- Precordial thump
A precordial thump is a
medical procedureused in the initial response to a witnessed cardiac arrestwhen no defibrillatoris immediately available. It can be used as a small part of the provision of advanced cardiac life support(ACLS). About 25% of patients in cardiac arrest who received a thump on the precordiumregain cardiac function (Scherf and Bornemann:, 1960)
To perform a precordial thump, a highly trained provider such as a
paramedic, physicianor registered nursestrikes a single very carefully aimed blow with the fist to the center of the patient's sternum. The intent is to possibly interrupt a life threatening rhythm. The precordial thump is thought to produce an electrical depolarizationof 2 to 5 joules. However, the thump is effective only if used at the onset of ventricular fibrillationor pulseless ventricular tachycardiaand so should be used only when the arrest is witnessed or monitored. There is no evidence that the precordial thump improves recovery in unwitnessed cardiac arrest.
A precordial thump may be given just once. While the odds of success are poor, if a precordial thump is done properly little time is lost. The provider will immediately continue with other ACLS skills, or
CPRif the needed ACLS drugs and equipment (such as a defibrillator) are unavailable.
The performance of a precordial thump is "outside the scope" of
first aidand requires "at minimum" training in advanced cardiac life support. ACLS is performed primarily by physicians, paramedics and nurses with advanced training in emergency care.
The use of the precordial thump technique has sometimes been shown in
movies and television, usually in passing without any explanation. Untrained laypersons have been known to attempt it and sometimes cause additional injury to the patient as the blow must be carefully aimed. Commotio cordis, cardiac arrest caused by blunt trauma to the heart, may ensue if a precordial thump is applied with a wrong timing.
Jack Penningtonand Bernard Lown's cardiology group at Harvard Universityare credited with formalizing this technique in the medical literature. They published their report in the New England Journal of Medicinein the early 1970s. Drs. Richard S. Cramptonand George Craddock, cardiologists at the University of Virginiahelped to promote the paramedicuse of chest thump through a curious accident. In 1970, the Charlottesville-Albemarle Rescue Squad (VA) was transporting a patient with an unstable cardiac rhythmin what was then called a Mobile Coronary Care Unit. When the vehicle inadvertently hit a speed bump in a shopping center parking lot, the patient's normal heart rhythm was restored. Further research confirmed that chest thumping patients with life-threatening arrhythmias could save lives [http://www.rwjf.org/files/publications/books/2000/chapter_10.html#fourteen] .
* [http://www.resus.org.au/public/guidelines/section_11/precordial_thump.htm Precordial Thump & Fist Pacing] . Australian Resuscitation Council Guideline (in PDF)
Advanced cardiac life support
* Scherf D, and Bornemann C: Thumping of the precordium in ventricular standstill. "American Journal of Cardiology" 1960; 1 (1): 30-40
* Kloeck W. et al. The Universal Advanced Life Support Algorithm. An Advisory Statement From the Advanced Life Support Working Group of the International Liaison Committee on Resuscitation . "Circulation". 1997;95:2180-2182. [http://circ.ahajournals.org/cgi/content/full/95/8/2180 Full paper] .
* Caldwell G, Millar G, Quinn E, Vincent R, Chamberlain DA. Simple mechanical methods for cardioversion: defence of the precordial thump and cough version. "Br Med J" 1985; 291:627-30.
* Miller J, Tresch D, Horwitz L, Thompson BM, Aprahamian C, Darin JC. The Precordial Thump. "Ann Emerg Med" 1984; 13:791-4.
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