Precordial thump
Encyclopedia
The precordial thump is a medical procedure
that may used by healthcare professionals, to respond to ventricular fibrillation
or ventricular tachycardia
under certain conditions. The procedure is outside the scope of first-aid
treatment and requires, at minimum, training in advanced cardiac life support
(ACLS). The precordial thump may be considered in those with witnessed, monitored, unstable ventricular tachycardia (including pulseless VT) if a defibrillator is not immediately ready for use, but it should not delay CPR and shock delivery or be used in those with unwitnessed out of hospital arrest.
of 2 to 5 joule
s. However, it is effective only if used near the onset of ventricular fibrillation
or pulseless ventricular tachycardia
, and so should be used only when the arrest is witnessed or monitored. About 25% of patients in cardiac arrest who received a thump on the precordium
regained cardiac function (Scherf and Bornemann, 1960); there is no evidence that the precordial thump improves recovery in unwitnessed cardiac arrest.
A precordial thump may be attempted only once during the onset of cardiac arrest. While the odds of success are poor, if the procedure is performed properly then little time is lost. The provider will immediately continue with other ACLS skills, including CPR, ACLS drugs, and defibrillation, as appropriate.
, 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. If applied incorrectly it may cause further injury, for instance inducing Commotio cordis
(cardiac arrest caused by blunt trauma) or breaking the tip of the sternum.
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, resulted in the procedure being removed from CPR training.
's cardiology group at Harvard University
are credited with formalizing this technique in the medical literature. They published their report in the New England Journal of Medicine
in the early 1970s. Drs. Richard S. Crampton and George Craddock
, cardiologists at the University of Virginia
helped to promote the paramedic
use of chest thump through a curious accident. In 1970, the Charlottesville-Albemarle Rescue Squad (VA) was transporting a patient with an unstable cardiac rhythm in 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.
Medical procedure
A medical procedure is a course of action intended to achieve a result in the care of persons with health problems.A medical procedure with the intention of determining, measuring or diagnosing a patient condition or parameter is also called a medical test...
that may used by healthcare professionals, to respond to ventricular fibrillation
Ventricular fibrillation
Ventricular fibrillation is a condition in which there is uncoordinated contraction of the cardiac muscle of the ventricles in the heart, making them quiver rather than contract properly. Ventricular fibrillation is a medical emergency and most commonly identified arrythmia in cardiac arrest...
or ventricular tachycardia
Ventricular tachycardia
Ventricular tachycardia is a tachycardia, or fast heart rhythm, that originates in one of the ventricles of the heart...
under certain conditions. The procedure is outside the scope of first-aid
First aid
First aid is the provision of initial care for an illness or injury. It is usually performed by non-expert, but trained personnel to a sick or injured person until definitive medical treatment can be accessed. Certain self-limiting illnesses or minor injuries may not require further medical care...
treatment and requires, at minimum, training in advanced cardiac life support
Advanced cardiac life support
Advanced cardiac life support or Advanced Cardiovascular Life Support refers to a set of clinical interventions for the urgent treatment of cardiac arrest and other life threatening medical emergencies, as well as the knowledge and skills to deploy those interventions.Extensive medical knowledge...
(ACLS). The precordial thump may be considered in those with witnessed, monitored, unstable ventricular tachycardia (including pulseless VT) if a defibrillator is not immediately ready for use, but it should not delay CPR and shock delivery or be used in those with unwitnessed out of hospital arrest.
