Podcasts about Valsalva maneuver

It's that time of year, the weather is cold and major snowstorms are occurring, and while beautiful to watch, they can turn deadly. Driving becomes hazardous. Frostbite is a very real risk. Skiing and snowboarding accidents can ruin a family vacation, and worse, cause a fatality. But our primary discussion this week is about the dangers of shoveling snow with a history of heart disease or prior heart attack. Learn what the Valsalva Maneuver is and how it can affect you.In this Episode:03:04 - Recipe: Texas Trash Pie03:55 - Celebrities Who Died Without a Will06:46 - Have a Will, and Make Sure It Can Be Found08:21 - How to Stay Safe in the Snow12:09 - Shoveling Snow: Valsalva Maneuver and Who is At Risk for Heart Attack24:24 - Film Review and Discussion: His Three Daughters39:24 - OutroSupport the showGet show notes and resources at our website: every1dies.org. Facebook | Instagram | YouTube | mail@every1dies.org

Dr. Rachel Moore // #ICEPelvic // www.ptonice.com  In today's episode of the PT on ICE Daily Show, #ICEPelvic faculty member Rachel Moore takes a deep dive into the Valsalva Maneuver from 3 different lenses: the scholarly research, the pregnancy & postpartum patient, and the strength & conditioning world. Take a listen to learn how to better serve this population of patients & athletes. If you're looking to learn more about our live pregnancy and postpartum physical therapy courses or our online physical therapy courses, check our entire list of continuing education courses for physical therapy including our physical therapy certifications by checking out our website. Don't forget about all of our FREE eBooks, prebuilt workshops, free CEUs, and other physical therapy continuing education on our Resources tab. Are you looking for more information on how to keep lifting weights while pregnant? Check out the ICE Pelvic bi-weekly newsletter! EPISODE TRANSCRIPTION00:00 - RACHEL MOORE Good morning PT on ice daily show. My name is dr. Rachel Moore. I am here with Representing the ice pelvic division. I'm on faculty with ice pelvic division. Whoo. Sorry. I need to drink my coffee um i just got back in last night super late night flying from a course this weekend our pelvic live course in um wisconsin it was so much fun we got to see some leaves change which is exciting for me because in houston we don't really have that happen um so really awesome super great weekend awesome and engaged group that we had. If you are looking to join us on the road to catch our live course, our live pelvic course, there are still so many opportunities this year. In that course, we are doing so many things. We are talking about pelvic floor considerations. We're talking about the internal assessment and actually going over and practicing it on your back and in standing. We're talking about pelvic girdle pain which is such a huge topic in the pregnancy and postpartum and just pelvic world in general and then day two we're diving into the actual fitness side of things where we're doing squats and we're learning how to brace and we're using weightlifting belts and we're getting up on the rig and doing gymnastics moves it is a blast every time I come home from a course I'm hyped and there are four more chances of in 2023 to catch this course on the road. So October 21st, we've got a course in Corvallis, Oregon. November 4th, we've got one coming up in Bozeman, Montana. November 18th, we've got one coming up in Bear, Delaware. And then December 2nd, we've got one in Nova Scotia, Canada. So tons of opportunities to catch this course live on the road. Our online course will pick up again in January. So if you're interested in joining us in the ice pelvic division, that's what we got coming up. 02:08 - THE HISTORY OF VALSALVA This morning we are here to talk about Valsalva. So the word Valsalva is kind of a term that nobody really knows what it means or everybody thinks they know what it means and they all have their own separate camps of what it could mean because it's described so many different ways in the literature. So what we're going to do this morning is clarify what the different definitions of this one word are, talk about the history of it a little bit more, where this term really even came from in the first place. So this topic is really near and dear to my heart. Recently, Christina Prevett and I recently just wrote a clinical commentary on Valsalva and on the nuances of Valsalva. and how as clinicians we can take this term and how we need to take this term and understand the lens, especially when we're looking at research, but when we're talking to patients about what this term even means and what we're actually looking for in our strength training fitness world when we say the word Valsalva. So let's kick it off with the history of Valsalva. The term Valsalva is actually named after a physician from the 18th century. So he was an otolaryngologist. Anyway, he worked in ears and throat, ear, nose and throat doctor. And he created this maneuver essentially as a way to push infection out of the ears. So, the maneuver that Dr. Valsalva described actually doesn't even look like the Valsalva that a lot of people talk about today. His maneuver was plugging your nose and blowing out, but not against a closed glottis. And when he created this maneuver, the purpose of it was to flush infection out of the ear by having that tympanic membrane push outwards to, in theory, push pus out of the ear. That is where this term was created. So when we look at Valsalva in the research lens, when we talk about diving into the specifics of research on this topic, if we're looking in the ENT world, autolaryngological world, we're thinking about this maneuver as a plugged nose, closed glottis, now push out in order to push that tympanic membrane out. When we're looking at this word in the urogynecologic world, it has a very different emphasis or purpose. So when we think about pelvic organ prolapse and the diagnosis of pelvic organ prolapse, that's where we see the Valsalva, quote unquote, being useful, I would say. So the Valsalva in a urogynecologic world is an intentional bear down and strain with a closed glottis. in order to measure the descent of the pelvic organs, particularly during that POPQ or that assessment for pelvic organ prolapse. So on the ENT side, we have the focus of plugging nose, blowing out, pushing tympanic membranes out. In the urogynecologic world, we've got this strain down through the pelvic floor in order to descend the pelvic organs and measure what that descent is. 06:04 - VALSALVA IN STRENGTH TRAINING In the strength and conditioning world, the term Valsalva means something completely different. In the strength and conditioning world, the Valsalva is a maneuver that is advantageous, particularly if you're a competing athlete in the strength training world, where we need a little bit extra spinal stiffness in order to hit a lift to PR. so in the strength training world this is an inhale into the belly and then a brace of those core muscles that anterior abdominal wall and all of those muscles within the core in general in order to increase that intra-abdominal pressure and spinal stiffness to be able to lift heavier. So when we do the Valsalva, we have a 10% increase in that spinal stiffness and that carries over or translates into pounds on the barbell. So when we're again thinking about our competitive athletes who are maybe trying to like edge somebody out, the Valsalva is an incredibly useful and productive maneuver. Even if we're not a competing athlete, if we're talking about just getting stronger and we're pushing ourselves to the capacity that we want to push ourselves to in order to make those strength gains, the Valsalva is likely utilized in order to increase that capacity to lift heavier. The confusion here comes from that one word having many different definitions. And when we look at the urogynecologic world versus the strength training world, they really are truly opposite. When we're thinking about straining and bearing down, we're pushing down with our abdominal wall muscles, we're pushing down with our pelvic floor, and we expect to see that descent. I 100% agree that we shouldn't put a heavy barbell on our back and then strain and push down through our pelvic floor. That is not beneficial and it is going to put a lot of strain through the pelvic floor. Absolutely. However, when we talk about Valsalva in a strength training capacity, that's not what the Valsalva is. The Valsalva in a strength and conditioning world is that intentional inhale into the belly and brace of that anterior abdominal wall muscles. When we do that brace of those anterior abdominal wall muscles, we don't want to see a descent of the pelvic floor. That would be an improper brace that would need training to improve that coordination. What we expect to see with a valsalva in the pelvic floor world is a matched degree of contraction for the demand that's placed on that system. So if we're thinking about somebody who's lifting a heavy lift, a one rep max, We expect that pelvic floor to kick on, but we're not necessarily volitionally thinking about lifting pelvic floor and doing that pelvic floor contraction. As that core canister is engaged and we engage that proper brace, the entire core canister should kick on to a relatively equal degree. So in the strength and conditioning world, that Valsalva is advantageous. In the urogynecologic world, if we're taking that concept and applying it to lifting, it is the opposite of advantageous. So when we're looking at recommendations for our strength training athletes and our patients, we need to understand the language that is being used and what the definition of that language is. So from the standpoint of our OBs who are telling our patients, don't ever do a Valsalva, in their mind, they're saying, don't ever strain and push your pelvic floor down when you're lifting. Totally. We agree. 100%. Don't do that. It's not going to be great. But the disconnect is that this one word has so many different definitions. So we really have to dive in and break down what was that recommendation specifically. So when we're with our patients, that looks like breaking down the definition for them. 09:01 - VALSALVA MANUVEUR IN THE LITERATURE But if we're looking in the research world and we're trying to read literature, read the newest evidence about what recommendations are for our pregnant and postpartum athletes, we need to go into the article itself and look at how they define Valsalva. Because we can easily read the abstract and the conclusion of an article that says Valsalva is not recommended, but if we're, looking at this article and it's actually meaning the bearing down, then we're not getting, we're not able to extrapolate that to the strength and conditioning side. So really with this term, it's one word named after a man who the original maneuver isn't even what we're talking about anymore anyway. Across the board, we have to either figure out different words or different ways to describe this, or it really falls on us as providers to break down what it is we're talking about. So rather than just telling your patients, do a Valsalva, maybe we don't use that language at all, and we just talk about bracing. When we do a brace, we can manipulate breath. If we're gonna take that intentional inhale and then brace, that is a Valsalva, But in order to eliminate the confusion across the board, we can just call it a brace. This makes a lot more sense to patients than being told by one person to never valsalva and then by another person to valsalva. And when we lay it all out and explain what all of these differences are and how it's all one term, but it has different meanings, and none of these meanings necessarily are the same. And in fact, in the urogynecologic world, in the strength and conditioning world, they're literally the opposite. It starts to click with patients, why it's okay that my physician told me not to do this Valsalva, but you're telling me that I can, because I understand that these are two very different physiologic mechanisms. Our clinical commentary over this that dives into all of this and so much more comes out in the spring. So keep an eye out. We'll be sending it out in the ice pelvic newsletter. So if you are not signed up for that newsletter, head to PT on ice.com, go to the resources tab, sign up for that newsletter, not only for our clinical commentary in the spring, but for all kinds of resources. in the pelvic floor world. Stay up to date on the newest evidence and also just check out some cool stuff that we find along the way. I hope you guys have an awesome Monday and I hope we see you on the road soon. OUTRO Hey, thanks for tuning in to the PT on Ice daily show. If you enjoyed this content, head on over to iTunes and leave us a review and be sure to check us out on Facebook and Instagram at the Institute of Clinical Excellence. If you're interested in getting plugged into more ice content on a weekly basis while earning CEUs from home, check out our virtual ice online mentorship program at ptonice.com. While you're there, sign up for our Hump Day Hustling newsletter for a free email every Wednesday morning with our top five research articles and social media posts that we think are worth reading. Head over to ptonice.com and scroll to the bottom of the page to sign up.

