When the precordial thump works

I was chatting with my acute MI patient. She was halfway through her dose of thrombolytics and her presenting symptoms, shortness of breath, profuse sweating and vomiting, had completely resolved along with her ST elevation. Things were looking good.

Her husband of 61 years sat at her side. He referred to her as his 'lovely bride.' They had held hand for most of her visit. He was calm and supportive but underneath you could tell he was rattled by the fact that his wife was having a heart attack.

She was telling me a story about one of her grandchildren when she stopped mid-sentence and said "oh" followed by seizure like activity. I was stunned into immobility for what seemed like an eon but really was only a second. The monitor showed v-fib, a lethal heart rhythm where the heart quivers like jello without pumping any blood. Basically the patient in v-fib is dead and will stay there unless something is immediately done.

Before I could fully thing the situation through my arm shot out and socked her mid-chest (also known as a precordial thump.) I didn't even know I had planned it. In a simultaneous motion I reached out and hit the code button.

By the time I opened the defibrillator pads some sinus beats were appearing on the monitor . The doctor and the rest of the nurses arrived at the same time to see my patient miraculously wake up. She got transferred to another hospital where she got stented and I still get a card from them every year on the date of her cardiac arrest - the card simply says "I'm still ticking."

We are taught the precordial thump in nursing school, I've only seen it work this one time. I sure did have a hard time getting her husband to understand why I hit his wife.