Procedure
To perform a precordial thump, a highly trained provider strikes a single, very carefully aimed blow with the fist to a specific place on the patient's sternum. The intent is to interrupt a potentially life-threatening rhythm. The thump is thought to produce an electrical depolarizationDepolarization
In biology, depolarization is a change in a cell's membrane potential, making it more positive, or less negative. In neurons and some other cells, a large enough depolarization may result in an action potential...
of 2 to 5 joule
Joule
The joule ; symbol J) is a derived unit of energy or work in the International System of Units. It is equal to the energy expended in applying a force of one newton through a distance of one metre , or in passing an electric current of one ampere through a resistance of one ohm for one second...
s. However, it is effective only if used near the onset of ventricular fibrillation
Ventricular fibrillation
Ventricular fibrillation is a condition in which there is uncoordinated contraction of the cardiac muscle of the ventricles in the heart, making them quiver rather than contract properly. Ventricular fibrillation is a medical emergency and most commonly identified arrythmia in cardiac arrest...
or pulseless ventricular tachycardia
Ventricular tachycardia
Ventricular tachycardia is a tachycardia, or fast heart rhythm, that originates in one of the ventricles of the heart...
, and so should be used only when the arrest is witnessed or monitored. About 25% of patients in cardiac arrest who received a thump on the precordium
Precordium
In anatomy, the precordium is the portion of the body over the heart and lower chest.Precordial chest pain can be an indication of a variety of illnesses, including costochondritis and viral pericarditis....
regained cardiac function (Scherf and Bornemann, 1960); there is no evidence that the precordial thump improves recovery in unwitnessed cardiac arrest.
A precordial thump may be attempted only once during the onset of cardiac arrest. While the odds of success are poor, if the procedure is performed properly then little time is lost. The provider will immediately continue with other ACLS skills, including CPR, ACLS drugs, and defibrillation, as appropriate.
Adverse effects
The use of the precordial thump technique has sometimes been shown in movies and televisionTelevision
Television is a telecommunication medium for transmitting and receiving moving images that can be monochrome or colored, with accompanying sound...
, 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. If applied incorrectly it may cause further injury, for instance inducing Commotio cordis
Commotio cordis
Commotio cordis is a disruption of heart rhythm that occurs as a result of a blow to the area directly over the heart , at a critical time during the cycle of a heart beat. It is a form of ventricular fibrillation, not mechanical damage to the heart muscle or surrounding organs, and not the result...
(cardiac arrest caused by blunt trauma) or breaking the tip of the sternum.
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, resulted in the procedure being removed from CPR training.
History
Drs. James E. Pennington and Bernard LownBernard Lown
Bernard Lown, M.D. is the original developer of the defibrillator and is an internationally known peace activist. International Physicians for the Prevention of Nuclear War, an organization he helped to create, was awarded the 1985 Nobel Peace Prize for its work against nuclear proliferation...
's cardiology group at Harvard University
Harvard University
Harvard University is a private Ivy League university located in Cambridge, Massachusetts, United States, established in 1636 by the Massachusetts legislature. Harvard is the oldest institution of higher learning in the United States and the first corporation chartered in the country...
are credited with formalizing this technique in the medical literature. They published their report in the New England Journal of Medicine
New England Journal of Medicine
The New England Journal of Medicine is an English-language peer-reviewed medical journal published by the Massachusetts Medical Society. It describes itself as the oldest continuously published medical journal in the world.-History:...
in the early 1970s. Drs. Richard S. Crampton and George Craddock
George Craddock
George Craddock was a British Labour politician. He was elected Member of Parliament for Bradford South at a 1949 by-election, and served until his retirement at the 1970 general election. He should not be confused with Sir George Beresford Craddock who served as a Conservative MP at around the...
, cardiologists at the University of Virginia
University of Virginia
The University of Virginia is a public research university located in Charlottesville, Virginia, United States, founded by Thomas Jefferson...
helped to promote the paramedic
Paramedic
A paramedic is a healthcare professional that works in emergency medical situations. Paramedics provide advanced levels of care for medical emergencies and trauma. The majority of paramedics are based in the field in ambulances, emergency response vehicles, or in specialist mobile units such as...
use of chest thump through a curious accident. In 1970, the Charlottesville-Albemarle Rescue Squad (VA) was transporting a patient with an unstable cardiac rhythm in 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.