- Siga no Instagram: @fabiodominski Gostou do podcast? Você vai gostar mais ainda desse livro! - Livro Exercício Físico e Ciência: Fatos e mitos de Fábio Dominski https://www.amazon.com.br/dp/6586363187?ref=myi_title_dp Fonte: Hackett, Daniel A.; Chow, Chin-Moi. The Valsalva Maneuver: Its Effect on Intra-abdominal Pressure and Safety Issues During Resistance Exercise. Journal of Strength and Conditioning Research 27(8):p 2338-2345, August 2013.   Benet, N., Kumar, V., Sharma, M. et al. Effect of Valsalva Maneuver by Heavy Weight Lifters on Ear and Its Attributes. Indian J Otolaryngol Head Neck Surg 75 (Suppl 1), 535–540 (2023). --- Support this podcast: https://podcasters.spotify.com/pod/show/fabiodominski/support

Pelvic organ prolapse is a dysfunction of the human body that is experienced by men and women. Yes, you read that right, men too. So it's important to understand the symptoms, causes, and treatment options so you're not left wondering: “Can I powerlift with a prolapse?” or “Do I need surgery if I have a prolapse?”   Vaginal and rectal prolapse are sensitive topics for most people. In fact, this often leads people to suffer in silence, lose enjoyment for life, and even stop barbell training or competing in powerlifting. However, there are ways to non-surgically address prolapse and continue to barbell train.    When belts are worn correctly, the Valsalva Maneuver is executed appropriately, and training volume, intensity, and technique are monitored and adjusted systematically, you can train without experiencing or worsening prolapse.     In this episode of the PRS Podcast Dr. Breanne Maruca, PT, PRSCC, CLT, WCS and Dr. Rori Alter, PT, PRSCC, SSC bring awareness to pelvic organ prolapse by discussing: Types of prolapse that men and women experience Symptoms of vaginal and rectal prolapse Their personal experiences with both A docked boat analogy for the pelvic floor muscles, organs, and ligaments Various treatment options for pelvic organ prolapse Pessary Surgery Medication   Resources Mentioned in this Episode: #48 - Functional Anatomy of the Core & Pelvic Floor in Barbell Training with Dr. Breanne Maruca, PT, PRSCC, CLT, WCS #38 - The Valsalva Maneuver Explained | How to Breathe While Lifting #8 - Peeing & Powerlifting - The Truth About Powerlifting Specific Urinary Incontinence Causes & Management   Need help with your pelvic floor issue? Book a free consultation with PRS Clinical Coach Dr. Breanne HERE!   If you're enjoying our podcast, please leave us a review on Apple or Spotify.   Join our Facebook Community for free form checks, live Q&As & more: https://www.facebook.com/groups/PRS.Barbell.Mastery    Got questions or guests you'd like to hear on the show? Submit them here: https://forms.gle/7Vu2HmgHoeQY9xM59    Get in touch with the show! Web: https://www.progressiverehabandstrength.com Email: podcast@progressiverehabandstrength.com Rori IG: @rorimegan_prs Alyssa IG: @alyssahope_prs Bre IG: @breannejulia_prs  

