Storm, CPR, and the Precordial Thump

July 15th, 2009

Filed under: Comics, Medicine

Storm’s CPR technique starts off looking quite good. Her rescue breathing appears fine, and her hand position — and correctly interlocked fingers — are impeccable.

scene from X-Men: Worlds Apart #4

However, when the traditional CPR doesn’t work, she reaches back and gives Cyclops a hard thump on his chest.

scene from X-Men: Worlds Apart #4

And that’s the problem.

The precordial thump is an actual medical technique — but it is only used in very limited circumstances. Consider how the precordial thump works: it doesn’t restart the heart or help circulate blood through the body, but instead works by interrupting dangerous heart rhythms such as ventricular fibrillation. The thump is only supposed to be used if the patient had a witnessed cardiac arrest (the rescuer actually saw the arrest occur), and only at the very beginning of resuscitation. Only one blow should be tried. The precordial thump has a small, but real, success rate (it depends on your source, but positive results are — at best — 25%). If it fails, the rescuer then proceeds with normal CPR.

By the time Storm gets around to performing the thump on Cyclops, it is too late for it to have any effect. She’s also being overly aggressive in her technique, and is likely to injure Cyclops along the way.

precordial thump
Personally, I’ve only used the precordial thump once. I was an intern, and it was my first night on call in the ICU. I was called to examine a patient who had been having a decreasing blood pressure. When I arrived, he was lying in bed and he looked a little pale, but was responsive. Suddenly, he collapsed and when I looked up at his heart monitor, I saw new onset torsades de pointe. Without thinking, I reached out and thunked him in the chest. His rhythm returned to normal and he came to. I called the attending ICU physician and ordered some magnesium sulfate. About thirty seconds later, the patient slipped into torsades again.

“Thump him!” I screamed at the nurse (let me assure you, I was not screaming in anger; more likely it was panic). She did, and once again his rhythm was restored to normal.

Both the attending and the medication took their sweet time to arrive and by the time they showed up in the room, we’d had to thump him two more times. Luckily, the magnesium sulfate worked and his torsades never recurred.

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13 Responses to “ Storm, CPR, and the Precordial Thump ”

  1. Slarti
    July 15th, 2009 at 2:03 am

    Still, at least she doesn’t do the obvious thing, given Storm and her powers, and shock the flatline, right? :-P

  2. Anonymous
    July 15th, 2009 at 4:33 am

    The Percordial Thump is a wonderful name for a medical procedure. It’s just a shame that the the artist didn’t grace the scene with the appropriate sound-effect.

  3. Aaron
    July 15th, 2009 at 7:06 am

    One of the medicine chiefs the year ahead of me in residency was legendary for this. The story went that he was just passing through the ICU one day when he passed a guy just at the moment he went into VFib. He apparently hauled off and thumped him with a big overhand punch and stopped the rhythm.

  4. arkonbey
    July 15th, 2009 at 7:10 am

    don’t be offended, but when reading your anecdote, all I could think of was the dream sequence in [Scrubs] where JD imagines that he is Fonzie waking a comatose patient with the lesser known Jukebox Thump.

  5. theOriginalKeith
    July 15th, 2009 at 7:24 am

    If you’re going to bring up Scrubs, you can’t ignore The Todd’s “Miracle Five”…

  6. Sean Duggan
    July 15th, 2009 at 9:32 am

    I guess that, in some ways, the precordial thump just resonates with people. Unlike things like CPR which require extensive training and following strict procedures, the thump seems like a primal expression of “Live, goddamit!” where we personally storm the gates of death through our sheer desire to save the victim. And it fits with our mental picture. When you hit someone, they bolt upright and gasp. Chest compressions just don’t conjure up the right image.

  7. Drafterman
    July 16th, 2009 at 8:28 am

    Maybe I’ve been out of the comic seen too long. When did Storm become orange? Why are we not addressing this House-style medical mystery?

  8. Marge
    July 16th, 2009 at 11:24 am

    My mum recounts a story from the Dark Ages of medicine, when defibrilators where the size of small cars. Patient kept going into Vfib, but was a long way from surgery – so they ended up wheeling them through the corridors of the hospital, past patients and visitors, with my mum thwacking him on the chest every few minutes every time he went into VFib. So she’s done it dozens of times :)

  9. J
    July 16th, 2009 at 5:49 pm

    It would be nice to read more of your very interesting med stories; the “True Tales of Medical School” section is rather lonesome for lack of updates : (

  10. Joe
    July 19th, 2009 at 10:47 am

    I swear I saw “Bones” McCoy do it to a Kingon in one of the Star Trek movies.. (VI?). I don’t think he did it right either.

  11. TayJK
    July 19th, 2009 at 6:49 pm

    Yeah, six, after the Chancellor got shot. He played with his gizmos, realized that he was going into come kind of arrest, then thumped him. Not sure if any CPR was used…

  12. MR
    April 28th, 2010 at 6:34 pm

    Ok, so I have paroxysmal atrial fib, rarely more than once every two or three years, and after jumping up to pee in the middle of the night, I had it again. Took over 300 mg of metoprolol over the next 24 hrs to keep my rate under 85 or so, plus ASA, but woke up the next morning still in afib (I am an ER doc, so I know afib when I have it). I was so pissed off that I might have had to go in for cardioversion that I actually hit myself in the chest out of frustration with my overly sensitive atrium… and yep, you guessed it, I immediately converted into sinus rhythm. It wasn’t from valsalva, I had tried that 10 minutes before without success. It was an unintended precordial thump (unless subconsciously I was trying this maneuver in deference to the two times I have converted asystole to supraventricular rhythms with serial thumps in other patients years ago). So, my N=1 of auto-cardioversion of rate-controlled paroxysmal atrial fib with self-administered precordial thump. Now I have to decide whether to try it again the next time – I suppose there is the risk of conversion to something far worse than afib, but there’s always tussive CPR as a backup.

  13. encephalopathy
    April 19th, 2011 at 12:14 pm

    walked into resus last week as patient went into pulseless VT as i walked past the cubicle. whacked her on the chest and reverted her to NSR and she woke up.

    2nd time it’s worked for me. secret is to hit very hard and almost bounce your fist back up off the chest

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