Precordial Thumps

[Ridryder911]

If your going to cite material, be sure to include the remainder and as well to understand scientific readings and studies.

...... In 17 of the 37 cases of ventricular tachycardia. The mean tachycardia rate was significantly higher (176/min, range from 120 to 250/min) than in successfully treated cases. Altogether, ventricular tachycardias with heart rate less than or equal to 160/min were terminated by mechanical stimulation in 17 of 22 cases, and ventricular tachycardias with heart rate greater than 160/min only in 3 of 15 cases. Ventricular fibrillation (n = 3) or ventricular flutter (n = 7) was not interrupted in any case by precordial thumps. In patients with ventricular tachycardia, mechanical stimulation extends the therapeutic possibilities. The rate of success is higher, the lower the tachycardia rate. The tachycardia rate is the only predictive parameter for therapeutic success....

We need to be careful here, we are comparing apples to oranges. First, this is an old study and as well, other methods have been proven to be more effective and less harmful to patients. The article was in regards of termination of ventricular tachycardia versus ventricular fibrillation in scientific controlled setting. As well, the study does not describe if the V-Tach could had not been terminated with pharmacology agents such as Lidocaine or another antiarrhythmic.

I believe we are beating a dead horse... (no pun intended) PCT is only to be performed and administered by approved by ACLS personal on cardiac monitored patients when electrical therapy is prolonged. Immediate electrical defibrillation has been proven to be more effective than PCT, as well as synchronized electrical cardioversion is far better than PCT for those in symptomatic ventricular tachycardia (chest pain, hypotension) etc.

R/r 911

 

[DisasterMedTech]

Rid-

Am I reading correctly that you say a pre-cordal will deliver .4 jules, as in less than half a jule. I thought I remembered being taught that it was 4 jules and I cant find a source to confirm.

Please advise. Thank you, sir.

 

[Paramajik]

Check AMLS... ~5J. Even for the EMT-B. If its me punch me in the sternum as hard as you like and as many times as you like. My wife wont sue you. Im worth more dead than i am alive! hahahaha

 

[Aileana]

In the region I am doing my ride-alongs, from what I understand neither BLS nor ALS providers administer PCT's...

 

[DisasterMedTech]

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

I know this is an old thread, but I was re-reading and found what you have said here to be quite confusing. First you say that PCT has been removed from CPR and ACLS curriculum. Then you say a person better have ACLS if they are going to do it. Which is it? Im confused. What good would it do for a person to have ACLS if PCT has been removed?

 

[Ridryder911]

PCT has been removed from the general education to common ACLS (yes, there are different ACLS courses as well as in-depthness). It can be taught, as it is still a procedure according to emergency cardiac care committee (ECC) which makes recommendations for ACLS . The same as "anal sweep" to cause vagal stimulation is technically in the ACLS program however; usually never discussed often. The same as intubation is no longer taught or tested in the standard ACLS course. This does not mean one cannot teach it, or use it, however; it is no longer part of the standard. There is now a separate course in advanced airway.

There are multiple procedures and procedures that are involved in ACLS, however; are not usually taught or in the AHA ACLS health care provider standardized course. Remember ACLS is NOT just a course, rather a methodology of treatment and involves multiple arenas that are briefly discussed in a regular ACLS course.

R/r 911

 

[enjoynz]

Just shows you the differences between Countries.
We are taught right at the start of our Ambulance training, at the first level, to do a PCT on the Pt at a Witnessed Cardiac Arrest ONLY.
Our Station Officer had a pt a couple of months ago arrest on him, and did the PCT with good results, so it does work.
We don't have the same issues with law suits, etc that you deal with over there. We do still have to adhere to protocols and answer to the Ambulance Service, should something go wrong on a call.
We also have a protocol here, that after 20 mins CPR (Unless the PT has arrested secondary to hypothermia), the job is called if there is no result (ROSC) within that time frame, of course that does vary at times.

Cheers Enjoynz

 

[FFPARAMEDIC08]

If you witness the arrest, what can it hurt? Might as well try it..