If the modified valsalva works & then they revert back into an SVT, can I perform the modified valsalva again? Is it only 2 attempts or 2 per episode if safe and feasible to do so; being sure not to perform more than 2 on scene delaying transport?
This is a great question. Should your modified Valsalva be effective, then the patient reverts back into SVT, it would be reasonable to perform a second attempt. However, should the second trial maneuver fail, then transport to hospital would be pertinent for other management options.
If the patient converts back into an SVT after two successful trials of modified Valsalva maneuvers, there is a very high chance that they will once again convert back into SVT if a third trial is performed. As such, focus on safely transporting the patient to the ED where other pharmacological agents or treatments may be required to prevent the paroxysmal SVT.