Category Archives: Tachydysrhythmia

Question: If the Valsalva Maneuver is not a medically controlled act why would a PCP not be able to carry out this procedure for a symptomatic narrow complex, regular rhythm tachycardia that is symptomatic? PCP's are supposed to be able to identify sinus tachycardia, atrial fibrillation or atrial flutter which would be contraindicated and especially if no other immediate care is available. Why such be restricted to only ACP's, again especially if no other immediate care is available?

Question: This question may be a very rare situation but I have not been able to get an answer from any paramedics I have asked. As per the "Patching" section in the introduction of the ALS PCS the literature states "BHP cannot be reached despite reasonable attempts by the paramedic to establish contact, a paramedic may initiate the required treatment without the requisite online authorization if the patient is in severe distress and, in the paramedic’s opinion, the medical directive would otherwise apply". In a situation where a cardioversion is required and the unstable patient is still conscious, it is fairly common practice to ask for sedation and pain control (i.e. Morphine/Midazolam) along with orders for cardioversion. If multiple BH patches cannot be completed and in the paramedics opinion cardioversion is required for the unstable but conscious patient, are we able to administer sedation and pain control? I ask this because there is not a directive that directly deals with pain and sedation prior to delivering the cardioversion, but is common to ask for such direction.

Question: In reviewing literature addressing treatment and management of tachyarrhythmias, I've encountered several articles stating that lidocaine and amiodarone are contraindicated for treatment of Torsades de Pointes as they could prolong the QT interval and worsen the situation. However, our medical directives for ventricular tachycardia make no mention of this contraindication and make no distinction in the management of VT vs TdP. Recognizing that lidocaine as a Class I antiarrythmic would be worse for the patient than amiodarone (Class III) and that amiodarone is the preferred drug in our protocols for VTach, should we nonetheless be concerned with the use of either of these in managing TdP? Thanks for providing the forum in which to ask and share with colleagues.

Question: A recent study, published in the Lancet showed an alternative way of performing a Valsalva maneuver, that is much more effective.

It is described and shown in a video here:
http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(15)61485-4/abstract

Is it acceptable for us to perform this when a Valsalva is called for in our directives?

Question: We haven't heard much discussion on this topic lately, so could you please detail which vagal maneuvers we are able to perform?