Paper Chase 1 - A Better Valsalva

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06:04
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Nurses Edition Commentary

Mizuho Morrison, DO
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01:31

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James M. -

I tried the maneuver the next day after I watched the video in a stable 24 year old with SVT heart rate 230. After the maneuver, the heart rate dropped to 78 in about a minute. Really nice.

Michael d. -

Really like this series, but I was struck by the use of adenosine in SVT. I hate adenosine. I don't ever want to receive it. It makes most patients feel awful (a natural response to dying, even if it is just for a few seconds...). Why not just use diltiazem or a similar agent?

Susan T. -

I've used this method now on 3 patients, all successful, two patients took 3 attempts though. Both of these had been in SVT for hours - one was pre-op, the other a farmer who thought it would just get better! The 'trick' I found for both of these patients was to ensure they were appropriately hydrated - both reverted with the manoeuvre after a fluid bolus.

Sonja K. -

So I've done this valsalva method -- every time I get a blank/confused/you're crazy look when I do. But it works pretty well! Much better than the cases I did before.

David S. -

I did it for the first time today. Never really had valsalva work before but it only took once. The patient said she much preferred this over adenosine!

Ryan M. -

Listened to the episode on the way to a shift on 1 day, used it the next. I also got some blank stares, specifically from nursing. But when it worked, they wouldn't stop talking about it. It's only the second valsalva I've had work.

Marc K. -

Tried it for the first time on a stable 30 something year old with SVT and a HR of 190. It worked great on the first time. When he converted there was the same brief pause and ventricular ectopy that I see with adenosine before he went into sinus rhythm. Definitely will be my go to from now on.

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