Ethanol4all
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Hey, I'm a newly licensed SoCal EMT-B...... and I never really heard of it in class .....but are Precordial Thumps CPR protocol? and are they proven to actually work?
Precordial Thumps
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SwissEMT
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I've heard of a three stories where they worked.
Ridryder911
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PreCordial Thumps, produce 0.4 joules of electrical shock. They have proven to work very effective in certain conditions and settings. AHA has removed PCT due to the advantage of having AED, and defibrillators that can deliver enough joules to convert rhythms such as V-Tach an V-Fib. It was removed because idiots was performing it incorrectly and as well patients were not being monitored prior. It is NOT part of the Basic or general Health Provider BLS criteria.
It can be used when the patient is on ECG monitor and defibrillation is not imminently available. Now these days is unusual to have a patient monitored and not have some form of defib readily available. Most ACLS courses no longer even address PCT or "fist pacing" (Which is repeatedly PCT), for brady rhythms until a pace maker can be placed. Yes, they worked and was used until better technology was available.
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It can be used when the patient is on ECG monitor and defibrillation is not imminently available. Now these days is unusual to have a patient monitored and not have some form of defib readily available. Most ACLS courses no longer even address PCT or "fist pacing" (Which is repeatedly PCT), for brady rhythms until a pace maker can be placed. Yes, they worked and was used until better technology was available.
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Airwaygoddess
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"RAMPART, THIS IS SQUAD 51 !"
Summit
Critical Crazy
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Do you think there are there wilderness applications for PCT in unmonitored patients in situations where neither AED nor monitor is going to show up in the next 30 min or 2hrs?
firecoins
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yes, it can be used in that situation
Ridryder911
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Actually, it used to be recommended that an witnessed cardiac arrest receive a PCT while getting an monitor/defib ready. If they are truly pulseless, what is it going to hurt?
Now with said, * I am not responsible for breaking protocols, injuries sustained, etc... etc..
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Now with said, * I am not responsible for breaking protocols, injuries sustained, etc... etc..
R/r 911
BossyCow
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Okay Rid... just since its you with your focus on spelling and grammar.....
did you mean 'a witnessed cardiac arrest' or 'an unwitnessed cardiac arrest'.
Ridryder911
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lol... A witnessed arrest.. spell check got me!
R/r 911
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We use them here in BC, Canada, but not all provinces do. Saskatchewan didn't, for example.
My protocols say that I precordial thump a witnessed arrest. Logic there is that it may resuscitate the pt since they've only been down a few seconds. Then we move to CPR and defibrillations. An unwitnessed arrest requires us to move our *** and get CPR underway and since an undeterminable amount of time has passed it is going to be pretty much a futile effort anyway. But if you know the pt and they owe you money, well, you may as well give 'em one anyway.
My protocols say that I precordial thump a witnessed arrest. Logic there is that it may resuscitate the pt since they've only been down a few seconds. Then we move to CPR and defibrillations. An unwitnessed arrest requires us to move our *** and get CPR underway and since an undeterminable amount of time has passed it is going to be pretty much a futile effort anyway. But if you know the pt and they owe you money, well, you may as well give 'em one anyway.
Never heard that one before. Nice.
This is also known as Percussion Pacing.
It was popular in the 1970s and is still studied according to articles appearing in several European Medical Journals.
http://www.americanheart.org/downloadable/heart/1104859986186a.fistpacing.CE.12Dec04Final.pdf
DT4EMS
Kip Teitsort, Founder
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I have tried the Precordial Thump a couple of times over the years. Both were during witnessed arrests. On one, a 74 y/o male on a side street, while I was off-duty. He left the hospital and lived for about 6 more months.
The precordial thump and fist pacing were a part of my medic school training.
As a side note............. the cough was talked about back then too.
The precordial thump and fist pacing were a part of my medic school training.
As a side note............. the cough was talked about back then too.
KEVD18
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in this scenario, do anything that comes into your mind. they are dead, and are more than likely going to stay dead.
(not responsible for the actions of persons who heed my advice)
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I've talked about it with some "old-heads"... and my understanding was that it was still on the AHA's curriculum, at least until the last revision.
