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What Is the Precordial Thump?

By Glyn Sinclair
Updated Mar 03, 2024
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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 procedure 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.

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 5 to 10 joules, far less than what is 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 the 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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Discussion Comments
By anon996790 — On Oct 13, 2016

Most studies say that a precordial thump delivers 2, 5, or 10 J.

By Ana1234 — On Jan 24, 2015

@browncoat - I do love the fact that the procedure was discovered when they ran over a pothole in the road though. I hope the patient who had that happen passed the story down to his or her grandchildren.

Although I guess the EMT staff might not want to admit what happened if there was a chance that the patient might sue. Which is a shame, because it sounds like he or she was incredibly lucky.

By browncoat — On Jan 23, 2015

@irontoenail - Well, it probably shouldn't get taught in general first aid classes, since it sounds fairly controversial. I don't think the possibility of a split sternum is necessarily an issue, to be honest, since CPR, properly done, has the potential to break ribs and cause other damage like that. It's a small price to pay to get the heart going again.

But this sounds like a last ditch, or specialized procedure that could do more harm than good in the wrong circumstances. If the patient is going to die otherwise, then use it, by all means, but the layperson on the street who was decent enough to do a CPR course is not going to know how to determined when it is necessary.

By irontoenail — On Jan 22, 2015

You know, I've seen this done on TV numerous times (usually in hospital dramas) and never registered it or realized what it was called. I guess I always thought it was something dramatic that they did for television rather than an actual procedure, seeing as it doesn't get taught in general CPR classes.

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