SVT on "Greys Anatomy"

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Specializes in emergency.

Apologies if this has been posted before, but I couldn't find any posts on this in my quick search. Australia is only about 1/2 way through season 3 of Greys, and in the episode just shown, Ellis Grey goes into SVT and she tells Christina to massage her carotid artery instead of getting drugs.

?????????????

Sorry if I sound really stupid, but I have never heard of this before. Would someone actually do this in hospital? I just assumed you would go straight for drugs like adenosine.

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It is called a "vagal" maneuver. There are several different ways to do this, and it will cause drop in blood pressure and pulse. Cold water to the face, bearing down like trying to move bowels (that is why it is important not to allow cardiac patients to become constipated). Short answer: Yes, it exists.

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working in the PACU i had a few pts who had SVT, and i was told to have the pt bear down while in bed as tho they were making a BM, it did slow the HR for a few secs but went right back up, so never officially broke it.

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Specializes in CMSRN.

I had a peer in nursing school who had this during clinical. She had to go to a cardiologist before she was allowed to return. The previous steps is exactly what the doc told her to do if it happened again. (the SVT's were infrequent and she was healthly otherwise, doc did not want to put her on meds)

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Specializes in Medical and general practice now LTC.

have seen carotid massage a couple of times in the UK but ended up giving IV drugs as the massage never worked

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Specializes in LTC , SDC and MDS certified (3.0).

As someone with wpw the doctors have tryed carotid massage many times but in the end adosine 12 was the answer for me. the bucket of ice water NeVER worked either (imagine being a kid and you dad and uncle holding you upside down over a bucket of ice water) when giving adosine please tell the pt what to expect nobody told me and I thought I was dying..

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Specializes in Adult and Pediatric Vascular Access, Paramedic.

If it is an UNSTABLSE SVT (ie. they are hypotensive, in CHF, or have a decreased level of consicousness) one should use syncronized cardioversion.

If they are stable then the initial action should be a valsalva meneuver which is when the patient pushes with a closed glottic opening, basically you tell them to push like they are having a BM. I will usually try this while getting a line in to save time... many patients with history of SVT are told to try this at home before going to the hospital.

Cartotid massage should not be done because you can loosen plack present in the carotid and this could result in a CVA. Some doctors will still do it on younger patients with no known history of vascular disease. I am a paramedic and would not do that on anyone, its to risky.

If vasalva fails to convert the SVT (I have not yet seen it work in the feild) Adenosine 6 mg very rapid IV push.

Remember if it is a-fib or a-flutter neither vasalva or Adenosine will be effective, cardizem is the drug of choice for that.

For a-fib and a flutter the first line is Cardizem 0.25 mg/kg which will not convert it, but it will slow the ventricular rate. Cardizem will also convert other SVTs to sinus, but Adenosine is a safer choice.

Hope this helps

Swtooth

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Specializes in Developmental Disabilities, LTC.

This was one of the first thing I ever saw on tv (on a tv "medical" show) where I was like, "Hey! I know what they're talking about! We just studied that in school!"

:offtopic:, but I just graduated school a few weeks ago, I sit here every day with this huge mound of ATI DVDs that actually feature a woman (teacher) who will deliver you a lecture on just about any nursing topic you can think of. It's a cool idea, but dreadfully boring and I actually thought to myself the other day, "How cool would NCLEX prep DVDs be that somehow incorporated a hit tv show (like Grey's Anatomy)?"

Wouldn't that be awesome? Cuz, seriously, there's a lot of stuff I remember from ER & Grey's & Scrubs - it would be cool if they had, like, Scrubs: NCLEX Edition. Just a thought...

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This was one of the first thing I ever saw on tv (on a tv "medical" show) where I was like, "Hey! I know what they're talking about! We just studied that in school!"

:offtopic:, but I just graduated school a few weeks ago, I sit here every day with this huge mound of ATI DVDs that actually feature a woman (teacher) who will deliver you a lecture on just about any nursing topic you can think of. It's a cool idea, but dreadfully boring and I actually thought to myself the other day, "How cool would NCLEX prep DVDs be that somehow incorporated a hit tv show (like Grey's Anatomy)?"

Wouldn't that be awesome? Cuz, seriously, there's a lot of stuff I remember from ER & Grey's & Scrubs - it would be cool if they had, like, Scrubs: NCLEX Edition. Just a thought...

There's a video on Youtube called "Wenkebach", to the tune of Justin Timberlake's Sexyback. It's done by a bunch of med students in Canada. It's hilarious, and I will forever remember the rhythm and that it's the same as Mobitz 1. If only all reviews were this fun!

Oldiebutgoodie

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Specializes in Nurse Scientist-Research.

Didn't ACLS used to have "vagal" maneuvers in there are an appropriate intervention for SVT? It probably isn't anymore as they like to change those protocols all the time and it's been about 6 yrs since I renewed.

Now that I'm in NICU I can tell ya'll that ice pack to the face is the 1st intervention attempted for SVT in neonates (generally in the presence of a Physician or Neo-NP). It is often effective. It was taught to one of our parents as a technique to be used at home with her infant as an alternative to taking her infant to the Children's ER.

I saw a cardiologist perform this on a patient undergoing cardiac catheterization. The SVT was thought to be caused by irritation from the catheter and didn't respond to the patient bearing down but did break immediately when the MD massaged her carotid.

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Specializes in ICU, M/S, Hospice.
, "How cool would NCLEX prep DVDs be that somehow incorporated a hit tv show (like Grey's Anatomy)?"

Wouldn't that be awesome? Cuz, seriously, there's a lot of stuff I remember from ER & Grey's & Scrubs - it would be cool if they had, like, Scrubs: NCLEX Edition. Just a thought...

That would be very funny! :lol2:

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Specializes in ER/Trauma.

You massage the carotids to help stimulate the "Carotid baroreceptors" to induce a "baroreflex" ...

... which is carried along by the Glossopharyngeal Nerve (CN-IX) to the NTS...

... which inhibits the Vaso Motor Center (VMC) ...

... which in turn increases parasympathetic tone ...

... which leads to resultant parasympathetic activity in the system (i.e. decreased cardiac output, decreased HR, contractility etc.)

I've seen everyone from ER docs to our Hospitalists use the maneuver - just be careful to not massage BOTH caroticds at the same time. The really careful ones will auscultate for a bruit before they massage the site (hopefully prevent a clot/plaque that maybe present from breaking away and causing a stroke).

cheers,

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