Precordial thump

A 78-year-old man with laryngeal cancer developed asystole 1 minute after an intravenous bolus of remifentanil 0.5 micrograms/kg followed by a continuous infusion of 0.5 micrograms/kg/hour. The asystole was unresponsive to intravenous atropine 1 mg. The remifentanil infusion was stopped and cardiac sinus rhythm resumed after two precordial thumps. 

For ventricular tachycardia in patients without a pulse, immediately give a precordial thump or apply synchronized direct-current countershock at 1-3 J/kg. If this is not successful, begin CPR and apply countershock at 3-5 J/kg administer amiodarone and/or lidocaine and repeated counter-shocks as recommended in ACLS guidelines. 

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