Standards Procedure (Skill)
Clinical Indications: Level: EMT-P only
Ø Treatment of supraventricular tachycardic dysrhythmias.
Procedure:
a. Oxygen, ECG monitoring, and IV therapy must be established before performing carotid sinus massage. Emergency medications and equipment should be immediately available.
b. Record the ECG rhythm continuously while performing all vagal maneuvers.
c. Try Valsalva’s maneuver first if the patient is able to cooperate.
d. Gently palpate both carotid arteries separately to assess the quality of the carotid pulses. Auscultate both carotid arteries for the presence of bruits. If the pulses are grossly unequal, consult with medical control before performing the procedure. If a bruit is detected, use the opposite artery (if bruit free) for this procedure.
e. Locate the carotid pulse near the angle of the jaw using the flat side or your two fingers and press firmly against the carotid artery toward the cervical vertebrae.
f. Massage the area using a circular or vertical motion until the heart rate starts to slow or for a maximum of 1-2 minutes. Never massage both carotid arteries at the same time.
g. Continuously monitor the ECG rhythm visually.
h. If unsuccessful, administer an appropriate pharmacological agent, and if necessary repeat carotid sinus massage on the same side.
i. The maximum number of attempts is three using the same side only.
j. Document procedure and patient responses on the ACR.
Certification Requirements:
Successfully complete an annual skill evaluation including the indications, contraindications, technique, and possible complications of the procedure.