Holding the breath and bearing down (Valsalva maneuver).
Have the patient take a deep breath in and hold it while trying to lift both legs up off the stretcher at the same time.
Gagging. Use a tongue depressor or culturette swab to briefly touch the posterior oropharynx.
Application of a cold stimulus to the face (e.g., a washcloth soaked in iced water, cold pack, or crushed ice mixed with water in a plastic bag or glove) for up to 10 seconds. This technique is often effective in infants and young children.
Blow forcefully through a straw (or IV catheter/similar device) for as long as possible (at least 20 seconds)
Carotid sinus pressure. This is a fairly dangerous maneuver and should not be done on patients with high cholesterol, previous strokes, or other significant risk factors for thrombus.
Abdominal pressure. Lay a patient supine and have them relax their abdomen. Place your hands near the umbilicus and apply firm pressure. Place your hands and take a stance similar to performing chest compressions. Warn the patient that you will place a lot of pressure as you slowly press into the abdomen. When you have a moderate degree of pressure, then ask the patient to lift you up or push you away with their stomach. They will tense their abdominal muscles and bear down as you are pushed away. Be prepared cause most are quite strong and you will actually want to put a lot of your weight on your hands as you encourage the patient to continue to push you up with their abdominal muscles.
Pressing on the suborbital area (inward just below the eyes.)
In all cases:
- Document the arrhythmia before treating
- Explain the procedure to the patient
- Turn the paper recorder on and leave on until the procedure is completed.
- perform procedure
- Monitor rhythm constantly throughout the procedure.
Patients should have continuous EKG monitoring and IV access. A 12-lead EKG is preferred prior to initiation.