Percussion pacing

Brandon O

Brandon O

Puzzled by facies
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It sounds like CPR
 
Nah... much less force, different location... read through that article, some good stuff there.
 
Its often referred to as "precordial thumps". It's NOT C.P.R. insofar as its goal isn't to mechanically pump the heart. The aim is to stimulate the cardiac tissue to self-excite (since we all know that heart cells are each capable of independent electrical stimulus). By "thumping" the chest with a closed fist, the belief is that you can reset a pacing problem (i.e. PEA or J-Waves), as the trauma might cause the cells to initiate an electrical impulse, which would then be carried to the surrounding cells.

Our protocol dictates that it should only be used when advised by online medical, and since it is an imperfect science and still debated, its probably not that commonly used. However, TV loves it, and its not uncommon to see fictional MDs winding up and sternum bashing a fresh corpse. I just watched a lesser known Hugh Jackman movie called 'The Fountain' yesterday which included just such a maneuver.

This is what we were taught in class about 'precordial thumps', and I'm sure there's a plethora of online stuff to read about it.

-Ryan.
 
Seriously guys... read the link. It's neither chest compressions (meant to mechanically squeeze the heart) nor the precordial thump (meant to cardiovert). It's pacing. With your fist.
 
The only difference I'm reading is that PC thumps are only performed once at the beginning of a witnessed unstable rhythm or asystole, and that percussive pacing is done to the desired rate.

The maneuver itself seems identical, as well as the statistics regarding successful survival or reactivation.

I call this one a case of too many doctors independently researching the same thing.
 
Sounds like they were percussing over the heart to induce ventricular depolarization. This is not the same thing as chest compressions, although chest compressions would have also been prudent in this case until a TC pacer could have been applied. With the availability of TCP, I do not see this technique being used at all. Plus, they were in an electrophysiology/cath lab, so why the heck could they have not tried other options?
 
That wasn't too clear. Hopefully not just to see if they could. But they may have just tried it and found that it was working great, therefore continued until the sinus rhythm returned. We're only talking 3 minutes here, so it may have taken them that long to dig up the equipment. (And to push epi and atropine -- why the latter, by the way? I didn't think atropine was normally considered much help in third-degree block?)

Anyway, just thought this was interesting stuff.
 
RyanMidd said:
By "thumping" the chest with a closed fist, the belief is that you can reset a pacing problem (i.e. PEA or J-Waves), as the trauma might cause the cells to initiate an electrical impulse, which would then be carried to the surrounding cells.
Click to expand...

What say you??

How does pacing fix PEA??
 
PEA isn't an electrical problem, because as it's former name, "Electrical-mechanical dissociation" implies, it's that the actual muscle of the heart that's not responding to the electrical stimulus by the foci.


There isn't a pacing problem with PEA, therefor I don't see how a PT can fix it.
 
Linuss said:
PEA isn't an electrical problem, because as it's former name, "Electrical-mechanical dissociation" implies, it's that the actual muscle of the heart that's not responding to the electrical stimulus by the foci.


There isn't a pacing problem with PEA, therefor I don't see how a PT can fix it.
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exactly. also, don't think pounding on their chest will get rid of the j-waves.
 
Percussion Pacing is old school. I have not even seen it done in the last 15 years. We used to be taught it. It can work, but why? We have technology for a reason!;)
 
reaper said:
Percussion Pacing is old school. I have not even seen it done in the last 15 years. We used to be taught it. It can work, but why? We have technology for a reason!;)
Click to expand...

Only known of it being done one time in the field....several years ago when the crew had a monitor malfunction. Don't recall the outcome.
 
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