3 Steps to Making the Valsalva Maneuver Effective.

Ask just about anyone what they think about the Valsalva Maneuver, and they will all probably tell you just about the same thing; “It works, sometimes”.  Here are 3 easy steps you can take to double your chances of success when using this infrequently successful technique.

Valsalva Maneuver + Passive Leg Raise

  1.   With the patient sitting upright on the bed or stretcher, instruct him or her to perform the Valsalva Maneuver for 15 seconds. (I would recommend asking them to try to blow the plunger out of a 3cc or 5cc syringe)
  2.   As soon as your patient finishes step 1, lie the head of the bed or stretcher back so that the patient is lying flat.
  3.   Immediately after completing step 2, raise the patient’s legs to 45 degrees and hold.

This technique was proven to more than double the effectiveness of the standard Valsalva maneuver in the REVERT study, which you can read the full article here.

Below is a video that illustrates the technique.

This study was released a little over a year ago, so it is not really new.  I figured that it would be worthwhile, though, for those who hadn’t heard about it.

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Appelboam A, Reuben A, Mann C, Gagg J, Ewings P, Barton A, Lobban T, Dayer M, Vickery J, Benger J. Postural modification to the standard Valsalva manoeuvre for emergency treatment of supraventricular tachycardias (REVERT): a randomised controlled trial. The Lancet. 2015;386(10005):1747–1753.

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