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What Is the Precordial Thump?

Emergency medical technicians (EMTs) and paramedics are sometimes called upon to administer a precordial thump.
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  • Written By: Glyn Sinclair
  • Edited By: Rachel Catherine Allen
  • Last Modified Date: 12 November 2014
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The precordial thump is a potentially life-saving procedure that is typically performed by a trained medical professional. The procedure involves a sharp thump to a specific location on the sternum or precordium, and is usually administered when a person has life-threatening heart problems ventricular fibrillation or ventricular tachycardia. The precordial thump is then swiftly followed by other lifesaving skills such as cardiopulmonary resuscitation (CPR). If the procedure is administered by someone without the proper training it could cause further damage to the patient, since the blow has to be well aimed. Ventricular fibrillation refers to a condition when the heart’s ventricles begin to shake as opposed to contract, and ventricular tachycardia is when there is a excessively fast heart rhythm.

This procedure seeks to interrupt the heart’s arrhythmia and reset it to a more normal beat. It is better to perform the precordial thump at the onset of ventricular fibrillation and tachycardia. The precordium is located over the heart and chest region of the body. If improperly delivered, the precordial thump can cause the patient to suffer cardiac arrest due to trauma, as well as potentially crack the sternum. The procedure was promoted when, by chance, an ambulance that a patient was being transported to a hospital hit a bump and the patient’s heart rhythm corrected itself.

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The precordial thump is thought to have the negative potential of converting ventricular tachycardia to ventricular fibrillation, and as such, certain countries no longer recommend this procedure. Research has shown that the thump only generates about 30 joules whereas up to 360 joules are typically necessary to bring about a stable heart rhythm. Some medical experts claim that with the lack of electrocardiographic images and proof that the procedure works, the evidence is not conclusive. However, certain studies recommended that the precordial thump procedure be reinstated into the medical manuals. The reasoning is that if a patient is without a pulse and there has been no success with resuscitation, then a precordial thump may be the difference between the patient living or dying.

When performing the precordial thump procedure, an Emergency Medical Technician (EMT) will typically hold a fist roughly 12 inches (about 30 cm) above the patient’s sternum. The fist is then brought down with a sharp thump onto the sternum. This technique may also be complimented by percussion pacing, which is a series of these rhythmic blows, designed to artificially keep the heart beat going until such time that other types of stimulation are available.

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