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The precordial thump is an application of mechanical energy through a calculated strike to the torso when in a specific fatal heart rhythm. This procedure is used in very specific circumstances by highly trained health professionals with ACLS certifications.
The Procedure
While in the presence of a patient that is suffering a potentially fatal heart rhythm, a medical provider can strike a calculated point on the sternum to disrupt that rhythm. The energy transferred by the provider is estimated to be 2 to 5 joules, which is enough to depolarize the heart and stop the fatal rhythm. While it will work, there are several factors to the success. The procedure must be performed early on in the onset of the fatal rhythm, the change must be witnessed to administer and it can only be performed once. The procedure should not be performed if it delays cpr or defibrillation. The provider should immediately proceed with the correct ACLS protocols for the patient condition.
What are the Fatal Rhythms
There are only two rhythms that are appropriate for the precordial thump and neither has a palpable pulse. The rhythms are ventricular fibrillation and pulseless ventricular tachycardia.
Possible Problems with the Procedure
The procedure is known to the layperson from television and it looks simple but done incorrectly can cause harmful injuries. The blunt trauma delivered to the wrong area can cause a break in the sternum or cardiac arrest. Even if done correctly, there is a chance that the rhythm will change into a more fatal rhythm, asystole. Asystole is where the heart is absent of any electricity and not beating.
Because of the number of injuries sustained by improper technique, the precordial thump was removed from standard CPR training and isn’t usually taught as a standard treatment.
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