The Precordial Thump

[mycrofft]

Point made

BTW, self-administered precordial does not help atria fib. Trust me.:wacko:

 

[webster44]

I'm pretty sure the most recent aha guidelines called for the reintroduction of the thump

Sent from mobile

 

[jjesusfreak01]

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

Good question. As mentioned, an AED that advises shock indicates that the patient is in Vfib or Vtach. You can also guess that a patient who simply "goes out" in front of you and is pulseless is probably in one of these rhythms (dropping straight into PEA or asystole isn't as likely unless the pt has a pre-existing problem).

The best use for it, however, is when you have a patient who is on a monitor, but not attached to the pads (or on a monitor that isn't a defibrillator). Remember that the precordial thump is most successful immediately after the patient goes into the nonperfusing rhythm.

So, that said, if you witness the patient going into vfib or vtach and you are physically standing over them and don't have the capability of shocking immediately, then a precordial thump is indicated and may be successful.

Where would I use it? Sitting in the back of my truck monitoring a patient with no pads on who drops into vfib/vtach. Also, if someone drops out in front of me, they are pulseless, and I don't think i'm going to get a defib anytime soon. Otherwise, i'll wait for the defib.

 

[IRIDEZX6R]

I've always been fascinated by this..

 

[Aidey]

I've done it once, without conversion. We were in the back and I thumped while the other medic got the pads (which worked) the pt was pulseless for less than a minute.

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

I was thisclose to thumping someone in a church in front of about 20 people. I still wish I had, because if it had worked it would be the most epic story ever. For the record he walked out of the hospital a week later.

 

[JPINFV]

I was thisclose to thumping someone in a church in front of about 20 people. I still wish I had, because if it had worked it would be the most epic story ever. For the record he walked out of the hospital a week later.

I imagine it would have been something like this?

[youtube]http://www.youtube.com/watch?v=8xU_vcb3kso[/youtube]

 

[IRIDEZX6R]

Ladies and gents.. the precordial thump...

 

[Aidey]

I imagine it would have been something like this?

[youtube]http://www.youtube.com/watch?v=8xU_vcb3kso[/youtube]

Probably, it was a Baptist church.








/apologies to the Baptists.

 

[BEorP]

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?

You would hope they do, but I have seen many cases where there was a rhythm change to non-shockable after or at the tail end of analysis that was still shocked.

 

[medicsb]

It has never been definitively shown to not work or to be harmful. But it's never been shown to consistently work. I believe the AHA rates "indeterminate." Anyhow, I know a few medics that have had it work. I tried it once and it didn't work (but the defib did!).

How about fist-pacing? Has anyone ever tried that? I know one long time medic who says she saw a cardiologist do it on patient he was taking to the cath lab.

 

[bigbaldguy]

I imagine it would have been something like this?

[youtube]http://www.youtube.com/watch?v=8xU_vcb3kso[/youtube]

I have got to sit down and watch that movie again.

 

[mycrofft]

My update didn't mention precordial thump/jump/whatever

.........

 

[JJR512]

Well, Dr. McCoy did it to Chancellor Gorkon in Star Trek VI: The Undiscovered Country, so clearly, in the future it will once again prove to be effective. At least on Klingons. Except he didn't survive, so maybe not...