The Precordial Thump

[jpbaker1988]

I was curious about the technique know as the "precordial thump", also referred to as the cardiopulmonary thump. It has been used in films and was initially part of standard CPR training but was discontinued due to cardiac injuries by untrained laypersons. Has anyone seed it done on witnessed v-fib? Has anyone ever seen it performed or performed it themselves where the resuscitation was successful? I'd love to hear everyone's thoughts on it.

 

[mycrofft]

It was D/C because..................

it was ineffective. Otherwise, MD's would still be doing it. What kind of cardiac injury was it supposed to inflict?

Our empiric knowledge of field resuscitation is littered with stuff that seemed to work but when followed long term was discovered not to work after all. SOmetimes when Granpaw c/o chest pain, passed out, then sat up, he would have anyway without the swig of brandy, sniff of sal ammoniac, etc. Also, some stuff might work for a few, but generally it was wasting precious time pounding on their chest when we could be, oh, rolling them over a big barrel or blowing irritating smoke into their mouths and nose.

 

[Akulahawk]

The thump can be effective in witnessed arrests where the person is known to be in VF or VT... here's the problem. The joules delivered to the heart depend upon how hard the thump is delivered and how can you be certain that you are delivering enough energy consistently? You can't... There's just too much variability involved.

The Defib machines are far more effective and consistently so...

Then there's the visual thing of a medical person appearing to beat the beejeezus out of someone... BEGONE CARDIAC DEMON!! (THUMP) BEGONE!!!

You'd actually have a better use of your time to reach for the paddles or applying the pads to the patient to deliver a more effective treatment than to be thumping away on someone's chest.

 

[Shishkabob]

I've seen it done once, by a doctor on a patient that went in to VF just after RSI.


It has been documented successful, but it has to be done RIGHT away. But you should only do it while someone else is getting the pads on.

 

[JPINFV]

it was ineffective. Otherwise, MD's would still be doing it. What kind of cardiac injury was it supposed to inflict?

A conversions a conversion, no matter the route. A conversions a conversion no matter how.

When applied properly, a thump works well. However given the choice of a thump or a defibrillator, I'd place bets on the defibrillator. However if a thump can be applied without delaying a defibrillator, I can't see why not to apply it.

 

[MasterIntubator]

I have done it once with conversion, but it was like as soon as the monitor showed fib, and you are looking at the pt... "Dude, you ok?".... and he says NO. and out he went.
Had a handful of times where it did not change a thing other than making me look like the hulk whapping the pt.

A couple other medics in our system have done it and got good change. I really think all of the moons need to be lined up for something like this to happen to me again.

 

[JPINFV]

Then there's the visual thing of a medical person appearing to beat the beejeezus out of someone... BEGONE CARDIAC DEMON!! (THUMP) BEGONE!!!

...but when it doesn't work, we can just blame Boone for not getting us epinephrine in a cardiac needle fast enough.


/Might be obscure, but source is well known.

 

[Akulahawk]

...but when it doesn't work, we can just blame Boone for not getting us epinephrine in a cardiac needle fast enough.


/Might be obscure, but source is well known.

Isn't that about the time you push the cardiologist out of the way and call for a cardiac exorcist?

 

[Martyn]

We got told during our training NOT to do it :sad:

 

[JPINFV]

We got told during our training NOT to do it :sad:

As an EMT, how do you know that the patient is in v-fib or v-tach to begin with?

 

[Shishkabob]

As an EMT, how do you know that the patient is in v-fib or v-tach to begin with?

"Shock advised. Charging."

 

[JPINFV]

"Shock advised. Charging."

....and at that point a thump is pointless.


Dear instructors,

Teach your students WHY not to do things. You insisting that either thinking and understanding isn't needed or that your students are too stupid to think and understand is THE PROBLEM with EMS. You are THE PROBLEM.

Sincerely,
The EMT-Medical Student.

 

[mycrofft]

10-4 that Linus

Anecdotal observations do not indicate it is widely-enough effective, or that some cases would not have snapped out of it spontaneously. When it didn't work, oh well, they rarely live anyway, right? Bury the victims.

PS: JPNV, you can thump me while your pretty sidekick slaps the electrodes on!

 

[abckidsmom]

I've done it once with success. I would do it again as I was reaching across the patient to the monitor. It doesn't take that much time at all.

 

[Shishkabob]

....and at that point a thump is pointless.

Not at all. Still takes 3-5 seconds for the average AED to charge.


Literally wham-bam-thankyou ma'am.

 

[JPINFV]

Anecdotal observations do not indicate it is widely-enough effective, or that some cases would not have snapped out of it spontaneously. When it didn't work, oh well, they rarely live anyway, right? Bury the victims.

PS: JPNV, you can thump me while your pretty sidekick slaps the electrodes on!

When it's literally the only option, yes. Does it work? Sometimes. Should it be used if it is going to delay something like defibrillation? No.

Sure, it can be used while pads are applied in a monitored patient. However, in a witnessed BLS arrest, you don't know what rhythm the patient is in.

 

[JPINFV]

Not at all. Still takes 3-5 seconds for the average AED to charge.


Literally wham-bam-thankyou ma'am.

Which would really suck if the thump converts the patient to a perfusing rhythm and the AED shocks them right back.

 

[Cup of Joe]

Not at all. Still takes 3-5 seconds for the average AED to charge.


Literally wham-bam-thankyou ma'am.

Would a semi-automatic AED interpret the thump as a change in the rhythm and advise to continue CPR rather than actually delivering the shock?

Do the AEDs continue to analyze the rhythm while they charge?

 

[Shishkabob]

Which would really suck if the thump converts the patient to a perfusing rhythm and the AED shocks them right back.

And everyone would be non-the-wiser.

 

[firemedic0227]

When we were going through ACLS it was Emphasized that we DO NOT DO this anymore because it's ineffective most of the time.