Everybody in the FOAM world probably has already seen these two ideas, but I wanted a spot here to be able to find them on my own site so, SVT…
Revert-Style Vagal Maneuver
Have patient exhale into a 10ml Syringe with a force sufficient to move the plunger for 15 seconds followed by placing the patient supine and holding up their legs for 15 seconds (Lancet 2015;386(10005):1747). They repeated the maneuver x 1 if not initially successful. They more than doubled the success rate of the vagal maneuver using this addition.
- See the excellent RebelEM Post for more info
I've tried the REVERT technique twice now, both times with success–how do you like that for evidence?
Adenosine without the Annoyance of the 3-Way Stopcock
Bryan Hayes, an extraordinary ED Pharmacist, taught me how to get rid of the stopcock ridiculousness when administering adenosine. Just draw the adenosine into a 20 ml syringe filled with saline. Then just rapidly push that bad boy. So simple, so smart!
Now as to whether you should be giving adenosine, given the patient's misery at the induction of death (albeit just for a few seconds), is an entirely different question.