Carotid Massage - very cool!

  1. 0
    I'm had a post-op ortho patient with no previous cardiac hx yesterday that became so tachy her HR was hard to count. I called the orthopedic surgeon who ordered a stat EKG and crit. The EKG showed superventricular tachycardia, rate 175 (crit was 28). The ortho doc called in a medical consult stat, the hospitalist had us put the pt on a monitor and told the pt to do a valsalva, then he massaged her carotid. We were all watching the monitor, within 10 seconds the HR went from 180 to 120. Very cool! The HR stayed in the 120's, we gave 5 of Lopressor and sent her to tele.
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  4. 0
    I actually was the recipient of carotid massage 6 years ago. Funny thing was, I was working on a telemetry unit at the time, and started with the fast rhythm! My coworkers put a monitor on me, which showed a heart rate of 200. Needless to say, I bought myself a trip to the ER! They tried carotid massage first without success, so I was given one dose of Adenosine, which did the trick! What a feeling though! I hope menopausal "hot flashes" aren't like that!
  5. 0
    Just remember, carotid massage is not a recommended NURSING intervention anymore. A piece of plaque could break off from the carotid arteries and travel upstream. Only docs can perform this, since it is so risky.
  6. 0
    I can relate to the SVT--started having it about 10 years ago. Very sporatic but scary when it happens. HR 180, BP 180/100. Dizzy, SOB, chest pain. Adenosine works real well, but OOOUW what a feeling when it kicks in :uhoh21: Doc put me on Verapamil because I can't take the B-blockers (I have asthma too). Doc also told me to carotid massage myself when it happens!!! I said no way--what with the Ca-channel blocker on board and no monitor--and all alone??!! I've seen carotid massage cause VERY LONG pauses--causing us to rush for the crash cart. Doc told me it's common for mid to late 30's women to develop new onset SVT. Some need ablation. Some, like me, are controlled with meds. Valsalva never worked for me.
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    Remember you can always have the Pt bear down as if trying to have a BM, and if you are trying to take a pulse there is no rule against attempting to find it in the carotid. As mentioned by Cheri P the Pt can also message their own carotid as long as they are in a hospital setting and being monitored I have no problem with a Pt attempting this. I a not sure how great the risk is mentioned by Vicky of (A piece of plaque could break off from the carotid arteries and travel upstream.)but I do know that Physicians instruct young Pts to perform this manuever themselves frequently. It is not approved Nursing technique also as mentioend by Vicky.
  8. 1
    Quote from CCU NRS
    Remember you can always have the Pt bear down as if trying to have a BM, ....
    ...Back when i worked step-down we had a patient go into a fast SVT...i rush to the room to check things out and help if needed (was another nurses patient). This poor little old lady was diaphoretic, short of breath, having chest pain, and just in general looking very sick. The nurse caring for the patient was standing over her, attempting to have the patient valsalva... conversation went like this:


    nurse:.."...bear down like you're pooping!.."

    Patient: "..i cant breath.."

    nurse "...push down like you're pooping!!.."

    p: "..what?...i cant breath?'..

    n: "...poop!!.."

    p: "...poop??....i need help!...i cant make it to the bathroom.."

    n: "..no, if you poop the bed it's OK!...just bear down like you're pooping!!..c'mon, you can do it!!...."

    p: "..call my doctor!...you're crazy.."

    At this point, the patient's diaphoretic because of her condition, the nurse was diaphoretic because her patient's crashing, and i was diaphoretic because i was having difficulty containing my laughter.
    What an absurd situation/conversation...
    nurse was too worked up to explain herself, pt too sick to understand anything...

    Now, i understand the potential benefits of the valsalva...but this incident tickles me to no end...
    jnurse13 likes this.
  9. 0
    Quote from Dinith88
    ...Back when i worked step-down we had a patient go into a fast SVT...i rush to the room to check things out and help if needed (was another nurses patient). This poor little old lady was diaphoretic, short of breath, having chest pain, and just in general looking very sick. The nurse caring for the patient was standing over her, attempting to have the patient valsalva... conversation went like this:


    nurse:.."...bear down like you're pooping!.."

    Patient: "..i cant breath.."

    nurse "...push down like you're pooping!!.."

    p: "..what?...i cant breath?'..

    n: "...poop!!.."

    p: "...poop??....i need help!...i cant make it to the bathroom.."

    n: "..no, if you poop the bed it's OK!...just bear down like you're pooping!!..c'mon, you can do it!!...."

    p: "..call my doctor!...you're crazy.."

    At this point, the patient's diaphoretic because of her condition, the nurse was diaphoretic because her patient's crashing, and i was diaphoretic because i was having difficulty containing my laughter.
    What an absurd situation/conversation...
    nurse was too worked up to explain herself, pt too sick to understand anything...

    Now, i understand the potential benefits of the valsalva...but this incident tickles me to no end...

    Lololol!
    I can just picture this happening! Too funny, but frustrating, too!
  10. 0
    Quote from Dinith88
    nurse:.."...bear down like you're pooping!.."

    Patient: "..i cant breath.."

    nurse "...push down like you're pooping!!.."

    p: "..what?...i cant breath?'..

    n: "...poop!!.."

    p: "...poop??....i need help!...i cant make it to the bathroom.."

    n: "..no, if you poop the bed it's OK!...just bear down like you're pooping!!..c'mon, you can do it!!...."

    p: "..call my doctor!...you're crazy.."
    that is
    hhhhhhhhhhhhhhiiiiiiiiillllllllarrrrrious!!!!!!!!

    Although with symptomatic SVT ie C/P Go to the NTG SL, 02, MS the big three attack
  11. 0
    Quote from CCU NRS
    that is
    hhhhhhhhhhhhhhiiiiiiiiillllllllarrrrrious!!!!!!!!

    Although with symptomatic SVT ie C/P Go to the NTG SL, 02, MS the big three attack

    As a general rule I wouldn't agree with that approach. There are cases, of course, where pain and/or anxiety cause tachycardias; in those cases treating the pain will treat the tachycardia.

    In the case of a known/identified P/SVT, however, the chest pain or other clinical deterioration is the result of the rapid rate; that is, converting the rhythm/slowing the rate will resolve the symptoms.

    Therefore, if the patient with PSVT and symptoms did not respond to the vagal manuvers/O2/carotid massage and the patient was relatively hemodynamically stable, there may be time for a trial of adenocard; otherwise (ie the nurse has determined the patient to have an unstable tachycardia) PSVT responds quite well to cardioversion. (PSVT and A-Flutter often respond to lower energy levels.)

    PSVT although possible is relatively uncommon in the presence of MI; in such cases your approach might be considered although even then cardioversion would be useful.
  12. 0
    Hey Dinith that patient was at our hospital too!?!?

    Think everyone's seen her at their's also.

    Funny story!


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