 (Mar 20, 2009)

tydek07 said:


> We are told to not do that anymore here. We are to go with the valsalva maneuver. B)



That is a local restriction. It is well accepted from the AHA & ECC to perform if properly educated and know the risks (check for carotid bruits >65 and left side only). Digital Anal circumvent sweep is also accepted but I doubt we see this popular. 

R/r 911


----------



## medic417 (Mar 21, 2009)

Ridryder911 said:


> Digital Anal circumvent sweep is also accepted but I doubt we see this popular.
> 
> R/r 911



LOL.  I can see a fight happening before that is implemented.


----------



## reaper (Mar 21, 2009)

Ridryder911 said:


> That is a local restriction. It is well accepted from the AHA & ECC to perform if properly educated and know the risks (check for carotid bruits >65 and left side only). Digital Anal circumvent sweep is also accepted but I doubt we see this popular.
> 
> R/r 911



I have always found that bilateral Carotid massage will work every time, to end SVT!


----------



## Melbourne MICA (Mar 23, 2009)

*Whoah!!!*



reaper said:


> I have always found that bilateral Carotid massage will work every time, to end SVT!



Do you guys have any stats on success rates, rates of side effects from the above being performed in the field - how does it stack up to adenosine eg?

We still use just valsalva +/- verapamil/aramine - adenosine is coming. We were supposed to have adenosine years ago but there were concerns re the asthmatic pt - one of our docs found some obscure studies re that problem.

There is another aspect to this which is the licensing of your practice. In our system we operate under the lincensure of our services docs - we stuff up big time its potentially their arses (medical license) on the line.

Are you given a bit more legal scope hence the carotid massage and extended drug portfolios you carry?

Its quite an interesting area of work - arrhythmia management.

MM


----------



## reaper (Mar 23, 2009)

Melbourne MICA said:


> Do you guys have any stats on success rates, rates of side effects from the above being performed in the field - how does it stack up to adenosine eg?
> 
> We still use just valsalva +/- verapamil/aramine - adenosine is coming. We were supposed to have adenosine years ago but there were concerns re the asthmatic pt - one of our docs found some obscure studies re that problem.
> 
> ...




That was actually a joke ["bilat Carotid massage"]! We are allowed Carotid massage, but it is not used that often.


----------



## medic417 (Mar 23, 2009)

Melbourne MICA said:


> Do you guys have any stats on success rates, rates of side effects from the above being performed in the field - how does it stack up to adenosine eg?
> 
> We still use just valsalva +/- verapamil/aramine - adenosine is coming. We were supposed to have adenosine years ago but there were concerns re the asthmatic pt - one of our docs found some obscure studies re that problem.
> 
> ...



Bilateral is 100% effective at killing the patient so guess you would say it stops tachycardia 100% of the time.


----------



## reaper (Mar 23, 2009)

Hey, you got the joke!


----------



## Melbourne MICA (Mar 24, 2009)

medic417 said:


> Bilateral is 100% effective at killing the patient so guess you would say it stops tachycardia 100% of the time.



I was repeating a previous query about the succeses or otherwise of CSM by EMS types. 

Oh all right  - I didn't get the joke!!! That's what happens when you become geriatric.

MM


----------



## reaper (Mar 24, 2009)

The old brain is slipping!!!!!!!


----------

