Episode Chapters
- January Introduction7:46C-Spine Clearance in the Obtunded10:51Zombie Month - Happy New Year!1:03LIN Sessions - THAM14:50Paper Chase 1 - A Better Valsalva6:04De-Escalating Agitation16:29Trauma Surgeons Gone Wild: When To Crack The Chest13:10Zombie Month - Zombie Insects2:40Trauma Surgeons Gone Wild: How To Crack The Chest27:44Paper Chase 2 - CT for Diaphragm Injury7:02Amiodarone Pulmonary Toxicity19:43Zombie Month - Is Your Cat Making You a Zombie?2:52Extensor Tendon Injury12:54Paper Chase 3 - HEART Gets Put To The Test5:41Pediatric Pearls - Pediatric Rheumatology20:34The UTI That Isn’tFree Chapter19:41Annals of Emergency Medicine - The Gas That Just Won’t Pass15:27Paper Chase 4 - Blood Clots and Cancer Screening6:23Cardiology Corner - Cardiogenic Shock19:41Zombies - Zombie Dancing4:47Paper Chase 5 - Pediatric Seizures and Brain Badness5:17Summary13:35EMRAP 2016 January Aussie Edition27:57EMRAP 2016 January Canadian Edition15:02EMRAP 2016 Janiver Résumé en Francais1h, 03mEMRAP 2016 Enero Resumen Español1h, 23m
Nurses Edition Commentary
Mizuho Spangler, DO
No me gusta!
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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.
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
James M., MD - January 7, 2016 5:20 AM
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. - January 7, 2016 12:25 PM
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 - January 18, 2016 2:32 AM
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. - January 25, 2016 5:35 AM
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. - January 29, 2016 6:36 PM
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. - January 31, 2016 5:10 AM
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. - April 8, 2016 10:29 AM
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.