If I wittnessed a cardiac arrest, ESPICIALLY if I am off-duty... I might thump the patient... on duty... well - I don't know... it would be against my protocol... but if they were dead, and now aren't... should they really complain?
If I wittnessed a cardiac arrest, ESPICIALLY if I am off-duty... I might thump the patient... on duty... well - I don't know... it would be against my protocol... but if they were dead, and now aren't... should they really complain?
If you witness the arrest, there's no harm done if you try a PT. It may or may not work, but it only takes a few seconds to attempt. I wouldn't try this, however, if in school you were not taught the proper technique, as commodio cordis (sp?) can occur if done wrong. I personally would not attempt it as of now, since I have not been trained in it, but situations do change...
Arkymedic
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I have seen it work once in the ER with a witnessed arrest.
Arkymedic
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You beat me to it. I was going to ask if it was the same as percussion lol.
I have used PCT on 2 patients. That is 2 where it made a difference. Both walked away from the hospital.
1st one the unit was squawking "No shock indicated" w/ flat line.
When we rolled pt for long board i saw v-fib gave pt. a thump and she converted. Enroute she went int V-Fib 3 more times and i thumped her each time. When she would revert the skin color changed almost immediately, and upon converting with the thump Pt's color would change back just as fast.
Pt got a pacer and is still alive today. 20 + years!
2nd was in a seniors complex across the st. from my residence.
Late at night Pt called for self, and i respond directly there w/pass keys. When i got into apartment pt. was in agonal breathing, Pulsless.
I started CPR and after 1 min, I gave pt a thump and got pulse back.
She lived 3-4 years.
The very next afternoon we were paged to a chocking adult male 80 years old.
When i got on scene, pt had lost con. and was just being lowered to floor by LEO's. We had intercept agreements by now, so one was enroute 14 miles.
After 6-7 procedures (BB, FS CC) another EMT?CPR instructor arrived and took his turn. Then i stopped everything, I had 2 assistants lift PT. to a sitting position by the arms, Butt off the floor, then I did the abdominal thrust as hard as i could about 8 times. I am 6' 4" and 250lbs, and i was squeezing for all i was worth and then some. He started to crock like a seal, and we started CPR w/ Hi flo O2, and transported. Met the intercept and pt was bagged to Hosp. Received last rites, and next day woke. No injury, No pain!
was home after one more day. His wish was "He wanted that big guy to be a pallbearer when the time came. It was 3 years and i was honored.
What a day that was for me. 2 saves in under 24 hrs. (rural service-380 annual runs).
1st one the unit was squawking "No shock indicated" w/ flat line.
When we rolled pt for long board i saw v-fib gave pt. a thump and she converted. Enroute she went int V-Fib 3 more times and i thumped her each time. When she would revert the skin color changed almost immediately, and upon converting with the thump Pt's color would change back just as fast.
Pt got a pacer and is still alive today. 20 + years!
2nd was in a seniors complex across the st. from my residence.
Late at night Pt called for self, and i respond directly there w/pass keys. When i got into apartment pt. was in agonal breathing, Pulsless.
I started CPR and after 1 min, I gave pt a thump and got pulse back.
She lived 3-4 years.
The very next afternoon we were paged to a chocking adult male 80 years old.
When i got on scene, pt had lost con. and was just being lowered to floor by LEO's. We had intercept agreements by now, so one was enroute 14 miles.
After 6-7 procedures (BB, FS CC) another EMT?CPR instructor arrived and took his turn. Then i stopped everything, I had 2 assistants lift PT. to a sitting position by the arms, Butt off the floor, then I did the abdominal thrust as hard as i could about 8 times. I am 6' 4" and 250lbs, and i was squeezing for all i was worth and then some. He started to crock like a seal, and we started CPR w/ Hi flo O2, and transported. Met the intercept and pt was bagged to Hosp. Received last rites, and next day woke. No injury, No pain!
was home after one more day. His wish was "He wanted that big guy to be a pallbearer when the time came. It was 3 years and i was honored.
What a day that was for me. 2 saves in under 24 hrs. (rural service-380 annual runs).