DrVirgo
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In which of the following arrhythmias do we perform Vagal Maneuvers to control the heart rate?
Pick all that apply:
A. SVT
B. A. Flutter
C. A. Fib
D. V Tach
E. V Fib
F. Asystole
G. Torsades
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| GOGETA
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 in usmle forum nd fisher said we diont use that anymore
But alll my life I heard we do it so is like confusing for me
I will gp with A fib
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| DrVirgo
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GOGETA wrote:in usmle forum nd fisher said we diont use that anymore
Where did he say that? HERE? in this forum? Do you know the thread?
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| GOGETA
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DrVirgo wrote:GOGETA wrote:in usmle forum nd fisher said we diont use that anymore Where did he say that? HERE? in this forum? Do you know the thread?
His video
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| DrVirgo
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What about for SVT?
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| arlete
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Yes, WE DO and it works! For SVT. What we don't do is ocular massage, because of the risk of retinal detachment. But carotid massage, for example... oh, yeah, you bet, baby! And sometimes Valsalva and imersing the face or hands in iced water are done by the patient himself at home, successfully.
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| DrVirgo
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Thanks arlete...
Do we use vagal maneuvers ONLY for SVT or for other arrhythmias as well?
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| arlete
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Only SVT.
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| usmletopper2
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carotid massage is no longer done ,as there is increased risk of embolic manifestations ,other manouvers can be done,isn't it what we have learnt in UW. am i right?
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| janan
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EVEN CAROTID MANEOURS ARE NOT DONE ANYMORE..they say it carries a potential risk of causing embolisation into the brain.Anyways, it's done for SVT...In case of Atrial Flutter with a two ratio one block, it's at times very difficult to differentiate from Mobitz Type two block. One way of differentiating them is to do vagal maneours which would accentuate the AV block and would cause prominence of the flutter waves and hence differentiates it.
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| Anand007
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oh ..i didnt know ocular massage is avoided cuz of risk of retinal detachment.. carotid massage -embolisation should b a problm only in an elderly patient..isnt dat so?
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| arlete
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Yes, the risk of embolisation exists in doing the carotid massage. But it's still being done. maybe not everybody knows it shouldn't be done anymore...  In a personal note, I've never seen any complications, and it does work fine for many patients. I'll know for sure during my next ACLS.
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| Vietnamese
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If tachycardiac presents 48 hours earlier ( I mean thrombosis not been made yet) , I chose
A
B
C
Valsava manerveur works for AV node ascendingly.
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| usmletopper2
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so if the pt is stable with AF/ A flutter do we answer drugs or carotid massage?
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| arlete
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Drugs. Carotid massage won't hold the AV node for long and the arrythmia is being generated in the atrium.
What carotid massage does for SVT with nodal re-entrance is to slow down the AV conduction, interrupting the "goes down, comes back up" circular motion of the eletric impulse inside the AV node and allowing the sinus rhythm to be restored. For a fib/a flutter, as soon as you stop the massage, the impulses will continue to pass through the AV node at a high velocity.
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| Vietnamese
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Thanks arlete.
Carotid massage works the best for SVT due to the only one re-entry spot inside AV node and modestly works for fib/flutter due to many re-entry spots in atria. However, objective here is for heat rate control, not sinal rhythm cardioversion.
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| DrVirgo
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Thanks arlete and everyone for the great discussion. 
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