To thump or not to thump....

dawngloves, BSN, RN · Apr 3, 2006

I've heard for it to work you have to do it the second the pt goes into VT.Not always an option so I'm more a shock 'em kinda person.

TennRN2004 · Apr 3, 2006

so my fellow nurses and i had a very heated debate last night at work about precordial thumps. i have thumped patients and seen it work, i have thumped patients and seen it not work. several of my co-workers are of the opinion that the precordial thump has fallen out of favor and is no longer taught as part of the acls protocol. i have never heard that, but they say they're pretty sure. what i have heard is that most precordial thumps are not delivered with enough force to generate the energy necessary, and that's why they're not done as often. so i'm settling a debate. to thump, or not to thump, and why?:crash_com:lol_hitti

it is not part of the acls protocol anymore. the precordial thump only generates about 25 jolts of energy, not nearly enough to defib unless it is delivered immediately at the time the pt goes into the ventricular arrythmia. the only time the thump is recommended is when there is not access to an acd, but again if it will work it has to be done immediately.nurses, especially in the icu should have quick and immediate access to a defibrillator, so that is what acls guidelines state to use now.

my2sons · Apr 5, 2006

If I see it, I thump it. Always. Meanwhile, I'm calling for the crash cart. I've seen it work too many times not to try it.

pricklypear · Apr 5, 2006

When I took ACLS last year, it was still an option - not forbidden, but not encouraged. I've never done it, but have seen it done a couple times - it worked both times. I don't think I could do it with enough force, and it would probably end up looking like a blatent case of patient abuse!!

suzanne4, RN · Apr 5, 2006

If I am right there, I thump. I have had it work too many times for me, but again, it needs to be done immediately, before anyone can even get the cart there.

And especially if you are some place where the AED is not available right away..............put it this way, you are thimping someone that is essentially dead, if you can bring them back, why not try hit.

It has been in ACLS, then out. Now it is back in, not as a first line, but it has never been prohibited.

And it works great on children.

HillaryC, RN, CRNA · Apr 8, 2006

I heard recently that a precordial thump is somewhat out of favor because it's just as likely to cause asystole as convert to a SR.

burn out · Apr 10, 2006

thumping is not even mentioned anymore in ACLS, so it doesn't say not to do it either. One night my patient went into Vtach while sleeping and as I was yelling for the crash cart as I ran into the room I turned on the light and THUMPED him on the chest. He instantly converted back to nsr and yelled at me What did you do that for? I couldn't help but laugh as the crashcart came in the room. When he was discharged we promised to go to Disney together so I could hit him in the chest if he needed it.

millkay · Apr 22, 2006

In the days before ICD's and EP labs people got thumped all the time. There have been several cases of patients in my hometown that, from what older nurses have told me, would not have lived their last few years without a good thump from an ICU nurse. Those patients, however, did learn to bear-down and convert themselves after a while to avoid the inevitable thump. I've never done it and don't know that it would come to mind immediately. I's more of a shock 'em nurse, too.

allnurses Guide · Apr 22, 2006

so my fellow nurses and i had a very heated debate last night at work about precordial thumps. i have thumped patients and seen it work, i have thumped patients and seen it not work. several of my co-workers are of the opinion that the precordial thump has fallen out of favor and is no longer taught as part of the acls protocol. i have never heard that, but they say they're pretty sure. what i have heard is that most precordial thumps are not delivered with enough force to generate the energy necessary, and that's why they're not done as often. so i'm settling a debate. to thump, or not to thump, and why?:crash_com:lol_hitti

from the aha acls provider manual...

" the precordial thump is an acceptable intervention (class iib) for healthcare providers to use for witnessed arrest when the victim has no pulse and no defibrillator is readily available."

in other words it shouldn't be necessary at the hospital most of the time because the defibrillator/crash cart is readily available.

i still teach about the precordial thump in my acls classes.

hope this helps..

LCRN · Apr 22, 2006

I'm in favor of the thump! (with the exception of fresh cabg/valves or any sternal incisions) In my experience I have seen it work more than a hand full of times which is enough practice based evidence for me :)

LCRN

chare · Apr 23, 2006

The 2005 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care contains the following regarding the precordial thump for VF or pulseless VT:

There are no prospective studies that evaluated the use of precordial (chest) thump. In 3 case series, 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.

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).

http://circ.ahajournals.org/cgi/content/full/112/24_suppl/IV-58