Modified Valsalva Maneuver

43% vs 17% response compared to the standard valsalva maneuver

1) Position patient with legs flat and head of bed to 45°
2) Have patient attempt to blow out plunger of 10ml syringe (or Valsalva around 40 mmHg) for 15 seconds
3) Quickly reposition patient's head of bed to flat and have the other assistant raise legs to 45° for another 15 seconds
4) Return head of bed to 45° and continue to monitor for resolution for 1 minute
5) Repeat if needed

2 years ago we timidly registered this video: our first time trying the Modified Valsalva Maneuver, a bit improvised. The patient very generously gave consent and he is very excited with the positive repercussion. It was such a good day.

REVERT Trial: https://www.ncbi.nlm.nih.gov/m/pubmed/26314489/

Video by Dr. Jule Santos @julesantosER

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