SVT Let’s Modify What We Do! Results from the REVERT Trial
We did what we did when we knew what we knew. Now we know better, so let's do better. Two simple ways to improve minor to moderate symptomatic SVT conversion rates.
SVT Let’s Modify What We Do! Results from the REVERT Trial
Valsalva Maneuvers - Standard Valsalva Maneuvers, (Vagal Maneuver) Bearing Down, Blowing out the plunger on a 10 ml syringe, etc. have an overall conversion rate of 17%. Modified Valsalva Maneuvers are simple to do, FREE, and increase the conversion rate to 43%. Steps to perform the Modified Valsalva Maneuver. Have the patient attempt to blow out the plunger on a 10 ml syringe for 15 seconds in a seated position on the stretcher or floor. Immediately take the patient from a sitting position to a supine position. (This works best with two providers, one on each side.) Perform a passive leg raising, take the patient’s legs and elevate them past 45 degrees while they are supine. https://youtu.be/8DIRiOA_OsA
Single Syringe Adenosine vs. Traditional Two Syringe or 3-Way Stop Cock Method.
Using the traditional Adenosine delivery method, 18 GA, AC, or more proximal site (preferably the right AC, as the Right AC is 3-5 seconds quicker delivery to the AV Node), rapid push and immediate rapid 20 ml normal saline flush, the endothelial cells break down the adenosine rapidly, often before it is able to reach the AV Node. Single Dose Conversion Rate - 41%Three Dose Conversion Rate - 70%. Single Syringe Administration Method - Adenosine does not react with normal saline. First Dose - Draw up 6MG of Adenosine into a 20ml normal saline flush after expelling 2ml from the flush. Second Dose - Draw up 12MG of Adenosine into a 20ml normal saline flush after expelling 4ml from the flush. Push as hard and fast as possible. Single Dose Conversion Rate -73%, Three Dose Conversion Rate - 100%.