stonez
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We were taught that we can use PCT on witnessed arrest.
Precordial Thumps
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Ridryder911
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PCT can be used if the patient is currently being monitored on a ECG and a witness V-fib, V-tach and there is a time delay of electrical defibrillation, cardioversion, per AHA. It is not taught as much since most monitors have defib attached or there is AED type devices within range.
R/r 911
R/r 911
Taught, to deliver PCT
Back when, the proper procedure for delivering a PCT was to align the lower arm with the mid-line of chest, Elbow about nose area, and then a crashing blow down on the sternum with a closed fist.
Dose that sound familiar to anyone??
I have never done it that way, I felt the procedure took into account those in the medical field would probably be much smaller and weaker than i am.
I fold my fingers, and with an open palm, wrist flexed back, From the pt's side i bring arm down rapidly, and at the same time snap my wrist down, making contact with the sternum with my 2nd knuckle's.
More of a snapping action.
Practice it on a box or something that gives a little.
Ribs are broken in a PCT, my procedure is more in line with the sternum, and it has worked for me.
I wouldn't hesitate to thump someone that went down in my presence and i had no monitor handy, Not only that, but think about the time it takes to apply pads, power up(can be done simultaneously), analyze rhythm, indicate shock advised, Charge up, check for clear. then the button can be pushed. The thump can be done in just about the time it takes to push the Dad-Burn-Button, with analyzing done simultaneously!
Just think about that...
Where did that come from you ask;
Years ago my wife and i were transporting a cardiac to the twin city's 225 miles, and that was before ALS in our area. We did have a RN on board, actually 2 as the Mrs. is also an RN, but only an EMT on the ambulance.
The pt. went into V-Tach over 40 times during that trip, and was converted with PCT's each time.
The pt. was really beat up upon arriving at the U of M, saying please don't hit me again.
Back when, the proper procedure for delivering a PCT was to align the lower arm with the mid-line of chest, Elbow about nose area, and then a crashing blow down on the sternum with a closed fist.
Dose that sound familiar to anyone??
I have never done it that way, I felt the procedure took into account those in the medical field would probably be much smaller and weaker than i am.
I fold my fingers, and with an open palm, wrist flexed back, From the pt's side i bring arm down rapidly, and at the same time snap my wrist down, making contact with the sternum with my 2nd knuckle's.
More of a snapping action.
Practice it on a box or something that gives a little.
Ribs are broken in a PCT, my procedure is more in line with the sternum, and it has worked for me.
I wouldn't hesitate to thump someone that went down in my presence and i had no monitor handy, Not only that, but think about the time it takes to apply pads, power up(can be done simultaneously), analyze rhythm, indicate shock advised, Charge up, check for clear. then the button can be pushed. The thump can be done in just about the time it takes to push the Dad-Burn-Button, with analyzing done simultaneously!
Just think about that...
Where did that come from you ask;
Years ago my wife and i were transporting a cardiac to the twin city's 225 miles, and that was before ALS in our area. We did have a RN on board, actually 2 as the Mrs. is also an RN, but only an EMT on the ambulance.
The pt. went into V-Tach over 40 times during that trip, and was converted with PCT's each time.
The pt. was really beat up upon arriving at the U of M, saying please don't hit me again.
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chico.medic
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I just "thumped" a guy the other day that I witnessed go into V-Fib. Didn't work, but was worth a shot while w/ were getting the fast patches out. He converted after defibrillation.
Ridryder911
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Couple of things, PCT should NOT be administered to a non monitored patient. Remember, this would be the same as defib someone at 4 joules of electricity, without a monitor! Would you shock somone without a monitor, or AED type of device?
If you are breaking ribs or producing so much force to do such, you are incorrectly performing it. This is the reason it was removed from the CPR and general ACLS courses more than twenty years ago. Yes, it is performed by measuring from nose (elbow) to about 6 inches upward, from mid sternum, with a quick thump. If used it should be only performed once and used only when a defibrillator is not readily available. It has never been thought as a replacement for cardioversion, or electrical therapy. By performing PCT, one better have a license and certification in advanced cardiac care, as it is NOT taught or recommended in lesser levels.
It has been proven it is more beneficial to perform CPR for one minute, if the monitor is not readily available or unable to immediate charge for defib. (As per 2005 ACLS Standards).
Let's not get away from the current National Standards, which most EMS and EMT's treatment is based upon.
