Carotid Massage - very cool!

[Sadie04]

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.

[rstewart]

well if the Pt is symptomatic you should treat the symptoms shouldn't you

If you have determined the problem to be PSVT you want to do something about the rate; resolving the rate problem will resolve the symptoms.

It's much the same as the hypotension which can occur with PSVT due to inadequate filling associated with the high rate: you wouldn't start dopamine to address the hypotension as you might in some other circumstances. Once you slow the heart down, the hypotention will resolve.

MONA can certainly be helpful in the context of general treatment of ischemic chest pain and at first that may be all you have to go on------but once you know the problem is P/SVT, efforts should be directed toward reducing the rate.

While ACLS algorithms are clear cut, determining the primary mechanism of a patient's distress may not be. Similarly, making the determination that a patient should be considered unstable requires clinical judgement at times. (When I teach ACLS for convenience I'll say that a "fluttering" feeling in the chest is stable and anything more serious than that will be considered unstable-----but in the real world things are not so black and white.)

[leslie :-D]

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.

isn't the valsalva maneuver the same thing as bearing down trying to have a bm?

[CCU NRS]

isn't the valsalva maneuver the same thing as bearing down trying to have a bm?

It has come to be called one and the same but in Tabers the actual method of Valsalva is: Attempt to forcibly exhale with the glottis, nose and mouth closed.

It is basically what has evolved but no one ever closes off the nose and you get the same result i would say. I just hadn't noticed anyone suggesting it prior to my mentioning it.

edited to correct late night spelling and speed typing errors LOL