Carotid massage, often called carotid sinus massage or MSC, is a medical maneuver that is used to slow a patient's dangerously fast heartbeat or to diagnose particular arrhythmias. Medical professionals can also use MSC to investigate the causes of a patient's erratic blood pressure and other potentially serious symptoms. To do this, you need to massage the area at the base of the patient's neck, where the carotid artery enters the head. The carotid artery carries blood to the brain, and an incorrectly performed MSC can cause serious health problems, especially in the elderly. Do not perform this maneuver on yourself or another person unless you are a doctor.
Steps
Part 1 of 3: Prepare the Patient
Step 1. Ask the patient to lie on their back
For safety reasons, the MSC should be performed first in the supine position (lying on the back) and then seated with at least a five minute break between the two phases of the massage. Once the maneuver has been carried out in both positions, the patient must remain under observation for 10 minutes in the supine position. If you are in the clinic, you can ask him to lie down on the examination table. If you are doing home MSC, ask him to lie down on a sofa or bed.
It is important for the patient to lie down in case of dizziness or loss of consciousness due to the massage
Step 2. Apply an electrocardiograph to the patient
This medical instrument monitors the electrical activity of the heart while MSC is being administered. Since massage is primarily a diagnostic measure, the ECG is very useful for checking the heart during the procedure. If the machinery indicates an asystole (heart stops beating) that exceeds 3 seconds, the maneuver must be stopped immediately. The ECG can also allow the diagnosis of carotid sinus syndrome.
Even if you are doing MSC to slow a patient's rapid heart rate (supraventricular tachycardia or TSV), you still need to monitor the electrical activity of the heart with the ECG. Use the ECG as often as you do the massage
Step 3. Check the patient's blood pressure before, during and after the procedure using a heart rate monitor and pressure gauge
This data can reveal information about the cause of arrhythmias. Blood pressure checks are also done for safety reasons.
Once the patient is lying down, after applying the ECG and starting to measure blood pressure, wait five minutes before starting the procedure. This allows the patient's heart to reach its resting rate, so that a more accurate measurement of blood pressure and heart rate is available
Part 2 of 3: Performing the Massage
Step 1. Find the carotid sinus massage point
There are two carotid sinuses in the patient's neck and you will perform the maneuver on both. Find the front center point of the neck (near the Adam's apple) and the angle of the patient's jaw. Trace the side of the neck with your fingers, until they are directly under the corner of the jaw. You should feel the carotid sinus.
- The angle of the jaw is where the bone bends, about 10 cm behind the tip of the chin.
- The second carotid sinus is located in the mirror position on the other side of the patient's neck.
Step 2. Massage the right carotid sinus for 5-10 seconds
MSC is usually done on the right side of the patient's neck first. Press firmly on the point you have identified; then, using circular motions, rub and massage the carotid sinus for 5-10 seconds.
Avoid pressing too hard or you risk restricting the flow of oxygen to the patient's brain. As a general rule, apply the same pressure you would use to indent the surface of a tennis ball
Step 3. Massage the patient's left carotid sinus
Once you have performed the maneuver on the right side of the patient's neck, repeat it on the left side. Massage in circular motions for 5-10 seconds.
Step 4. Instruct the patient to lie down and still for 10 minutes
At the end of the MSC, the patient may feel dizzy or light-headed. Ask him to lie on his back for another ten minutes. This allows the heartbeat to return to normal (if it has ever become abnormal) and the body to restore proper oxygen supply to the brain.
Part 3 of 3: Stop the Massage
Step 1. Stop the MSC if the ECG shows an asystole
Asystole is a severe form of cardiac arrest (heart attack) that can be caused by massage. If the ECG shows an asystole lasting more than three seconds, stop the maneuver immediately.
If the patient's cardiac arrest continues after the massage is stopped, you may need to resort to resuscitation procedures, such as the precordial punch (blow to the chest)
Step 2. Stop the massage if the patient faints
If the patient loses consciousness for any reason when you perform the MSC, even for a moment, stop the maneuver. You or a caregiver should register that the patient has experienced syncope (loss of consciousness) or pre-syncope (dizziness or dizziness immediately preceding fainting).
If you are doing MSC as a diagnostic test, ask the patient if the dizziness or loss of consciousness they have just experienced are similar to the other symptoms they usually experience
Step 3. Stop MSC if any neurological complications occur, such as a stroke
In the event of a stroke, you should give the patient aspirin (if there are no contraindications) and keep him under close observation.
Step 4. Do not massage patients with carotid sinus hypersensitivity
Sufferers of this problem are very sensitive to pressure on the carotid sinuses. This syndrome occurs most often in men over the age of 50, although it can also affect women over the age of 50. Practicing MSC on a patient with this problem can lead to cardiac arrest or other serious heart and blood pressure problems.
Ask the patient if he has been diagnosed with carotid sinus hypersensitivity or if he has ever experienced any adverse reactions (or fainting) following carotid sinus massages
Step 5. Also, do not perform MSC on patients with the following conditions:
- Heart attack
- Transient ischemic attack within the past three months
- Stroke in the past three months
- History of ventricular fibrillation
- History of ventricular tachycardia
- Carotid occlusions
- Previous MSC adverse reactions
- If a patient has a carotid murmur, you should first have an ultrasound examination of the carotid artery to check for stenosis.
Advice
Carotid massage is one of the medical procedures called "vagal maneuvers". These maneuvers stimulate the vagus nerve (located on the side of the head), so that it releases chemicals that slow the patient's heartbeat
Warnings
- Do not perform MSC in an outpatient clinic if there are no resuscitation tools available.
- Never do MSC on both carotids at the same time.
- Massage can cause a heart attack in older patients (due to a lack of oxygen to the brain). Consequently, MSC should only be done within a medical facility with resuscitation tools.
- Always confirm the presence of an ACLS resuscitation cart (with defibrillator) and control instruments (ECG, heart rate monitor and pressure gauge).