R/r 911
If you are breaking ribs or producing so much force to do such, you are incorrectly performing it. This is the reason it was removed from the CPR and general ACLS courses more than twenty years ago. Yes, it is performed by measuring from nose (elbow) to about 6 inches upward, from mid sternum, with a quick thump. If used it should be only performed once and used only when a defibrillator is not readily available. It has never been thought as a replacement for cardioversion, or electrical therapy. By performing PCT, one better have a license and certification in advanced cardiac care, as it is NOT taught or recommended in lesser levels.
It has been proven it is more beneficial to perform CPR for one minute, if the monitor is not readily available or unable to immediate charge for defib. (As per 2005 ACLS Standards).
Let's not get away from the current National Standards, which most EMS and EMT's treatment is based upon.
R/r 911
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Rid said;
Were you thinking about the Dog's shock collar?, Uncle John's electric fence, or deputy Marks Tazer?
If you are asking if i would thump without a monitor, I think you know the answer to that one.
Would i delay or omit any thing to do this, again i think you know the answer.
Will i sleep well knowing i did everything possible, Thats a yes.
One must remember, when i am 30-50 min out, most wouldn't/Might not do anything. I am not in that circle.
Were you thinking about the Dog's shock collar?, Uncle John's electric fence, or deputy Marks Tazer?
If you are asking if i would thump without a monitor, I think you know the answer to that one.
Would i delay or omit any thing to do this, again i think you know the answer.
Will i sleep well knowing i did everything possible, Thats a yes.
One must remember, when i am 30-50 min out, most wouldn't/Might not do anything. I am not in that circle.
chico.medic
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I was a little pre-occupied with concentrating on my target, whilst holding onto the ceiling railing with my other hand because my partner, Mario Andretti, was in front, rocketing my Ford Econovan-350 around a corner, into opposing traffic at 90 MPH. Not sure if it made a "bump" on the monitor. (Maybe he wasn't in V-Fib after all, and it was just artifact from the EMT driving! :unsure
All I know is the before/after looked the same and it returned to an organized sinus rhythm-- w/ those tombstones we all know and love-- after I delivered 200J of Edison Medicine, (My LEMSA hasn't adopted the new ACLS yet).
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Holly Molly;
I sure hope you were doing a touch of exaggerating on that speed issue.
Our protocol demands that we pull over and stop to analyze(AED) rhythm & shock.
There are known cases of slowing down to do this.
With our roads its a common thing for the AED to give us a "Check Pt." message, I usually tell the pt., that it should say "Check Road",
Most defibs (if not all) will print out several seconds of pre- print time tracings.(i know there is better terminology for that ,Hey it's 0540).
Hypothetical Situation;
You are hunting with (Dad, Granddad, Whom-ever) and they may or mayn't have MI, HX.
They code on you, right in front of you, or someone else at the hunting shack. You are right there,but may not see the event unfold. You assess and maybe give a quick PCT and rescue breath, (although this person would almost certainly be in agonal breathing). start chest compressions, assess after 1 min, deliver PCT,resume CPR.
Help is being summoned, 30-60 min away,
"IS" there anyone, "ANYONE" that wouldn't feel right delivering one or more PCT"s?.
Now if you are within 4-10 min of ALS this need not be considered.
I sure hope you were doing a touch of exaggerating on that speed issue.
Our protocol demands that we pull over and stop to analyze(AED) rhythm & shock.
There are known cases of slowing down to do this.
With our roads its a common thing for the AED to give us a "Check Pt." message, I usually tell the pt., that it should say "Check Road",
Most defibs (if not all) will print out several seconds of pre- print time tracings.(i know there is better terminology for that ,Hey it's 0540).
Hypothetical Situation;
You are hunting with (Dad, Granddad, Whom-ever) and they may or mayn't have MI, HX.
They code on you, right in front of you, or someone else at the hunting shack. You are right there,but may not see the event unfold. You assess and maybe give a quick PCT and rescue breath, (although this person would almost certainly be in agonal breathing). start chest compressions, assess after 1 min, deliver PCT,resume CPR.
Help is being summoned, 30-60 min away,
"IS" there anyone, "ANYONE" that wouldn't feel right delivering one or more PCT"s?.
Now if you are within 4-10 min of ALS this need not be considered.
