Thursday, September 12, 2013

Roles of Precordial thump and its SHOULD and SHOULDN'Ts in CPR

Although,  precordial thump is relatively ineffective for ventricular fibrillation, and it is no longer recommended for this rhythm. A precordial thump should be considered if cardiac arrest is confirmed rapidly following a witnessed and monitored (ECG) sudden collapse (VF or VT) if the defibrillator is not immediately at hand.
There is insufficient evidence to recommend for or against the use of the precordial thump for
witnessed onset of asystole caused by AV-conduction disturbance.
The precordial thump should not be used for unwitnessed cardiac arrest.
A precordial thump should not be used in patients with a recent sternotomy (eg. for coronary artery grafts or valve replacement), or recent chest trauma.

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The rationale for delivering a precordial thump is that it generates a mechanical energy, which is converted to electrical energy, which then may be sufficient to achieve successful cardioversion. Following the onset of VF, the threshold for successful defibrillation rises steeply after a few seconds. In all reported cases of successful use of the precordial thump for VF, it was delivered within 10 seconds. This demonstrates the importance of witnessing the collapse.

 The clenched fist of the rescuer is held approximately 25-30cm (10-12 inches) above the sternum of the victim.  The fist is then brought down sharply so the inside (medial, ulna) side of the fist makes contact with the mid-sternum of the victim's chest.  The precordial thump should not be taught as an isolated technique.  It should be taught as part of an ALS course in which the student learns to identify life threatening arrhythmias and the appropriate steps to undertake if the chest thump fails.  It is best taught with the skill of defibrillation.

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