Quality Review
Meet the Q&PS Team
MedicASK Answers
MedicASK Answers Full List
Patient Safety Incident Report
Loss or theft of controlled substances
MedicASK
Files
AIV Treatment of Tachydysrhythmia
Question# 950
As an AIV PCP, if I come across a patient in SVT that is hypotensive; can I fix the hypotension and then perform the valsalva maneuver or is the patient out of the protocol for good with the initial hypotension? Would this be a good chance to patch to ask for direction?
Answer:
Current evidence suggests that narrow complex tachycardias (NCTs), including SVT, rarely cause hemodynamic instability on their own. When a patient presents as unstable (hypotension, altered mental status, chest pain, or signs of shock), it is critical to determine whether the tachycardia is the cause of the instability or simply a response to another underlying condition like sepsis. If the patient is truly unstable due to the tachycardia, the recommended course of action is immediate synchronized cardioversion rather than vagal maneuvers. This may require rapid transport to the hospital or engagement of an ACP, as synchronized cardioversion is not within the PCP scope of practice.
While the initial presence of instability does not necessarily preclude the patient from the valsalva maneuver, the ALS PCS outlines that it is reserved for normotensive patients. As mentioned above, this is a rare presentation and a more fulsome assessment and history should be conducted. As you alluded to, this would also be a good opportunity to patch to OMC for further discussion on patient centered care.
While the initial presence of instability does not necessarily preclude the patient from the valsalva maneuver, the ALS PCS outlines that it is reserved for normotensive patients. As mentioned above, this is a rare presentation and a more fulsome assessment and history should be conducted. As you alluded to, this would also be a good opportunity to patch to OMC for further discussion on patient centered care.