Precordial thump

Source: Wikipedia, the free encyclopedia.
Precordial thump
Specialty
cardiology
]

Precordial thump is a

defibrillator is not immediately available.[1][2] It should not delay cardiopulmonary resuscitation (CPR) and defibrillation, nor should it be used in those with unwitnessed out-of-hospital cardiac arrest.[1][3]

Procedure

In a precordial thump, a provider strikes at the middle of a person's

sternum with the ulnar aspect of the fist.[4] The intent is to interrupt a potentially life-threatening rhythm. The thump is thought to produce an electrical depolarization of 2 to 5 joules.[citation needed
]

Effectiveness

Precordial thump may be effective only if used within seconds near the onset of ventricular fibrillation or pulseless ventricular tachycardia,[5] and so should be used only when the arrest is witnessed and monitored. There is no evidence that precordial thump improves recovery in unwitnessed cardiac arrest.[citation needed] It is also not useful against ventricular fibrillation after time has passed.[6] It has very low efficacy against ventricular arrythmia[7] (possibly even making it worse)[4][7] and ventricular tachycardia,[2] especially compared to the alternatives of CPR and defibrillation.

While the odds of success are poor, the procedure is rapid, allowing the provider to continue with other resuscitation procedures, including CPR, medication and defibrillation as appropriate.[citation needed]

Adverse effects and appearance

There are concerns that the precordial thump can result in worsening of a person's heart rhythm more often than it improves it.[2]

The use of the precordial thump technique has sometimes been shown in famous

movies and television, such as in The Good Doctor Season 2 episode 5 in which it is performed by Dr. Brown, and The Resident Season 1 episode 2 in which it is performed by Conrad Hawkins, usually in passing without any explanation. Untrained laypersons have been known to attempt it, and sometimes cause additional injury to the person as the blow must be carefully aimed. If applied incorrectly it may cause further injury, for instance inducing cardiac arrest by blunt trauma, or breaking the tip of the sternum, risking fatal damage to the liver or other abdominal organs.[citation needed
]

At one time, the technique was also taught as part of standard CPR training with the requirement that it must be administered within 60 seconds of the onset of symptoms. That time restriction, combined with a number of injuries caused by improper technique,[citation needed] resulted in the procedure being removed from CPR training.

History

James E. Pennington and

arrhythmias could save lives.[8]

Fist pacing

Percussion pacing or fist pacing was proposed as a method of delivering mechanical pacing to someone in cardiac arrest. There is little evidence to support its use.[9] In 1920, German physician Eduard Schott originally described percussion pacing, and a 2007 BJA article describes good benefit to this technique.[10]

References

  1. ^
    PMID 26472989
    .
  2. ^
  3. ^ .
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  6. ^ .
  7. ^ Diehl, Digby (2000). "The Emergency Medical Services Program". To Improve Health and Health Care. Vol. 2000. Robert Wood Johnson Foundation. p. 21. {{cite book}}: |work= ignored (help)
  8. ^ "Guideline 11.3: Precordial Thump & Fist Pacing" (PDF). Index of Guidelines. Australian Resuscitation Council and New Zealand Resuscitation Council. July 2011. Archived from the original on October 6, 2011. Retrieved February 15, 2014.
  9. PMID 17327252
    .