ACLS review: Wide Complex Tachycardia (WCT) Part 4

Vagal maneuvers

·         Carotid sinus massage

·         Coughing

·         Valsalva maneuver

·         Ice water compress to the face

·         Blowing through a straw

Rationale

·         Depresses AV node and sinus node

·         Terminates AV nodal reenterant tachycardia

·         Clarifies rhythm

Valsalva Maneuver

·         Performed by the patient (patient must be conscious and cooperative)

·         Document the dysrhythmia before treating

·         Explain the procedure to the patient

·         Instruct the patient to inhale and hold their breath and:

·         Bear down as if to have a bowel movement, and to hold this position for 20-30 seconds.

Precautions for Carotid Sinus Massage

·         Avoid carotid massage in older adults

·         Never perform bilateral carotid massage

·         Listen for bruits before carotid massage- contraindicated if bruits are present

·         Should not be continued for more than 10 sec.

·         Patient should be on cardiac monitor

·         Should have IV access before attempting vagal maneuvers

Procedure for carotid sinus massage

·         Turn head to the left

·         Apply firm pressure over the right carotid bifurcation near the angle of the jaw

·         If unsuccessful, repeat with a 5- to 1- second rotary “massage motion”

·         If unsuccessful, turn the head to the right side and perform left carotid massage

Contraindications

·         Avoid in elderly

·         Carotid bruits

·         History of CVA

·         Recent MI or myocardial ischemia


Reviewed/ 2/28/16