SVT on "Greys Anatomy"

[bluetack]

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.

[barbyann]

I have frequent bouts of SVT and have mastered the valsalva technique. It took me two years to figure it out but I can now bring myself to NSR in seconds. I practiced at work by putting on the pulse ox when I would go into SVT. I would watch my heart rate plummet if I filled my lungs to capacity and bore down. My coworkers were amazed to witness my skill. No more ED for me, tyvm. Adenosine bye bye.

I was told to never do carotid massage when alone. Besides it never worked when the MD did it anyway.

[TazziRN, RN]

when giving adosine please tell the pt what to expect nobody told me and I thought I was dying..

I can't stress this enough. Also make sure the pt and family know what they will see on the monitor if it's within their view. I once had an elderly woman brought in by her granddaughter. Neither the doc nor I thought to explain what they would see on the monitor. When the rate broke and there was a flatline the doc and I smiled. The granddaughter started crying because she thought her grandmother had just died and we weren't doing anything.

[Danish, MSN, APRN, NP]

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

Well, that helped me! :)

thanks

[bluetack, RN]

Thanks everyone for your replies!

[scrubsnhugsRN]

The Vagal manuver is still taught in the new ACLS. They want you to have the patient bear down, or blow through a straw bearinbg down....so it is still being taught.

[XB9S, BSN, MSN, EdD, RN, APN]

Carotid Sinus Massage is still in the 2005 international resuscitation guidelines for patients who are Not comprimised

In the absence of adverse features:

* Start with vagal manoeuvres. Carotid sinus massage or the Valsalva

manoeuvre will terminate up to a quarter of episodes of paroxysmal

SVT. Record an ECG (preferably multi-lead) during each manoeuvre.

If the rhythm is atrial flutter, slowing of the ventricular response will

often occur and reveal flutter waves.

if unstable

Tachycardias

If the patient is unstable and deteriorating, with signs and symptoms caused by the tachycardia (e.g. impaired conscious level, chest pain, heart failure, hypotension, or other signs of shock), attempt synchronised cardioversion immediately. In patients with otherwise normal hearts, serious signs and symptoms are uncommon if the ventricular rate is www.resus.org.uk

I am not sure if the guidelines differ slightly in the US

[EricJRN, MSN, RN]

To be honest, I'm not sure whether CSM is still on equal standing with other vagal maneuvers in the American Heart Association ACLS guidelines or not, but there is something that bothers me. When a source does mention CSM, they always caution to listen for carotid bruits.

How many of us, outside of maybe a classroom setting, actually incorporate carotid auscultation into our assessment routines?

If we're not routinely listening to normal carotids, how are we supposed to pick up a carotid bruit when the heart rate is blowing along at 200 bpm?

Just seems like high potential for a missed bruit and embolization of a carotid plaque.

[Atl_John]

Its funny I ran across this thread. We just a week ago had a 4 hour lecture on arrhythmias and what is done for various things. We talked about Valsava maneuvers and not doing Carotid massage for the very reasons in this forum. The prof. was telling us about how they were trying to do massage on this patient with SVT and he just couldn't get the hang of the Valsava maneuver. She told us that she told the patient to go Ahhhhhhhh, at which point she stuck a tounge depressor down his throat causing a nice gag reflex. It broke the SVT. Maybe you can try that on your next time instead of the bearing down, might not be getting enough of a reflex if they are too concentrated on their heart rate instead of bearing down.

[cardiacRN2006, ADN, RN]

My DH has bouts of PSVT as well. He used to get all freaked out, and panicky. We tried the traditional 'bear-down' method, ice on the face, I even heard that pressure on the eyes would help. Nothing helped.

What worked for us was having him hold his breath for as long as he could with a long inspiration and releasing his breath with a long, forced expiration, then going right back to holding his breath again. I had my steth at the bedside when this happend once, and it's amazing to hear him convert. From a loud, slappy sound to a very muffled sound for a few beats, and then on to normal. Very interesting.