In the general hospital setting, patients often wish to leave hospital before doctors and other health care providers feel it is safe to discharge them. There can be multiple reasons for this, such as the patient requiring ongoing treatment of a medical illness or psychiatric treatment of a mental disorder, or they are at risk of abuse, neglect, or self-neglect due to their social circumstances. Balancing the often competing interests of protecting vulnerable patients and preserving patient autonomy can leave physicians unsure of the most appropriate course of action.
Vagal reflexes are well known to cause a change in blood pressure or heart rate. This is seen often in medicine and is termed a “vagal response.” The most common example of vagal reflex stimulation used clinically involves slowing the heart rate with external carotid massage to correct supraventricular tachycardia. However, other maneuvers, such as rubbing the eyes or temples, can also cause a reduction in blood pressure or heart rate.
In accordance with new recommendations from the National Advisory Committee on Immunization, British Columbia has extended the interval between first and second doses up to 16 weeks for all currently approved COVID-19 vaccines in Canada.[1] In light of this change—developed to maximize the number of individuals receiving their first doses of the COVID-19 vaccine—we have updated our review of the literature.
