Overview of Precordial Thump

We often see in medical TV shows a character’s heart suddenly stops, and a doctor dramatically hits their chest, apparently bringing them back to life. This is known as a ‘precordial thump’ and, while it looks effective on TV, it’s not as successful in real life. Today, it’s only recommended for use in specific circumstances: when there’s a witnessed abnormal heart rhythm called ‘unstable ventricular tachycardia,’ and a defibrillator – a device used to normalize the heart’s rhythm – isn’t immediately available.

The precordial thump method is simple and fast to do, and was first talked about back in the 1920s. The aim of a precordial thump is to bring back a regular electrical pattern in the heart and switch the person from an unstable, fast heart rhythm to a more regular and steady pace.

Anatomy and Physiology of Precordial Thump

A precordial thump is a specific medical technique where a doctor uses their fist to give a thump to your chest. To do it properly, they need to know exactly where to hit and how to make contact with you. They will make a closed fist and hit you with the side of their fist where their little finger is. The thump should be targeted on the lower third area of your breastbone.

Your breastbone, or sternum, is a flat bone in the middle of your chest. It looks like a plate and is made up of three parts: the manubrium (the upper part), the body (the middle part), and the xiphoid (the lower, pointy part). Your sternum plays an important role because it safeguards your heart and lungs, which are inside your chest. Your ribs also attach to your sternum to form the front of your skeletal chest area.

Your doctor can find your sternum by touching and feeling on your chest. They’ll start at the top where there’s a U-shaped dent (the sternal notch) and then move downwards until they reach the pointy lower end (the xiphoid).

Why do People Need Precordial Thump

A precordial thump, which is a forceful punch delivered to a person’s chest, can sometimes be used if a person’s heart suddenly stops (known as a cardiac arrest) and is witnessed by another person. This is only used if a medical device called a defibrillator, which is normally used to restart the heart, is not immediately nearby. This might be done if the person’s heart is beating in an unusual, fast rhythm called ventricular tachycardia, which can be seen on a heart monitor. This unusual heartbeat might be happening even if the person has a pulse, or it might be happening without a pulse. It’s important to note that if a precordial thump is used, it should not delay other life-saving actions, such as chest compressions and breaths (known as cardiopulmonary resuscitation or CPR) or using a defibrillator if one becomes available.

When a Person Should Avoid Precordial Thump

If a defibrillator, or a machine that can help control the heartbeat, is readily accessible, it’s best to use it rather than a method called a precordial thump. A precordial thump is a forceful hit to the chest in an attempt to restart the heart, but there isn’t enough evidence to show it works well in situations of cardiac arrest that were not witnessed or when the heart has stopped altogether (a condition called asystole).

Equipment used for Precordial Thump

To confirm if you have a condition called ventricular tachycardia, which is a fast, abnormal heart rate, we’ll need to monitor your heart. Also, one of our medical professionals will need to be on hand who can deliver a firm physical action called a ‘clenched fist’ if necessary.

While we’re doing this, other medical staff will gather the standard equipment used to help someone’s heart and lungs work (known as cardiopulmonary resuscitation or CPR). We do this so we’re prepared in case the first approach isn’t as successful as we hope.

Who is needed to perform Precordial Thump?

The procedure can be done by one person, yet the chances of it working are not high. If the procedure doesn’t work, a team of healthcare professionals – including doctors, nurses, and technicians – will be needed to start a life-saving method called cardiopulmonary resuscitation. This is a process that attempts to restore the blood flow and breathing in those whose heart has stopped. Even if the procedure is successful, a team of various healthcare professionals will still be needed. Their job will be to keep the patient stable, and to figure out the health problem that led to this situation.

Preparing for Precordial Thump

The “precardial thump” is a first-aid procedure performed by a doctor when a patient’s heart behaves abnormally. The doctor clenches their fist and positions it around 20 centimeters above the patient. It’s very important that they correctly identify the proper spot to strike. Meanwhile, other medical team members should be getting ready with any needed supplies and preparing for any possible adverse events. These backup preparations can include implementing advanced life support techniques or additional stabilizing efforts if the precordial thump successfully normalizes the patient’s heartbeat. Remember, the goal is to ease the patient’s condition.

How is Precordial Thump performed

If the heart monitor shows a condition called unstable ventricular tachycardia (heartbeat that is too fast), and there is no device available immediately for electric shock treatment (defibrillation), the next best option is to use a method known as precordial thump. This is performed by making a quick, strong blow with a tightly clenched fist to the lower part of the patient’s breastbone (sternum). The medic delivering the fist punch should distance their fist about 20 centimeters above the patient’s chest before striking.

