Review: Lesser-Known Variants of the Precordial Thump

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The precordial thump is a technique by which a health care professionals thumps the chest of a patient in ventricular fibrillation or pulseless ventricular tachycardia when a defibrillator is not present.  It has a low success rate as the energy generated from even the most vicious punch doesn’t translate into enough joules; for this very reason, the People’s Elbow is preferred.  Despite the failure rate of the precordial thump, the idea of punching a patient as hard as you can has led to other subspecialties developing lesser-known variants of the precordial thump.  How many of these have you tried?

Preabdominal thump – With a success rate of 0.000001%, the preabdominal thump may be used in the most refractory cases of abdominal pain, nausea, vomiting, constipation, or diarrhea.

Precarotid thump – Also known as a sucker punch, this is frequently used to take down an aggressive patient.  Interestingly enough, a favorite maneuver of members of the palliative care team.

Precranial thump – Essentially similar to smacking a TV, computer, or other device when it isn’t working properly, the precranial thump involves a licensed neurologist slapping a patient with seizures or pseudoseizures upside the head to get them to stop.

Predental thump – The most blunt way dentists and oral maxillofacial surgeons remove cavities.

Predermal thump – Probably the most frequently used of these thumps, also known as “pimple popping.”

Preextremity thump – A last ditch effort by vascular surgeons to treat compartment syndrome, critical limb ischemia, or peripheral vascular disease.

Prenasal thump – An unproven methodology to offset postnasal drip.

Preocular thump – Administered by ophthalmologists in the field to treat sudden vision loss.

Prepenile and pretesticular thumps – Theoretical methods to treat erectile dysfunction.

Preradial thump – Used by respiratory therapists when an ABG is proving difficult.

Prerectal thump – A rarely used option to treat constipation when lactulose and GoLYTELY have failed.

Prerenal thump – Only used by seasoned nephrologists and urologists to dislodge kidney stones.

Pretracheal thump – Slightly more successful than the precordial thump, pulmonologists recommend this in the event of a tracheal obstruction from a foreign body without immediate access to a bronchoscope.

Prevaginal or preuterine thumps – An OB/GYN’s “kitchen sink” maneuver to treat abnormal uterine bleeding or technically-difficult labor.

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