PArescueEMT
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i'm lucky enough that the local fire co for my hunting grounds left a first in bag at my property. I have taught most of the people up there how to use the equipment. This all came from a drowning i responded on my dirt bike to a few properties over. I DID thump x2 since the ambulance was 30mins out. and the kid flew after 2 shocks with ROSC. It's not really something you think about in the heat of the moment... to quote and old Nike slogan, you "just do it"
Ridryder911
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One needs to remember the point of a PCT. It is used only to help terminate V-fib or V-tach, that's it. If you are not able to see that, then you really do not know what you have, as well PCT on a patient with a rythm may actually cause v-fib (vulnarable period). Yes, it can be dangerous and lethal! So one needs to be very cautious and as well, it should be in your standard protocols. If it is not, then one should not perform it!.
There is a reason, they no longer actively teach it or recognize it as a standard of care.
R/r 911
There is a reason, they no longer actively teach it or recognize it as a standard of care.
R/r 911
chico.medic
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I thought there was sufficient sarcasm in that post, indicating I was only kidding. Maybe not.
EMTmetzger
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what are Precordial Thumps?
Ridryder911
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Google can answer ...
wow, I did not realize that PCT's can cause v-fib! Thanks for that information, It'll definately change how I view this issue. How much do protocols vary regarding PCT's typically?
With our service,
I asked the Medical director, He said he has no problem with using PCT's,
No protocol, use with a monitored pt. witnessed arrest, V-fib or V-tach.
So Rid,
When you stated;
What is this "Vulnerable period" you are cautioning about, PVC's? as "V-Fib" is quite lethal in and of itself.
I asked the Medical director, He said he has no problem with using PCT's,
No protocol, use with a monitored pt. witnessed arrest, V-fib or V-tach.
So Rid,
When you stated;
What is this "Vulnerable period" you are cautioning about, PVC's? as "V-Fib" is quite lethal in and of itself.
Ridryder911
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Vulnerable period is the point of where the cells are responsive to stimulus after refractory period of depolarizing the cells. It is between the R & mid T wave on the ECG.
This is where when "cardioversion" occurs and where someone is cardioverting the patient. The ECG senses the upward "R" wave (one will see a "blip" bright point on the monitor oscilloscope in synch mode) and the defib will automatically "fire" on this area. It would be difficult to perform such maneuver without a automatic sensing device. In other words, when someone is "cardioverting" the defib is synchronizing with the monitor (hence synchronized cardioversion), the operator only holds the button down and allows to the defib to fire. Also why it is so dangerous of not "waving" charge paddles around in a sych mode. Any artifact resembling a R wave can cause discharge.
The same concern of the "R on T" wave PVC. Again, firing on the "vulnerable period" which can cause v-fib....
So in theory, without monitoring and thumping randomly, one could produce the "joules" on that location causing v-fib...
Again, it has been proven not to be very effective, especially in comparison to electrical therapy or Edison medicine.
R/r 911
This is where when "cardioversion" occurs and where someone is cardioverting the patient. The ECG senses the upward "R" wave (one will see a "blip" bright point on the monitor oscilloscope in synch mode) and the defib will automatically "fire" on this area. It would be difficult to perform such maneuver without a automatic sensing device. In other words, when someone is "cardioverting" the defib is synchronizing with the monitor (hence synchronized cardioversion), the operator only holds the button down and allows to the defib to fire. Also why it is so dangerous of not "waving" charge paddles around in a sych mode. Any artifact resembling a R wave can cause discharge.
The same concern of the "R on T" wave PVC. Again, firing on the "vulnerable period" which can cause v-fib....
So in theory, without monitoring and thumping randomly, one could produce the "joules" on that location causing v-fib...
Again, it has been proven not to be very effective, especially in comparison to electrical therapy or Edison medicine.
R/r 911
So;
Even though the school of thought is to deliver only 1 PCT(PT), There are talks about multiple thumps.
Like;
That quote if found here;
http://www.ncbi.nlm.nih.gov/sites/entrez?cmd=Retrieve&db=PubMed&list_uids=2087859&dopt=AbstractPlus
I just like the idea of giving something more than one shot.
(can be hard to do with a flintlock rifle)
Even though the school of thought is to deliver only 1 PCT(PT), There are talks about multiple thumps.
Like;
.
That quote if found here;
http://www.ncbi.nlm.nih.gov/sites/entrez?cmd=Retrieve&db=PubMed&list_uids=2087859&dopt=AbstractPlus
I just like the idea of giving something more than one shot.
(can be hard to do with a flintlock rifle)
doc5242
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PCT from a bls provider...?? can you spell lawsuit and loss of card for being out side the scope of practice?.. not a good idea, in my experience, and from what i have seen, they do not work and are ineffective.