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Paper Chase 1 - A Better Valsalva

Sanjay Arora, MD and Mike Menchine, MD
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06:04
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Nurses Edition Commentary

Mizuho Spangler, DO
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EMRAP 2016 January Summary 874 KB - PDF

What if we told you there was a valsalva maneuver that was 3 times more effective than the one we usually do, would you be interested? Of course you would! By simply laying the patient supine and raising their legs, the authors of this study found a 3 fold increase in conversion to sinus rhythm.


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James M., MD -

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 del Castillo-Hegyi, M.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., Dr -

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., M.D. -

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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Cracking The Chest Full episode audio for MD edition 254:13 min - 354 MB - M4AEMRAP 2016 January Aussie Edition Australian 27:57 min - 38 MB - MP3EMRAP 2016 January Canadian Edition Canadian 15:02 min - 21 MB - MP3EMRAP 2016 Janiver Résumé en Francais Français 63:14 min - 87 MB - MP3EMRAP 2016 Enero Resumen Español Español 83:06 min - 114 MB - MP3EMRAP 2016 January Board Review Answers 120 KB - PDFEMRAP 2016 January Board Review Questions 422 KB - PDFEMRAP 2016 January MP3 314 MB - ZIPEMRAP 2016 January Summary 874 KB - PDF

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