People commonly breathe incorrectly when bench pressing and it can affect their pelvic floor. The proper way to breathe when you bench press is to perform the Valsalva Maneuver. But even still, people execute the Valsalva Maneuver improperly while bench pressing. Breathing correctly while benching is important for injury prevention and optimal strength.   When observing bench press technique, if you see the lower abdomen protruding out while the bar is moving down, up, or upon contacting the chest or upon executing the Valsalva Maneuver, this is an indication that the lifter is not performing the Valsalva Maneuver or breathing correctly while benching. Particularly in females, this pattern may indicate some weakness in the core or pelvic floor.    In this less-than-ten-minute episode of the PRS Podcast, Clinical Coach Dr. Rori Alter, PT shares a tip for identifying a lifter's incorrect breathing pattern when benching and how to correct it to improve performance, prevent injuries, and protect the pelvic floor while bench pressing.    Resources: How to Barbell Bench Press (Youtube) Barbell Bench Press | How to (coach the) Bench in 10 Minutes (10 Minute Tip Podcast)     If you're enjoying our podcast, please leave us a review on Apple or Spotify.   Join our Facebook Community for free form checks, live Q&As & more: https://www.facebook.com/groups/PRS.Barbell.Mastery    Got questions or guests you'd like to hear on the show? Submit them here: https://forms.gle/7Vu2HmgHoeQY9xM59    Get in touch with the show! Web: https://www.progressiverehabandstrength.com Email: podcast@progressiverehabandstrength.com Rori IG: @rorimegan_prs Alyssa IG: @alyssahope_prs

If you're following a strength training or powerlifting program utilizing progressive overload, you'll eventually need a lifting belt. When worn and used properly and combined with the Valsalva Maneuver, a lifting belt is a positive addition to your strength training program.   The problem is, there is a lot of misinformation out there about belts. A proper lifting belt is made of a stiff material and applies pressure to the abdomen to enhance your body's ability to utilize the Valsalva Maneuver to create intra-abdominal pressure to indirectly stabilize the spine.   Here are some common beliefs about the utilization of powerlifting or lifting belts that we do not agree with: You should push your belly into your belt Lifting belts make your core weak Lifting belts are a crutch  You should only train without a lifting belt otherwise your abdominals shut off   In this 10-Minute Tip episode of the PRS Podcast, Drs. John Petrizzo, Rori Alter, and Alyssa Haveson discuss: The proper mechanism by which a lifting belt is combined with the Valsalva Maneuver to improve and enhance your strength development and safety under the barbell How your core muscles actually work with the belt and why you shouldn't push your belly into your lifting belt The way in which belts actually work to strengthen your core instead of making your core weak And how to tell if your belt is too loose because if it's too loose, it's not working properly!     If you're enjoying our podcast, please leave us a review on Apple or Spotify.   Join our Facebook Community for free form checks, live Q&As & more: https://www.facebook.com/groups/PRS.Barbell.Mastery    Got questions or guests you'd like to hear on the show? Submit them here: https://forms.gle/7Vu2HmgHoeQY9xM59    Get in touch with the show! Web: https://www.progressiverehabandstrength.com Email: podcast@progressiverehabandstrength.com Rori IG: @rorimegan_prs Alyssa IG: @alyssahope_prs

    If you're enjoying our podcast, please leave us a review on Apple or Spotify.   Join our Facebook Community for free form checks, live Q&As & more: https://www.facebook.com/groups/PRS.Barbell.Mastery    Got questions or guests you'd like to hear on the show? Submit them here: https://forms.gle/7Vu2HmgHoeQY9xM59    Get in touch with the show! Web: https://www.progressiverehabandstrength.com Email: podcast@progressiverehabandstrength.com Rori IG: @rorimegan_prs Alyssa IG: @alyssahope_prs

People commonly breathe incorrectly when bench pressing. The proper way to breathe when you bench press is to perform the Valsalva Maneuver. But even still, people execute the Valsalva Maneuver improperly while bench pressing. Breathing correctly while benching is important for injury prevention and optimal strength.   When observing bench press technique, if you see the inhalation and exhalation occur while the bar is moving up and down, this is an indication that the lifter is not performing the Valsalva Maneuver or breathing correctly while benching.   In this less-than-ten-minute episode of the PRS Podcast, Clinical Coach Dr. Rori Alter, PT shares a tip for identifying a lifter's incorrect breathing pattern when benching and how to correct it to improve performance and prevent injuries while bench pressing.    Resources: The form check video that inspired the episode How to Barbell Bench Press (Youtube) Barbell Bench Press | How to (coach the) Bench in 10 Minutes (10 Minute Tip Podcast)     If you're enjoying our podcast, please leave us a review on Apple or Spotify.   Join our Facebook Community for free form checks, live Q&As & more: https://www.facebook.com/groups/PRS.Barbell.Mastery    Got questions or guests you'd like to hear on the show? Submit them here: https://forms.gle/7Vu2HmgHoeQY9xM59    Get in touch with the show! Web: https://www.progressiverehabandstrength.com Email: podcast@progressiverehabandstrength.com Rori IG: @rorimegan_prs Alyssa IG: @alyssahope_prs

Matt talks to Nate Garrison about strength training with autoimmune disease. Nate is a videographer and video editor for Barbell Logic that Matt met through Tactical Response. He discusses his journey with autoimmune disease and how barbell training helped his physical and mental health throughout the ongoing process. Ulcerative Colitis and Crohn's Disease Nate's story begin with his older sister, who struggled with and ultimately died from Crohn's disease. He had seen his sister confront Crohn's. When going through Navy EOD School, he realized that he was seeing symptoms that his older sister has had. Instead of quitting or going to the military medical personnel, he toughed it out and got private medical care as long as he could. He was first diagnosed with Ulcerative Colitis (UC). Later, the doctors diagnosed him with Crohn's disease. He has undergone multiple surgeries, and struggled with excruciating stomach pain, chronic diarrhea, and resultant mental anguish. He had to constantly be aware of where the closest toilet was and bring extra clothes, just in case. He faced obstacles and pain, and could have easily used his disease as an excuse to not further himself and continue to pursue health and excellence. That's not what he did. Weight Lifting with Autoimmune Disease Nate was used to difficult military training, but had never lifted weights. Strength training provided an opportunity to build and better himself in an area he had no experience. He started squatting with 85 pounds, and began his linear progression from there. Strength training with autoimmune disease helped him, but came with voluntary and involuntary hardship. He did his bet to eat food to support his training, and sometimes had to go to the bathrooms multiple times just during the squats. But he completed his workouts and kept training. He worked with Matt as his coach to adjust the stress appropriately and dealing with the Valsalva Maneuver and wearing a belt after a surgery that require cutting through his abdomen. After every surgery he has completed, he has had to reset with a low weight, but he knows it's good for him. In fact, the surgeon asked what he had been doing, as his abdominal wall had grown noticeably thicker after he began squatting and deadlifting heavy.   GET STARTED with one-on-one online coaching FOR FREE! Get your FIRST MONTH FREE on all strength and nutrition coaching plans.  No discount code needed and includes a 10-day, no obligation trial.  https://bit.ly/2MKeOoh Special offers from BLOC and our partners:  https://barbell-logic.com/offers/ Connect with the hosts Matt on Instagram Niki on Instagram Connect with the show Barbell Logic on Instagram Podcast Webpage Barbell Logic on Facebook Or email podcast@barbell-logic.com

