wilderness911
paramedic student
- 59
- 26
- 18
Let's talk precordial thumps! What did you think I was talking about, you deranged medics...
Some questions and some thoughts. Yes, I know it got bumped from ACLS, but my personal stance is that if I witness an arrest (confirm they are pulse less, someon, etc) I am sure as hell going to thump the patient before I get started on anything else. Why? Because it's not going to hurt them, think - I guess it could theoretically cause cardioversion to a worse arrhythmia, but is that likely? More importantly it might help them, especially if I am off duty and the chances of a defibrillator on hand before medics arrive on scene are slim (and no, I don't cruise the streets in my Ricky rescue cape looking for arrests to thump). Plus, it is, in my opinion, the coolest freakin procedure in emergency medicine. Never had the occasion to try one myself, though, as all my arrest patients have been down for a couple minutes prior to arrival on scene.
So, why has the precordial thump fallen out of favor? The other day I was in a rig for a lively debate between an EM resident who claimed that it was useless and a 27-year paramedic captain who claimed to have personally performed it successfully on a number of patients, and sometimes multiple times on the same patient which sounds reasonable given the likelyhood of returning to a bad rhythm after cardioversion in the field. I have talked to plenty of folks who claim it has worked for them or they have seen it done successfully, but without seeing a strip to confirm its obviously impossible to make any scientific conclusions from that. So time for an unscientific poll. It would be interesting to get an idea how many of us have would/wouldn't use it, have used it successfully/unsuccessfully, or have heard from trusted colleagues who reported using it successfully.
Lastly, as an aside, I was in the shower the other day mulling precordial thumping and I had a thought...I always wondered how to get away with it without bystanders assuming I am a violent or unskilled a-hole. And then it hit me...if I ever have the occasion to use it, I am going to yell "Stand clear - administering precordial thump" in my best George C looney from ER voice and then administer a mighty blow. If that fails, at least I will sound like I knew what I was doing. Good plan right?
- Wilderness911 out
Some questions and some thoughts. Yes, I know it got bumped from ACLS, but my personal stance is that if I witness an arrest (confirm they are pulse less, someon, etc) I am sure as hell going to thump the patient before I get started on anything else. Why? Because it's not going to hurt them, think - I guess it could theoretically cause cardioversion to a worse arrhythmia, but is that likely? More importantly it might help them, especially if I am off duty and the chances of a defibrillator on hand before medics arrive on scene are slim (and no, I don't cruise the streets in my Ricky rescue cape looking for arrests to thump). Plus, it is, in my opinion, the coolest freakin procedure in emergency medicine. Never had the occasion to try one myself, though, as all my arrest patients have been down for a couple minutes prior to arrival on scene.
So, why has the precordial thump fallen out of favor? The other day I was in a rig for a lively debate between an EM resident who claimed that it was useless and a 27-year paramedic captain who claimed to have personally performed it successfully on a number of patients, and sometimes multiple times on the same patient which sounds reasonable given the likelyhood of returning to a bad rhythm after cardioversion in the field. I have talked to plenty of folks who claim it has worked for them or they have seen it done successfully, but without seeing a strip to confirm its obviously impossible to make any scientific conclusions from that. So time for an unscientific poll. It would be interesting to get an idea how many of us have would/wouldn't use it, have used it successfully/unsuccessfully, or have heard from trusted colleagues who reported using it successfully.
Lastly, as an aside, I was in the shower the other day mulling precordial thumping and I had a thought...I always wondered how to get away with it without bystanders assuming I am a violent or unskilled a-hole. And then it hit me...if I ever have the occasion to use it, I am going to yell "Stand clear - administering precordial thump" in my best George C looney from ER voice and then administer a mighty blow. If that fails, at least I will sound like I knew what I was doing. Good plan right?
- Wilderness911 out
