Download 310 – Vagal Maneuvers - Nor

Nor-Cal EMS Policy & Procedure Manual
ALS PROTOCOLS MODULE
310 – Vagal Maneuvers
DEFINITION:
Vagal maneuvers increase parasympathetic tone and slow conduction through the AV node. Refer to
ACLS: Tachycardia protocol to see where vagal maneuvers are included in the PSVT regimen.
Not in AEMT Scope of Practice.
INDICATIONS:
1. Monitor shows Supraventricular Tachycardia or Atrial Flutter with Rapid Ventricular Response.
2. Patient must be conscious and able to cooperate with instructions.
RELATIVE CONTRAINDICATIONS:
1.
2.
3.
4.
5.
Extreme hypertension.
Hypotension.
Suspected acute myocardial infarction.
Patient complaint of chest pain.
Suspected increase intracranial pressure.
COMPLICATIONS OF VAGEL MANEUVERS:
1.
2.
3.
4.
Bradyarrhythmia.
Syncope and or seizures.
Stroke.
Increased systolic blood pressure.
TREATMENT:
1.
2.
3.
4.
5.
6.
7.
8.
ABC’s
Supplemental oxygen
Establish IV NS TKO.
Continuous Cardiac monitor. Determine arrhythmia. 12 lead EKG if available.
Vagal Maneuvers: various methods for blowing against a closed glottis.
All procedures should be performed until arrhythmia is terminated or for a maximum of 10 seconds.
Re-evaluate cardiac and hemodynamic status.
Other Vagal Manuevers: (MICN only)
a. Squatting.
b. Bearing down (as in attempting a bowel movement).
c. Facial immersion in ice water (contraindicated for anyone with atherosclerotic heart disease, or
over 40 years of age).
9. If patient becomes unstable, i.e. hypotensive, chest pain and/or altered level of consciousness
prepare to initiate synchronized cardioversion.
DOCUMENTATION:
1. Indications for use.
2. Patient’s response to procedure, (attach rhythm strips or 12 lead EKG).
3. Skills and medication usage form as indicated.
Originated: January 3, 2003
Last Revision: July 14, 2011
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