Episode 83: Solitary Rectal Ulcer. Dr Singh explains how we can diagnose and treat solitary rectal ulcer syndrome (SURS) and Brandy gave an introduction regarding Elvis Presley's death.  Introduction: Did Elvis Die Pooping?By Brandy Truong, MS4, Ross University School of Medicine. A pop culture trivia fact I always found interesting was that Elvis Presley may have died from trying to have a bowel movement. There are different statements on the cause of death ranging from cardiac arrest, drug overdose, anaphylactic shock, and straining to have a bowel movement. But we're not here to figure out which one is accurate or debate all that. Elvis was found in the bathroom on the floor and many people described it as if he was on the toilet and then fell forward. If he died from pooping, how does that even happen? We're going to explore that a little.When we strain to have a bowel movement, it's called the Valsalva maneuver. This maneuver is divided into 4 stages. Phase 1 is when one first starts straining or bears down. This causes an increase in chest pressure and blood being forced out from the large veins. This is reflected in a rise in blood pressure and a decrease in heart rate. In phase 2, there is reduced venous return to the heart because the blood was forced out of the large veins. Because there is less return to the heart, the heart doesn't pump out as much as it normally would which leads to a fall in blood pressure. The body senses this fall in blood pressure and will compensate by increasing the heart rate significantly. Phase 3 is when one stops bearing down which results in a release of chest pressure. This causes a fall in blood pressure which causes the heart rate to increase as a reflex. In phase 4, the decreased venous return seen in phase 2 is now restored, which causes an increase in blood pressure. The heart rate then decreases as a reflex response. Both blood pressure and heart rate will return to normal. This entire process occurs over a span of a little over 10 seconds.Elvis was known to have a drug addiction and later some doctors found that he had hypertrophic cardiomyopathy which is a condition in which the heart is unable to pump blood well. He abused a variety of pain medications including opioids. Opioids often cause constipation; therefore, if Elvis was constipated and straining, the Valsalva maneuver compounded by heart disease and other unhealthy lifestyles he had would have caused his cardiac arrest. Intense straining during the process of defecation can result in subarachnoid hemorrhage in people with congenital berry aneurysms, for example. If you end up googling to find out how Elvis died, let us know what you think and if you think he died from pooping. This is Rio Bravo qWeek, your weekly dose of knowledge brought to you by the Rio Bravo Family Medicine Residency Program from Bakersfield, California. Our program is affiliated with UCLA, and it's sponsored by Clinica Sierra Vista, Let Us Be Your Healthcare Home.   Solitary Rectal Ulcer Syndrome.  By Parneeta Singh, MD, Ross University School of Medicine. Discussed with Hector Arreaza, MD.Solitary Rectal Ulcer Syndrome (SRUS) is a benign, rare, underdiagnosed disorder that can mimic and be incorrectly diagnosed as inflammatory bowel disease (IBD) or rectal cancer. The exact prevalence is unknown but in general, it is reported as an annual prevalence of one in 100,000 people. It mostly occurs in the third decade in men and fourth decade in women, with men and women being equally affected. However, cases have been identified in the pediatric and geriatric populations as well. SRUS is a misnomer because although some patients may present with a solitary ulcer, many present with multiple ulcers that may also involve the sigmoid colon. Presentation. Rectal bleeding (with the amount varying from a little fresh blood to severe hemorrhage that may require blood transfusions), mucus discharge, excessive straining, abdominal and perineal pain, constipation, or diarrhea, feeling of incomplete defecation, tenesmus, and rarely rectal prolapse are clinical symptoms associated with SRUS. Presentation may resemble intestinal parasites such as Entamoeba histolytica (amebiasis) and Enterobius vermicularis (pinworm).The underlying etiology is unknown, but a number of mechanisms have been suggested including ischemic injury from the pressure of impacted fecal matter and local trauma due to repetitive self-digitation, although the latter remains unproven. Ulcers usually occur in the mid-rectum which cannot be reached by self-digitation. Additionally, it has been proposed that the perineum's descent along with the abnormal contraction of the puborectalis muscle during defecation results in trauma or a prolapsed rectum with mucosal prolapse being the most common underlying pathogenesis in SRUS. Diagnosis. The diagnosis of SRUS is based on clinical features and proctosigmoidoscopy findings, with histological examination and biopsies being the key to the diagnosis. Imaging studies including defecating proctography, dynamic MRI and anorectal functional studies also aid in the diagnosis with the latter showing that 25% to 82% of SRUS patients have dyssynergia with paradoxical anal contraction. A thorough evaluation is important in ruling out IBD, ischemic colitis, and malignancy.Histology evaluation of biopsy establishes the diagnosis of solitary rectal ulcer syndrome. Findings include fibromuscular obliteration of the lamina propria. This obliteration causes hypertrophy and disorganization of the muscularis mucosa and regenerative changes. There is an abnormal crypt organization. In cases were polypoid lesions are prevalent, the mucosa has a villiform configuration, and in some cases, the glands may be trapped in the submucosa, which is called colitis cystica profunda.Treatments.Various treatment options are available for SRUS with the treatment choice depending on symptom severity and the presence of rectal prolapse. The initial steps, especially in asymptomatic patients, include patient education and behavioral modifications which include a high-fiber diet, straining discontinuation, and a discussion of psychosocial factors. Biofeedback is the next step in those who fail to respond to conservative measures. Biofeedback seems to help by altering efferent autonomic pathways to the gut that reduces straining with defecation by correcting abnormal pelvic-floor behavior. Topical treatments used include corticosteroids, salicylate, sulfasalazine, mesalazine, sucralfate suppositories and topical fibrin sealant. Unfortunately, surgery is necessary in almost one-third of adults with associated rectal prolapse who do not respond to the above treatment options. Surgical treatments include ulcer excision, treatment of internal or overt rectal prolapse, and de-functioning colostomy. Open rectopexy and mucosal resection have shown a success rate of 42% to 100%. In conclusion, SRUS is an uncommon disease that can mimic IBD and rectal cancer. Thus, a thorough and complete patient history and work-up is required to accurately diagnose SRUS, following which patient education, reassurance that the lesion is benign and a conservative, stepwise individualized approach is important in the management of this syndrome.Conclusion: Now we conclude our episode number 83 “Solitary Rectal Ulcer.” Rectal bleeding, constipation, diarrhea, abdominal pain… yes, it sounds like Chron's syndrome, but your list of differentials may be very long. You may want to add to that list Single Rectal Ulcer Syndrome. The treatment goes beyond medications for inflammation and includes pelvic floor training. Even without trying, every night you go to bed being a little wiser.Thanks for listening to Rio Bravo qWeek. If you have any feedback about this podcast, contact us by email RioBravoqWeek@clinicasierravista.org, or visit our website riobravofmrp.org/qweek. This podcast was created for educational purposes only. Visit your primary care physician for additional medical advice. This week we thank Hector Arreaza, Brandy Truong, and Parneeta Singh. Audio edition: Suraj Amrutia. See you next week! _____________________References:“Elvis Presley.” Wikipedia, Wikimedia Foundation, 21 Jan. 2022, https://en.wikipedia.org/wiki/Elvis_Presley#Cause_of_death.  Markel, Dr. Howard. “Elvis' Addiction Was The Perfect Prescription for an Early Death.” PBS, Public Broadcasting Service, 16 Aug. 2018, https://www.pbs.org/newshour/health/elvis-addiction-was-the-perfect-prescription-for-an-early-death.   Srivastav, Shival. “Valsalva Maneuver.” StatPearls [Internet]., U.S. National Library of Medicine, 28 July 2021, www.ncbi.nlm.nih.gov/books/NBK537248/.  Zipes, Douglas. “Valsalva Maneuver.” Valsalva Maneuver - an Overview, ScienceDirect Topics, www.sciencedirect.com/topics/neuroscience/valsalva-maneuver . Qing-Chao Zhu, Rong-Rong Shen, Huan-Long, Yu Wang. Solitary rectal ulcer syndrome: Clinical features, pathophysiology, diagnosis, and treatment strategies. World J Gastroenterology. 2014 Jan 21; 20(3): 738–744. doi: 10.3748/wjg.v20.i3.738. PMID: 24574747; PMCID: PMC3921483. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3921483/ Young Min Choi, Hyun Joo Song, Min Jung Kim, Weon Young Chang, Bong Soo Kim, Chang Lim Hyun. Solitary Rectal Ulcer Syndrome Mimicking Rectal Cancer. The Ewha Medical Journal. 2016 Jan 29; 39(1): 28-31. doi: https://doi.org/10.12771/emj.2016.39.1.28. Department of Internal Medicine, Surgery, Radiology and Pathology, Jeju National University School of Medicine, Jeju, Korea. https://synapse.koreamed.org/articles/1058669 Sachin B Ingle, Yogesh G Patle, Hemant G Murdeshwar, Chitra R Hinge Ingle. An unusual case of solitary rectal ulcer syndrome mimicking inflammatory bowel disease and malignancy. Arab J Gastroenterol. 2012 Jun 13(2):102. doi: 10.1016/j.ajg.2012.02.004. Epub 2012 Apr 11. Department of Pathology. PMID: 22980604. https://pubmed.ncbi.nlm.nih.gov/22980604/     

