Key result
Only 2.2% (1 of 46) of surveyed MICA Paramedics correctly identified all three criteria (posture, pressure, and duration) of an evidence-based model for performing the Valsalva manoeuvre.
Cross-Sectional (n=46)
No
Prehospital intensive care paramedics demonstrated poor knowledge of the evidence-based criteria for the Valsalva manoeuvre, indicating a need for standardized education to improve supraventricular tachycardia management.
Paramedic knowledge gaps in Valsalva criteria may hinder prehospital SVT care; leaves open the impact of targeted education on outcomes.
BACKGROUND: The Valsalva Manoeuvre (VM) is a primary measure for terminating haemodynamically stable supraventricular tachycardia (SVT) in the emergency care setting. The clinical use and termination success of the VM in the prehospital setting has not been investigated to date. The objective of this study was to determine Melbourne Mobile Intensive Care Ambulance (MICA) Paramedic knowledge of the VM, and to compare this understanding with an evidence-based model of VM performance. METHODS: A cross-sectional study in the form of a face-to-face interview was used to determine Melbourne MICA Paramedic understanding of VM instruction between January and February, 2008. The results were then compared with an evidence-based model of VM performance to ascertain compliance with the three criteria of position, pressure and duration. Ethics approval was granted. RESULTS: There were 28 participants (60.9%) who elected a form of supine posturing, some 23 participants (50%) selected the syringe method of pressure generation, with 16 participants (34.8%) selecting the "as long as you can" option for duration. On comparison, one out of 46 MICA Paramedics correctly identified the three evidence-based criteria. CONCLUSIONS: The formal education of Melbourne's MICA Paramedics would benefit from the introduction of an evidence based model of VM performance, which would impact positively on patient care and may improve reversion success in the prehospital setting. The results of this study also demonstrate that an opportunity exists to promote the evidence-based VM criteria across the primary emergency care field.
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Smith et al. (2009) conducted a cross-sectional in Knowledge of Valsalva Manoeuvre for supraventricular tachycardia (n=46). Knowledge of evidence-based Valsalva Manoeuvre criteria was evaluated on Correct identification of the three evidence-based criteria for Valsalva Manoeuvre performance (position, pressure, and duration). Only 2.2% (1 of 46) of surveyed MICA Paramedics correctly identified all three criteria (posture, pressure, and duration) of an evidence-based model for performing the Valsalva manoeuvre.
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