November 12, 2004

• I believe it is indeed a recognised technique - but I have been told that, contrary to the impression you get from films, the great majority of cardiac arrests are fatal, no matter how many adrenalin injections and fancy electric shock treatments may be available.
• I remember getting CPR training some years back and the old technique of 'whacking the chest' was a very big no-no because in some cases it had broken bones in the rib cage which went into the heart/lung area. "We Destroyed the Heart/Lung Area To Save It."
• The technique is called a "precordial thump" and IIRC from my EMT trainer's comments, was used before the advent of automated external defibrillators to restore normal rythms to fibrillating hearts. It's close to useless, but not a Hollywood invention.
• Yes, its my understanding that is the old school, pre-cpr technique. Sort of like when someone on tv drowned (sp?) they will sometimes hit the person on teh back or move their arms.
• Whacking the chest isn't going to bring someone back to life. CPR probably won't either. The whole point is to keep oxygen going to the brain until the pros roll up in the ambulance.
• ... and as one of the "pros," I'd add that this technique is not included in our protocols for handling a cardiac arrest. As others have pointed out, CPR essentially keeps the brain alive until more aggressive techniques can be mounted. Without it, irreversible brain damage takes place within 10 minutes. Early defibrillation is generally seen as the single most important factor in surviving a full arrest. On a side note, I'm told that the standard CPR training for the public now says that "mouth-to-mouth" is optional - it's the chest compressions that are essential. Apparently it's increasingly common for bystanders NOT to start CPR after witnessing a cardiac arrest, out of concern for catching a communicable disease by performing "rescue breathing."
• Actually, if you ask me, there is still room for the thump in the ACLS algorithm. Understand that while the technique may have detrimental effects, there is evidence to suggest that you can convert someone out of ventricular rhythms. But obviously cardioversion is much preferred. So ultimately, the decision depends on whether a defibrillator will be available in say 20-30 minutes, which is about the time period after which most all interventions are useless. If you're in the middle of nowhere then, you might not have a choice.
• A hospital anesthesiologist friend of mine tells me that if you get revived while in the hospital, regardless of method, you have only a small chance of ever leaving there alive. This includes shocks, CPR, and injections to the heart. What you are likely to experience is being dehumanized by the rest of the process, as they try to keep you from dying on their shift. On the other hand, if it was me, I would want them to try, for a while.
• IIRC from my badass EMT instructor (years ago), the precordial thump produces about 50 joules of electricity. Defibrillation uses 200-360 joules. 50 joules might be sufficient to convert an atrial flutter, but not ventricular fibrillation. We learned about The Thump in our wilderness EMT class because it was better than nothing. On a side note, the only times I have seen CPR really work has been on drowning children.
• Eastern medicine (and conversely, some martial arts) tells us that a carefully directed strike in the appropriate place(s) can both stop, and re-start the heart. (or in other words, the difference between accupuncture/accupressure and dim-mak, is whether you are using your powers for good or evil.) :)