In this episode, I have a conversation with David Wilson, from The Wilson Method regarding two of his blog posts,The Pelvic Floor And The Larynx: Sisters In ArmsOur Other Health Pandemic: The Unconscious Chronic Valsalva Maneuver (UCVM)Are you willing and able to becoming a Supporter of The Visceral Voice Podcast to help keep this podcast running? Please click herehttps://www.patreon.com/TheVisceralVoice

Tune in to today's show as Brad talks about the 4 big lifts that can help you build strength, better posture, and confidence. For each lift he speaks about the: 1.) Requirements 2.) Potential Restrictions or Limitations 3.) Benefit 4.) How to Perform See below on how to perform each lift. Barbell Deadlift: 1.) Walk up to barbell until your shins are just one inch away-this will place the barbell directly over your mid foot, which is the balance point for all barbell exercises. Your heels should be 6-8 inches apart. This is a more narrowed stance than the squat. 2.) Lean over with stiff legs, and take a grip that places your elbows just outside your knees. Be careful not to move or roll the bar from your mid foot. 3.) Bring your shins forward to touch the barbell-again without moving or rolling it away from your mid foot. Keep your hips in place, they are not supposed to move from this point forward. 4.) Squeeze your chest up to tighten all the muscles of your back. Avoid dropping your hips while you squeeze your chest up. This crucial step sets our lumbar spine in a normalized anatomical position (avoids excessive flexion) 5.) Drag the barbell up your legs while maintaining lumbar/thoracic extension until you are standing straight with chest out. 6.) Slowly lower the weight with the back still in the neutral spine position all the way back down to the ground. 7.) Reset and Repeat. Squat: With Barbell: The barbell should sit in the rack at the height of mid-sternum. Take a thumbless grip on the bar that is narrow enough to facilitate straight wrists by placing the heel of the palm against the bar and placing fingers on top. This is an important step to learn, because the hands don't hold the bar on the back – our back muscles holds the bar on our back. The hands simply keep the barbell from rolling down our back. With grip and hands in place, walk under the bar and place it just below the spine of the scapula, on the meat of the rear deltoids muscles. Remember, we use the low bar position to allow us to bend over and use the posterior chain to stand up. With the bar in position, take a deep breath, and stand up with the bar on the back. Step out of the rack and take the same shoulder width stance as the stretch without the bar. Take a big deep breath with a closed glottis – the Valsalva Maneuver – to increase the intra abdominal pressure of our gut and provide stability for our back. As you prepare to squat down, remember two things: 1) you have to push your thighs apart – your elbows won't do it for you and 2) don't stop at the bottom; squat down to depth and come right back up. Barbell Overhead Press: With the bar in front of you, place your hands just outside shoulder width apart. Keep elbows and forearms in a vertical position, stacked upon each other. If your elbows are tucked or flared, your grip is either too narrow or too wide. Elbows should be approximately at 30 degree angle which helps to put the shoulder in the plan of scapula (explain this importance)Please adjust accordingly. Place the bar on the heel of your palm — this is where most force will generate from. Make sure your middle knuckles face upwards to ceiling. Pull-Up: Use step to get to bar, retract and depress (bring shoulder blades down and in) prior to pulling your chest up to the bar to get your neck above the bar. Your hand grip should be just outside your shoulders. You wan to avoid shrugging your shoulders at the top. You should be squeezing down and in. Lower back down slowly. Avoid locking arms out to avoid stress on joints.

