Vagal Manuevers

[AJ Hidell]

Dysrhythmias
Asystole
Stroke from dislodged carotid artery thrombus in persons with
atherosclerotic disease.
Brain ischemia from occlusion of carotid artery or compromise of
marginally perfused areas of brain.​

But nothing serious, right?

Done a lot of vagals over the years. I've worked on the same patient for hours on end trying to end their SVT, with nothing working. Others have miraculously converted with a simple Valsalva before I even had to take any other measures. You just never know what is going to work and what is not. By the time you get down to getting a salad bowl full of ice water for the Mammalian Diving Reflex, you're pretty much out of options. But I've seen that one work too, so never overlook any option in the process.

Not only should EMTs not be performing this unsupervised, but I'd also say that most medics in the US probably shouldn't be either, unless the patient is measurably decompensating. The level of education and competence simply is not there in too many systems for this to be a procedure we perform just because "we can". This is not a cookbook skill to be used indiscriminately.

 

[PapaBear434]

Uh-huh. Thank you very much.B)

In all honesty, I'm a fan of every legend coming out of the great state of Mississippi:

Elvis Presley
Robert Johnson
B.B. King
Muddy Waters
Jimmy Buffet
Bret Favre
Faith Hill
Morgan Freeman

Just to name a few.

Yeah, well, I'm from Michigan. We have... Um... The Unibomber? Tim McViegh? The Nicoles brothers? Oh, and David Duke... Gerald Ford, but he sucked... Ok, wait, I'm sure there's SOMEONE good.

Oh! Michigan militias! Make other "survivalist" groups look like a girl scout troop. Seriously, these guys are crazy on a level that would make Hannibal Lector go "Whoa, guys, chill out a little, you're starting to freak me out."

/still love my home state in spite of itself

 

[MSDeltaFlt]

But nothing serious, right?

Done a lot of vagals over the years. I've worked on the same patient for hours on end trying to end their SVT, with nothing working. Others have miraculously converted with a simple Valsalva before I even had to take any other measures. You just never know what is going to work and what is not. By the time you get down to getting a salad bowl full of ice water for the Mammalian Diving Reflex, you're pretty much out of options. But I've seen that one work too, so never overlook any option in the process.

Not only should EMTs not be performing this unsupervised, but I'd also say that most medics in the US probably shouldn't be either, unless the patient is measurably decompensating. The level of education and competence simply is not there in too many systems for this to be a procedure we perform just because "we can". This is not a cookbook skill to be used indiscriminately.

True. God did create the mantra "BLS before ALS", but He also created Adenosine, Cardizem, Amiodarone, and the ever popular electricity.

"Light 'em if ya got 'em"... in that order.

 

[PapaBear434]

But nothing serious, right?

Done a lot of vagals over the years. I've worked on the same patient for hours on end trying to end their SVT, with nothing working. Others have miraculously converted with a simple Valsalva before I even had to take any other measures. You just never know what is going to work and what is not. By the time you get down to getting a salad bowl full of ice water for the Mammalian Diving Reflex, you're pretty much out of options. But I've seen that one work too, so never overlook any option in the process.

Not only should EMTs not be performing this unsupervised, but I'd also say that most medics in the US probably shouldn't be either, unless the patient is measurably decompensating. The level of education and competence simply is not there in too many systems for this to be a procedure we perform just because "we can". This is not a cookbook skill to be used indiscriminately.

I know it must be old hat to you at this point, but I witnessed my first chemical cardioversion almost a year ago, and I still say it was the coolest thing I've seen in the back of an ambulance. I of course knew what happens when you push Adenosine, read about cardiovert procedure plenty of times and even how to do it. But to watch it happen for the first time was just plain cool.

I mean, here's this woman feeling the "impending feelings of doom" and asking if she was already dead. I'm just a two week trainee, sitting next to her and holding her hand because she grabbed mine and wouldn't let go. And of course, there goes the LifePack with the nice steady "Beeeeeeeeeeeeeeeeeep." This woman, fully wide awake, starts flipping out yelling "WHAT DOES THAT MEAN!?"

Surprisingly, she didn't react well to watching her own heart stop.

She was fine afterward, of course. And in between shifts, proctored training, and clinicals, I've seen it I don't know how many times since. But that first time was what solidified me in knowing I was going to go all the way to medic.

 

[AJ Hidell]

Yeah, well, I'm from Michigan. We have... Um... The Unibomber? Tim McViegh? The Nicoles brothers? Oh, and David Duke... Gerald Ford, but he sucked... Ok, wait, I'm sure there's SOMEONE good.

Oh! Michigan militias! Make other "survivalist" groups look like a girl scout troop. Seriously, these guys are crazy on a level that would make Hannibal Lector go "Whoa, guys, chill out a little, you're starting to freak me out."

/still love my home state in spite of itself

Actually, you just listed the only things I admire about Michigan.

 

[Aidey]

In response to the OP yes i've used them, and I've only had success once, and it was semi-success at best.

I was on the last shift of my internship and we were called for a 67 year old male "seizure". We get there and his son tells us there wasn't a seizure, but his dads arm has been twitching on and off for 3 days. Only history is emphysema, controlled with oral meds. Initial vitals were all normal. SpO2 was a little low at 97%, but he had emphysema so that isn't bad. When doing his BP I noticed his pulse was a little irregular, but not fast, so I started thinking new onset A-fib.

We get him out to the ambulance, hook him up to the monitor and he's in bloody unifocal V-tach. My preceptor hadn't seen it yet and she asked me if I was ready to go and all I said was "Yes, go now. Code" and the EMT took one look at me, and started driving without asking any questions. My preceptor gave me a strange look and I turned the monitor towards her and she said "Oh, I see, I agree"

Anyway, since he was totally stable (no chest pain, SOB, BP was normal etc) we had to try vagal manuvers before lidocaine. We would have him bear down and then about 10 seconds later he would convert into a perfect sinus rhytym. That would last for 10-30 seconds and then he would go right back into V-Tach. We converted him like 4 times before we gave up.

When we gave the radio report to the hospital the nurse was like "yeah yeah, whatever stable v-tach" and you could tell she didn't beleive us. After we got the guy into his room at the ED and only an ER tech met us my preceptor literally grabbed a doctor and showed him the strip and he looked at it, looked at the patient, looked at it again and said "Well, he really is in V-Tach isn't he?"

I felt like telling him "told you so", but I didn't.