After striking the chest, it’s important for the medical provider to instantly take off their hand. This is to allow the chest to move back to its original position (chest recoil). The health provider would then need to check the heart monitor to see if there’s any change in the heart rhythm. This is followed by providing a set of treatments and medications as per the advanced cardiac life support protocol. This protocol is a series of actions medical professionals follow to try and restore the heart’s normal functioning after cardiac arrest or heart-related emergencies.

Possible Complications of Precordial Thump

The precordial thump is a technique used by doctors to stop dangerous irregular heart rhythms. However, sometimes, this method can make things worse, causing the heart to fall into an even more unstable rhythm or to stop beating altogether (also known as asystole).

If the thump isn’t done in the right place, it can cause damage from harsh force, like a broken breastbone or bone infection. There have even been cases where it has led to a kind of stroke caused by a clot (thromboembolic stroke). A strong blow to the wrong area, such as the lower part of the sternum (the xiphoid), can harm the internal organs, like the liver and cause bleeding. It can even result in a muscle or bone injury to the doctor or nurse performing the procedure.

What Else Should I Know About Precordial Thump?

A precordial thump is a sharp thump given to a person’s chest, specifically on the breastbone, to correct an abnormal heart rhythm or to restart the heart in a sudden cardiac arrest situation. There have been some mixed results in studies trying to determine its effectiveness.

One notable study by a researcher named Pellis, along with several reports, showed promising results where the precordial thump was successful. They found that about 25% of cardiac arrest patients regained their normal heart rhythm after receiving a precordial thump. Furthermore, they didn’t observe any negative side effects from this procedure.

However, a contrasting study by Nheme and his team gave less optimistic results. They found that the use of the precordial thump didn’t often result in the return of a normal heart rhythm, and more often caused the heart rhythm to get worse. In this study, out of 434 cardiac arrests, 103 people received a precordial thump while 325 people were treated with defibrillation, which is the use of an electric shock to restore the heart’s normal rhythm.

Interestingly, out of the 103 who received a precordial thump, only five experienced the return to a normal heart rhythm; moreover, three of them had repeat arrests requiring defibrillation. Ten of these patients experienced a worsening heart rhythm. In comparison, defibrillation restored a normal heart rhythm without significantly worsening it in 57.8% of cases versus 4.9% for the precordial thump.

When researchers studied the results of using the precordial thump in hospital settings, like during heart testing, they found it to be not very effective. For example, in a study involving patients who developed an abnormal heart rhythm during testing, only one out of 80 patients responded to a precordial thump—the other 79 required defibrillation.

Another similar study found that only two out of 155 patients with an abnormal heart rhythm benefited from a precordial thump, suggesting it had a very low success rate. The conclusion drawn from these studies is that a precordial thump might only be useful when there’s no immediately available defibrillator.

Frequently asked questions

1. When is a precordial thump recommended as a treatment option? 2. How does a precordial thump work to restore a regular heart rhythm? 3. What are the potential risks or complications associated with a precordial thump? 4. What is the success rate of a precordial thump compared to other treatments like defibrillation? 5. Are there any specific circumstances or conditions in which a precordial thump is more likely to be effective?

A precordial thump is a medical technique where a doctor uses their fist to give a thump to your chest. It is targeted on the lower third area of your breastbone. The thump can potentially affect you by providing a temporary electrical shock to your heart, which may help to restore a normal heart rhythm in certain emergency situations.

Based on the given text, there is no specific reason mentioned for why someone would need a Precordial Thump. However, it is stated that if a defibrillator is readily accessible, it is best to use it instead of a precordial thump. Precordial thump may be considered as an alternative method in situations where a defibrillator is not available or not accessible.

A person should not get a Precordial Thump because there isn't enough evidence to show that it works well in situations of cardiac arrest that were not witnessed or when the heart has stopped altogether. It is best to use a defibrillator, if available, to control the heartbeat instead.

The recovery time for Precordial Thump is not mentioned in the provided text.

To prepare for a precordial thump, the patient should be in a situation where their heart suddenly stops and there is no defibrillator immediately available. The patient should also have a witnessed abnormal heart rhythm called unstable ventricular tachycardia. Other medical staff should be ready with any needed supplies and prepared for any possible adverse events.

The complications of Precordial Thump include the heart falling into a more unstable rhythm or stopping altogether, damage to the chest area such as a broken breastbone or bone infection, thromboembolic stroke caused by a clot, harm to internal organs like the liver and bleeding, and muscle or bone injury to the doctor or nurse performing the procedure.

The symptoms that require a Precordial Thump are a sudden cardiac arrest witnessed by another person, the absence of a nearby defibrillator, and the presence of an unusual, fast rhythm called ventricular tachycardia on a heart monitor.

There is no specific information available in the provided text regarding the safety of performing a precordial thump during pregnancy. It is always important to consider the potential risks and benefits of any medical procedure during pregnancy, and consult with a healthcare professional for personalized advice.

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