Sarah and Dimity tell: -Christine to “have at it” if she wants to run the same-ish route and distance every run; -hydration best-practices to Sharon, who gets “ridiculously thirsty” on her runs; -Erin what to make of on-the-run heart palpitations (Valsalva Maneuver how-to); and, -book recommendations to motivate and enlighten Lexi.   Titles the duo recommend: The Amateurs: The Story of Four Young Men and Their Quest for Olympic Gold: David Halberstam. The Boys in the Boat: Nine Americans and Their Epic Quest for Gold at the 1936 Berlin Olympics: Daniel James Brown A Most Beautiful Thing: The True Story of America’s First All-Black High School Rowing Team: Arshay Cooper. Swimming to Antarctica: Tales of a Long-Distance Swimmer: Lynne Cox Find a Way: The Inspiring Story of One Woman's Pursuit of a Lifelong Dream: Diana Nyad Let Your Mind Run: A Memoir of Thinking My Way to Victory: Deena Kastor Learn more about your ad choices. Visit megaphone.fm/adchoices

To learn more and apply to work one-on-one with Rachel, visit her website: https://www.killinitketo.com/ Join Rachel’s weekly newsletter: https://www.killinitketo.com/newsletter  In this episode, Rachel talks about how to build a strong AND sexy core, effective anti-movement training and the importance of breathing and bracing. “If you're not doing effective reps, and you are just going there and going through the motions. Honestly, you're just wasting your time.” Rachel Gregory “Realy, the goal is to strike a balance between training your core for functionality/stability AND looks. You can have both...you just need to understand what to do and why you’re doing it.” Rachel Gregory Top Takeaways: A deep dive into ALL things core and ab training Key factors and example exercises to use in your own training to help you build and maintain a strong core What moves can best strengthen your core after c-sections Show Notes: [2:45] Don’t forget to screenshot, tag @rachelgregory.cns, and post to instagram! [4:30] Disclaimer: Be cautious about jumping back into certain core exercises after a C-Section [5:30] Main function of the core: to help stabilize your spine and help your trunk resist movement [6:00] The core extends way beyond your abs. The core also includes your diaphragm, the pelvic floor muscles, erector spinae, and more.  [8:30] What should you be focusing on to train your core properly? [9:30] Anti-Movement training and the different types [10:00] For more guidance in this area, check out Rachel’s exercise programs and one on one coaching [11:00] Anti-Rotation, Anti-Extension, and Anti-Lateral Flexion [13:00] Building an anti-fragile body [13:30] Compound, or full-body, movements. [14:30] Even though the ability to see your abs is predominantly related to your body fat percentage; your abs are just like every other muscle in your body, you also have to build them  [17:30] Proper breathing and bracing. One of the most underrated aspects of core training [19:00] Ben Pakulski is an expert in breathing and bracing. Click here to listen to our episode with Ben! [21:30] Valsalva Maneuver and the water bottle analogy [22:30] Information summary and practical tips [23:30] Don't forget: Lift heavy shit [26:30] “If you're not doing effective reps, and you are just going there and going through the motions. Honestly, you're just wasting your time.” [27:00] Rachel’s favorite spinal flexion exercises [30:30] Use proper form on the ab-wheel [32:00] One last mention to share on instagram! Don’t forget to get in your questions, every monday, on @rachelgregory.cns insta story THINGS MENTIONED IN THIS EPISODE: MetFlex and Chill: Episode 8 with Ben Pakulski Rachel Gregory’s One-on-One Coaching Rachel Gregory’s Online Exercise Programs Valsalva Maneuver --- Join the FREE MetFLex Life Course: www.metflexandchill.com Rachel Gregory (@rachelgregory.cns) is a Board-Certified Nutrition Specialist, Strength and Conditioning Specialist, and Author of the best-selling book, 21-Day Ketogenic Diet Weight Loss Challenge. She received her Master’s Degree in Nutrition & Exercise Physiology from James Madison University and Bachelor’s Degree in Sports Medicine from the University of Miami. Rachel helps her clients transform their lives by starting with the physical (body), realizing the power of the mental (mindset), and ultimately gaining massive confidence that bleeds into every aspect of their lives (family, relationships, work, etc.).

From this YouTube video: https://youtu.be/XN8uzQELkys -- What I am showing you here is not a "tip" or a "nice have", it's something you _must_ know in order to lift properly and make progress without injuring yourself. Follow me on social media: Twitter: https://twitter.com/samydindane Instagram: https://instagram.com/samydindane

Breathing Series: Breathing for HIIT, Metcons, Cross Training   After discussing the Valsalva Maneuver last week, you may be wondering, “Nicole, what other breathing techniques are available for sports aside from heavy lifting?”   Well, in this episode we will be breaking down four more breathing techniques for various physical activities.  But first, we will review your foundation for breathing: normal diaphragm breathing. From there we will differentiate between the other techniques and what they are best suited for.   In this episode we will discuss: Biomechanical breathing commonly used for strength training Anatomical breathing most often used to relax into movement.  This is great for mobility exercises and running. System breathing most often seen used by those participating in crossfit Box breathing, or tactical breathing, which is best for meditation and relaxation   Don’t forget to check out the YouTube channel for videos demonstrating each of the above-mentioned techniques.   Did you enjoy this episode?  Take a screenshot to post in your IG stories and tag us! @mobilityathletes   Join our Free Facebook Group here!   Connect with Nicole: Mobility Physical Therapy Website Instagram Facebook YouTube   Other resources: https://oxygenadvantage.com/ https://opexfit.com/podcast/

What is the one thing the human body cannot live without?   We know you can live without food for weeks; without sleep for almost a week and a half; even without water for a couple of days.   But the one thing your body cannot survive without is AIR.  You must be breathing, always.   Over the next few episodes, we will be discussing different breathing techniques for different types of training, starting with the Valsalva Maneuver.   In this episode we will break down: What the valsalva maneuver is most effectively used for What the valsalva maneuver should not be used for Whether or not it truly improves your strength versus normal breathing And how to properly perform this technique   Don’t forget to check out the YouTube channel for videos on this technique and other breathing techniques to maximize your performance.   Connect with Nicole: Mobility Physical Therapy Website Instagram Facebook   Other resources: https://oxygenadvantage.com/ https://opexfit.com/podcast/ https://www.wimhofmethod.com/breathing-exercises   Medical Study on the Valsalva Maneuver: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2883611/   If you like this episode subscribe, take a screenshot & share on Instagram @mobilityathletes! Want to know if you are breathing right during your lifts to maximize your potential join our FB group to submit your videos for FREE analysis!

