Clinical Procedures - The Valsalva manoeuvre • This is forced expiration against a closed glottis. Increasing intrathoracic pressure stimulates baroreceptors in the aortic arch and results in increased vagal stimulation • This can be successful in 25-50% of cases. Procedure • Ask the patient to take a deep breath in and then 'bear down' as if they are trying to open their bowels (or for women, as if they are in labour) Some patients may struggle with this concept and so alternatively: • Give them a 10mL syringe and ask them to blow into the tip, in an attempt to expel the plunger. Showing off The technique is named after Antonio Maria Valsalva a 17th-century physician from Bologna, who was mainly interested in the workings of the ear. He first described the manoeuvre with regard to testing the patency of the Eustachian tubes. The Diving Reflex • This involves either submerging the face in ice cold water (not very practical or covering the face with a towel soaked in ice cold water. Carotid Sinus Massage • This is described separately (see topic). Eyeball Pressure •This is not recommended as a clinical procedure as it can be both painful and damaging. Do NOT perform.
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