The good old precordial thump

According to the 2010 guidelines "The precordial thump may be considered for patients with witnessed, monitored, unstable VT (including pulseless VT) if a defibrillator is not immediately ready for use, but it should not delay CPR and shock delivery." The problem is that the guidelines do not explain how to do it. The precordial thump has really been de-emphasized when compared to the 2005 guidelines. A strong precordial thump can generate from 5 to 30 Jules of electricity. The heel of the fist is swung down over the lower half of the sternum forcefully, from a height of 12 inches or so. Some advocates say that to get the amount of energy needed, two hands should be used, at a height of about 2 feet. I have seen it approximately 5-6 more times, effective about half the time, and have performed it twice, with a 50 percent success rate of conversion of the rhythm. Research varies on overall percentages of success, but, at best, about 25 percent success rate overall.