A quick neighborhood update, going to California, the 1940 Western - Virginia City - and its treatment of Confederate rebels and horses, the Valsalva Maneuver, YouTube documentary of Amazing Johnathan and a justification for believing in magic, a Dimland Radio Science Zero: The WHO, and a Creepy/Cool thing. The show notes for this week's Dimland Radio are up at http://dimland.blogspot.com/2019/06/dimland-radio-6-15-19-show-notes.html

What would you do if you were offered a recording contract with one of your favorite celebrities/producers but were recently diagnosed with a mental illness?  Would you neglect your mental health for fame and fortune, or choose your mental health? Our guest singer and songwriter Jermaine “Nate” Tolbert is no stranger to the music industry and making sacrifices and has an amazing story. After being diagnosed with schizophrenia and depression, he walked away from a contract with Grammy Award-Winner Pharrell Williams. References/Resources: Connect with Jermaine & Listen To His Music Twitter: Nate__Hancock, IG: Jermaine_Tolbert Soundcloud: Soundcloud.com/nate-calloway Facebook: www.facebook.com/TheRealNateCalloway Share Your Story & Audition For This Is My Brave: https://calendly.com/thisismybravearlington/auditions/06-28-2018 Save Our Babies Tickets: Ticket Option 1: https://saveourbabies.eventcreate.com/ or Ticket Option 2: https://saveourbabiesffu.eventbrite.com Therapist Shout-Out: Black Men Find Your Therapist Here: https://therapyforblackmen.org/ Mind, Body & Soulness: Be Careful With Those Detox Teas…I’m Just saying. (The attack/side effects she was experiencing Valsalva Maneuver) http://www.xonecole.com/the-ugly-truth-heres-what-detox-teas-are-really-doing-to-your-body.amp?__twitter_impression=true

Chief Complaint Pt comes in with a heart rate of 170-200. Complains of palpitations/sob/chest pain/dizziness/or nothing.  Is this SVT or A-Fib? Hint! Today we are talking about SVT. Bedside Checklist Take off clothing waist up. Put on a hospital gown. Immediately place pulse ox, leads, and bp cuff - in that order. If oxygenation is poor with good waveform - address this first. Start with a nasal cannula, if that doesn't give your pt relief. Apply NRM, while you set up BIPAP. Find out if they have COPD or emphysema or a chronic smoker - oxygen saturation requirements are less for this population. High flow nasal cannula may be an option. Keep hob elevated to min. 30 degrees. 45-90 better. Watch the position that your patient is sitting. If they are leaning forward or sitting up straight - Put the hob at 90 degeees and ask them, is it easier for you to breathe sitting up. Obese patients may prefer to have legs over the side of the stretcher due to abdominal girth. Get an EKG stat. After you get the 12 lead - keep the EKG leads on pt Is this an atrial or ventricular rhythm? Today it’s an atrial rhythm. It’s so fast, we don’t know if it’s SVT or A Fib! Get 1-2 iv access. Preferably 2. Labs now or later? This is controversial. If the pt looks like they are a hard stick, I get labs so I can at least run a venous panel to get a baseline pCO2 level. If the pt goes on BIPAP or high flow nasal cannula - you can trend this along with other values to direct the oxygen needs. Look at your pt. If they are talking to you and appear somewhat calm - you have the time to get labs off that first iv line. If the pt looks really bad, just get the iv access and you can get the labs later. Ideally you have a 2nd nurse who is putting in the IV line while the EKG is in progress so you can get the labs right away. While you are doing this - examine your patient: Mental status - hello sir! Can you tell me your name? Do you know where you are? What day is it? If you know the pt has dementia, what year or who's the president seems to work better. Work of breath - are they gasping for air? What is the respiratory rate? Do they look tired? - worried about losing compensatory drive? Auscultate the lungs. Wheezing - inspiratory or expiratory or both? Upper or throughout the lungs? Crackles? Decreased air movement? Trick question - are they coming in with multiple problems? Yes, sometimes that happens. Get the story as the above is happening: What happened? When did this happen? Were you sitting, walking, lying down? SOB/Chest pain/Palpitations/Dizziness or Lightheadedness/Nausea/Vomiting/LOC? If BIBEMS, Ask EMS how did they find the patient and where, what interventions (oxygen, iv line, meds), do they look better now? Has this ever happened to you before? Any fevers or recent illness? Do you have a pacemaker or defibrillator? What medications are you on? Do you have any allergies to medications? SVT Treatment First line of treatment: Vagal Maneuvers. Ice to face Carotid massage Tell the pt to bear down Modified Valsalva Maneuver Technique Second line of treatment: Adenosine In 2015 the Lancet published the REVERT trial and the findings were pretty impressive. The REVERT trial created another vagal maneuver that actually works!  It’s called a Modified Valsalva Maneuver Technique.  I’ve tried this out myself and it works pretty well. You just have to make sure your technique is good and you have 2 people at the bedside. Modified Valsalva Maneuver Technique: Have the pt sit down on the stretcher with HOB elevated at 45 degrees (semi-recumbent) or the pt can just sit up straight. Use a 10mL syringe (pressure of 40mmHg) and have them blow into it for 15 seconds (creating the Valsalva strain) Immediately afterwards, place the pt in a supine position and passive leg raise 45-90 degrees for 45 seconds. (Increases the relaxation phase of venous return and vagal stimulation). This is the modification.

This week we welcome Andy Little onto the show to discuss the modified Valsalva maneuver for breaking SVT. https://media.blubrry.com/coreem/content.blubrry.com/coreem/Episode_102_0-AVNRT_Final_Cut.m4a Download Leave a Comment Tags: Adenosine, AVNRT, Cardiology, SVT, Tachydysrhythmia Show Notes Read More Rebel EM: The REVERT Trial – A Modified Valsalva Maneuver to Convert SVT SGEM: This is a SVT and I'm Gonna Revert It Using a Modified Valsalva Manoeuvre Appelboam A et al. Postural Modification to the Standard Valsalva Manoeuvre for Emergency Treatment of Supraventricular Tachycardias (REVERT): A Randomised Controlled Trial. Lancet 2015. PMID: 26314489 Read More

This week we welcome Andy Little onto the show to discuss the modified Valsalva maneuver for breaking SVT. https://media.blubrry.com/coreem/content.blubrry.com/coreem/Episode_102_0-AVNRT_Final_Cut.m4a Download Leave a Comment Tags: Adenosine, AVNRT, Cardiology, SVT, Tachydysrhythmia Show Notes Read More Rebel EM: The REVERT Trial – A Modified Valsalva Maneuver to Convert SVT SGEM: This is a SVT and I’m Gonna Revert It Using a Modified Valsalva Manoeuvre Appelboam A et al. Postural Modification to the Standard Valsalva Manoeuvre for Emergency Treatment of Supraventricular Tachycardias (REVERT): A Randomised Controlled Trial. Lancet 2015. PMID: 26314489 Read More

