NORTH RICHLAND HILLS — Austin Miller has no memory of his teammate’s knee smacking into his chest as they ran for a pop fly during a softball game.
Lucky guy! He received intentional hypothermia after his resuscitation, and I wonder how much that contributed to his neurologic recovery.
We have had remarkably good results here with hypothermic therapy post CPR.
This is an interesting and rare occurance. What I find most …amusing… is that often what causes the injury is often what is the first resort to resuscitate the patient. So, if you are at your son’s T-ball game, and the pitcher crumples after taking a line drive to the chest, and you arrive to find him pulseless, the first thing you should do is to punch him in the chest again.
Doc Russia,
Since the AHA discourages precordial thump, why do you suggest that it may be the appropriate therapy?
I’m with Doc Russia on this one. I still do precordial thumps if they drop or code right in front of me. It’s anecdotal, but it sometimes does work.
You can generate a few Joules with a good thump (estimates range from 5-30 Joules), and done early enough in the process, it may convert them to sinus.
I know the thump is taught as optional these days, and nobody would fault you for not doing it, but think of it this way: they’re already “dead,” and it only takes a second to thump them. It’s not like you’re wasting a lot of time.
That said, if your medical director says no, you’re better off doing what he tells you.
I have had about 30% success with precordial thumps, I still do them if applicable. Agree with the philosophy of if they are already dead, what harm can be done?
Precordial Thump for VF or Pulseless VT
There are no prospective studies that evaluated the use of precordial (chest) thump. In 3 case series (LOE 5),104–106 VF or pulseless VT was converted to a perfusing rhythm by a precordial thump. In contrast, other case series documented deterioration in cardiac rhythm, such as rate acceleration of VT, conversion of VT to VF, or development of complete heart block or asystole following the use of the thump (LOE 5105,107–111; LOE 6112).
The precordial thump is not recommended for BLS providers. In light of the limited evidence in support of its efficacy and reports of potential harm, no recommendation can be made for or against its use by ACLS providers (Class Indeterminate).
2005 AMERICAN HEART ASSOCIATION GUIDELINES FOR CARDIOPULMONARY RESUSCITATION AND EMERGENCY CARDIOVASCULAR CARE:
Part 7.2: Management of Cardiac Arrest
Circulation, Dec 2005; 112: IV-58 – IV-66.
Interventions Not Supported by Outcome Evidence
I have had good results with the precordial thump on one patient. Long ago, with a LifePak 5, at the end of a long shift with a CHF patient insisting on a refusal. when we switched him to his home oxygen he switched to a pulseless VT. When I tried to charge the defibrillator, the battery died. This left me with just one working battery (out of at least half a dozen). Do I put the battery in the defibrillator half of the LP5 and shock something I cannot see, or keep it in the monitor side and thump the VT. The precordial thump was effective at temporarily converting him to his baseline rhythm every time he went into VT.
Since the modern monitor/defibrillators, unlike the LP5, have all functions operating off of the same battery, I do not have much of a delay to shock the patient, so there is no potential benefit for me to thump the patient.