Sinus Tach maneuver name?

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

You medics never let us have ANY fun!
 
medic417 said:
Do not just use vagal w/o precautions such as heart/lung sounds, check for bruits, establish IV, ekg 12 lead, etc.
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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.
 
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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.
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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.
 
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...!
 
Toxscreen too.

Have the pt cough deeply a few times.
Unless you know they are at risk for aneurysm or have active TB.....;)
 
boingo said:
Vagal maneuvers aren't done for sinus tach, they are done for svt.
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Which could be a sinus tach (not trying to bust any b***s here) :ph34r:
 
SInus Tachy

fma08 said:
Which could be a sinus tach (not trying to bust any b***s here) :ph34r:
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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:):):)
 
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Whoah

medic417 said:
Yes it is one of the vagal manuevers we are allowed.
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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
 
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.
 
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.

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:):):)
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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.
 
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
 
Cardioversion of Sinus Tach is like using benzo's to treat cardiac siezures.;)
 
sinus tach- above 100 BPM, regular, narrow complex
SVT- rate above 150 regular w/ possibly indecernible P wave,narrow complex QRS..
 
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
 
the old freezing cold coke from the fridge chug....or bucket full of ice water for the kids..
 
the old freezing cold coke from the fridge chug....
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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!
 
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