Stef Bradford, Ph.D., discusses the role of the Valsalva Maneuver (holding your breath against a closed glotis) in strength training and why it is not only safe, but why you should do it. Recorded at the December 2015 Starting Strength Seminar held at the Wichita Falls Athletic Club in Wichita Falls, TX. ------------------- Watch Podcast on YouTube: https://youtu.be/d8_1xq8c23c WEBSITE: http://startingstrength.com FORUM: http://startingstrength.com/resources/forum/ STORE: http://aasgaardco.com Subscribe on YouTube: http://www.youtube.com/subscription_center? add_user=AasgaardCo Follow on Twitter: https://twitter.com/SS_strength Like on Facebook: https://www.facebook.com/pages/Starting- Strength-The-Aasgaard-Company/142424022490628

On this podcast we review some background on AVNRT and focus on Emergency Department management. https://media.blubrry.com/coreem/content.blubrry.com/coreem/Episode_20_0_Final.m4a Download 2 Comments Tags: AVNRT, PSVT, REVERT Trial, Tachydysrhythmias Show Notes AVNRT with Aberrancy vs. VT REBEL EM: SVT with Aberrancy Versus VT Amal Mattu's ECG Case of the Week: August 26th, 2013 Valsalva Maneuver ALiEM: Tricks of the Trade: Valsalva Maneuver By Using a 10cc Syringe St. Emlyn's: JC The REVERT Trial Adenosine in AVNRT Larry Mellick: Treating SVT with Adensoine ALiEM: Trick of the Trade: Combining Adenosine with the Flush Verapamil in AVNRT RAGE Podcast:

On this podcast we review some background on AVNRT and focus on Emergency Department management. https://media.blubrry.com/coreem/content.blubrry.com/coreem/Episode_20_0_Final.m4a Download 2 Comments Tags: AVNRT, PSVT, REVERT Trial, Tachydysrhythmias Show Notes AVNRT with Aberrancy vs. VT REBEL EM: SVT with Aberrancy Versus VT Amal Mattu's ECG Case of the Week: August 26th, 2013 Valsalva Maneuver ALiEM: Tricks of the Trade: Valsalva Maneuver By Using a 10cc Syringe St. Emlyn's: JC The REVERT Trial Adenosine in AVNRT Larry Mellick: Treating SVT with Adensoine ALiEM: Trick of the Trade: Combining Adenosine with the Flush Verapamil in AVNRT RAGE Podcast:

On this podcast we review some background on AVNRT and focus on Emergency Department management. https://media.blubrry.com/coreem/content.blubrry.com/coreem/Episode_20_0_Final.m4a Download 2 Comments Tags: AVNRT, PSVT, REVERT Trial, Tachydysrhythmias Show Notes AVNRT with Aberrancy vs. VT REBEL EM: SVT with Aberrancy Versus VT Amal Mattu’s ECG Case of the Week: August 26th, 2013 Valsalva Maneuver ALiEM: Tricks of the Trade: Valsalva Maneuver By Using a 10cc Syringe St. Emlyn’s: JC The REVERT Trial Adenosine in AVNRT Larry Mellick: Treating SVT with Adensoine ALiEM: Trick of the Trade: Combining Adenosine with the Flush Verapamil in AVNRT RAGE Podcast:

Postural modification to the standard Valsalva manoeuvre for emergency treatment of supraventricular tachycardias (REVERT): a randomised controlled trial Andrew Appelboam, FRCEM, Adam Reuben, FRCEM, Clifford Mann, FRCEM, James Gagg, FRCEM, Prof Paul Ewings, PhD, Andrew Barton, MSc, Trudie Lobban, MRCP, Mark Dayer, FRCP, Jane Vickery, MSc, Prof Jonathan Benger, MD on behalf of the REVERT trial collaborators The Lancet. 2015; DOI:10.1016/S0140-6736(15)61485-4 Published Online: 24 August 2015 Background: The Valsalva manoeuvre is an internationally recommended treatment for supraventricular tachycardia, but cardioversion is rare in practice (5–20%), necessitating the use of other treatments including adenosine, which patients often find unpleasant. Researchers assessed whether a postural modification to the Valsalva manoeuvre could improve its effectiveness. Methods: The study authors did a randomised controlled, parallel-group trial at emergency departments in England. They randomly allocated adults presenting with supraventricular tachycardia (excluding atrial fi brillation and flutter) in a 1:1 ratio to undergo a modified Valsalva manoeuvre (done semi-recumbent with supine repositioning and passive leg raise immediately after the Valsalva strain), or a standard semi-recumbent Valsalva manoeuvre. A 40 mm Hg pressure, 15 s standardised strain was used in both groups. Randomisation, stratified by centre, was done centrally and independently, with allocation with serially numbered, ...

Postural modification to the standard Valsalva manoeuvre for emergency treatment of supraventricular tachycardias (REVERT): a randomised controlled trial Andrew Appelboam, FRCEM, Adam Reuben, FRCEM, Clifford Mann, FRCEM, James Gagg, FRCEM, Prof Paul Ewings, PhD, Andrew Barton, MSc, Trudie Lobban, MRCP, Mark Dayer, FRCP, Jane Vickery, MSc, Prof Jonathan Benger, MD on behalf of the REVERT trial collaborators The Lancet. 2015; DOI:10.1016/S0140-6736(15)61485-4 Published Online: 24 August 2015 Background: The Valsalva manoeuvre is an internationally recommended treatment for supraventricular tachycardia, but cardioversion is rare in practice (5–20%), necessitating the use of other treatments including adenosine, which patients often find unpleasant. Researchers assessed whether a postural modification to the Valsalva manoeuvre could improve its effectiveness. Methods: The study authors did a randomised controlled, parallel-group trial at emergency departments in England. They randomly allocated adults presenting with supraventricular tachycardia (excluding atrial fi brillation and flutter) in a 1:1 ratio to undergo a modified Valsalva manoeuvre (done semi-recumbent with supine repositioning and passive leg raise immediately after the Valsalva strain), or a standard semi-recumbent Valsalva manoeuvre. A 40 mm Hg pressure, 15 s standardised strain was used in both groups. Randomisation, stratified by centre, was done centrally and independently, with allocation with serially numbered, ...

Topics: [4:58] Kill Cliff Recovery Drink [11:30] BCAA Ratio [14:26] Making Up Calories On Weekends [18:15] Oleic Acid And Seborrheic Dermatitis [22:34] Valsalva Maneuver [18:20] Atrial Fibrillation [32:18] Acupuncture [38:42] Chiropractic [48:47] Strengthening Joints And Connective Tissue