Precordial Thump. In this report, I describe a case of successful cardiac resuscitation at my work place in the Intensive Care Unit, where an uncommon practice was performed and has helped save a patients life.

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Grace Shak

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To thump, or not to thump?

Abstract

It has been a known fact that a cardiac arrest is a medical emergency that is potentially reversible if treated early, but however, with delayed or absent intervention, clinical death is inevitable.

In this report, I describe a case of successful cardiac resuscitation at my work place in the Intensive Care Unit, where an uncommon practice was performed and has helped save a patient’s life.

Introduction

In the cardiac chain of survival (American Heart Association, 2011), it is emphasized that early access, recognition, cardiopulmonary resuscitation (CPR), defibrillation and advanced life support can improve chances of survival and recovery for such patients. But how about an early precordial thump?

I remember being briefly told in nursing school about the existence of a precordial thump as an early life saving measure of pulseless ventricular tachycardia (VT) and monitored ventricular fibrillation (VF) if no early access to a defibrillator is around.  It is performed by a highly trained medical professional, witnessed, where he/she gives a single strike to a patient’s precordium with the fist, and that would cause an electrical depolarization to the heart of about 5 joules, which can regain a patient’s cardiac function. (NursingTimes.net)

In the 1980s, The American Heart Association recommended the precordial thump as the initial maneuver in treatment of VT and VF, based on a large report of successful attempts. (Miller J. et all 1984) However, as times progressed, precordial thumps have been deemphasized, and in my opinion, due to the large number, and easy accessibility to medical assistance and an automated external defibrillator, either in public or in hospitals, and also the increasing number of reported studies of failed attempts.

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Case Report

Mr. XYZ, a 60-year-old Chinese male has been admitted to our unit after going through a surgery for decortication of his right lung.

The patient, a taxi driver, had a medical history of hypertension, hyperlipidemia, and non-insulin dependent diabetes mellitus for the past 10 years. His regular daily medication includes aspirin, simvastatin and metformin. He was an ex-smoker and has quit 3 years ago.

On admission post surgery, he was sedated and intubated, his vital signs stable. A mediastinal and right pleural chest drain was attached to 80mmHg intermittent suction with moderate to minimal ...

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