Everything about Precordial Thump totally explained
A
precordial thump is a
medical procedure used in the initial response to a witnessed
cardiac arrest when no
defibrillator is immediately available. It can be used as a small part of the provision of
advanced cardiac life support (ACLS). About 25% of patients in cardiac arrest who received a thump on the
precordium regain cardiac function (Scherf and Bornemann:, 1960)
To perform a precordial thump, a highly trained provider such as a
paramedic or
physician strikes a single very carefully aimed blow with the fist to the center of the patient's
sternum. The intent is to possibly interrupt a life threatening rhythm. The precordial thump is thought to produce an electrical
depolarization of 2 to 5
joules. However, the thump is effective only if used at the onset of
ventricular fibrillation or pulseless
ventricular tachycardia and so should be used only when the arrest is witnessed or monitored. There is no evidence that the precordial thump improves recovery in unwitnessed cardiac arrest.
A precordial thump may be given just once. While the odds of success are poor, if a precordial thump is done properly little time is lost. The provider will immediately continue with other ACLS skills, or
CPR if the needed ACLS drugs and equipment (such as a defibrillator) are unavailable.
The performance of a precordial thump is
outside the scope of
first aid and requires
at minimum training in advanced cardiac life support. ACLS is performed primarily by
physicians,
paramedics and
nurses with advanced training in
emergency care.
Adverse effects
The use of the precordial thump technique has sometimes been shown in
movies and
television, usually in passing without any explanation. Untrained laypersons have been known to attempt it and sometimes cause additional injury to the patient as the blow must be carefully aimed.
Commotio cordis, cardiac arrest caused by blunt trauma to the heart, may ensue if a precordial thump is applied with a wrong timing.
History
Drs
Jack Pennington and
Bernard Lown's cardiology group at
Harvard University are credited with formalizing this technique in the medical literature. They published their report in the
New England Journal of Medicine in the early 1970s. Drs.
Richard S. Crampton and
George Craddock,
cardiologists at the
University of Virginia helped to promote the
paramedic use of chest thump through a curious accident. In 1970, the Charlottesville-Albemarle Rescue Squad (VA) was transporting a patient with an unstable
cardiac rhythm in what was then called a
Mobile Coronary Care Unit. When the vehicle inadvertently hit a speed bump in a shopping center parking lot, the patient's normal heart rhythm was restored. Further research confirmed that chest thumping patients with life-threatening
arrhythmias could save lives
(External Link
).
Further Information
Get more info on 'Precordial Thump'.
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