Ep. 17 - Resuscitation of the Buried Avalanche Victim, Part 2: The Rescue Algorithm
Nov 15, 2024
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Dive into the life-saving techniques behind the ICAR resuscitation algorithm for avalanche victims. Discover the critical factors that determine survival, from burial duration to airway management. Detailed explanations of Basic and Advanced Life Support algorithms make complex protocols accessible. Real-life case studies illustrate practical rescue scenarios, emphasizing the urgency of quick action and the impact of hypothermia. Essential listening for anyone involved in avalanche emergencies!
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Quick takeaways
Quick assessment of airway patency and burial duration is crucial for improving survival chances in avalanche victims.
The differentiation between BLS and ALS algorithms is essential for rescuers, emphasizing advanced measures based on burial duration and victim condition.
Deep dives
Understanding Avalanche Burial Physiology
Burial under an avalanche significantly impacts survival rates and causes of death in victims. In the initial 10 minutes post-burial, deaths typically result from trauma, while after this period, asphyxia becomes the primary concern due to lack of oxygen. The survival rate drastically decreases as time extends beyond 60 minutes, with only a small percentage surviving due to factors like having a large air pocket. Hence, quick access to the airway and timely extraction are critical in improving survival chances for those buried.
Critical Determinants of Survival
When assessing a buried avalanche victim, there are four critical determinants of survival that should be evaluated: the duration of burial, airway patency, signs of life, and lethal injuries. Knowing the time of the avalanche helps determine if asphyxia or hypothermia is likely to have occurred. Checking for airway obstruction is essential, as obstructions can lead to rapid demise within minutes. Additionally, identifying any lethal injuries will inform whether resuscitation efforts are appropriate or if they should be ceased promptly.
Basic Life Support (BLS) Algorithm for Victims
The BLS algorithm emphasizes quick assessment and action based on the burial duration of the victim. For individuals buried for less than 60 minutes, any absence of signs of life prompts immediate rescue breaths followed by CPR to address asphyxia. If the victim has been buried for over 60 minutes, the approach changes, allowing more time to check for signs of life due to the possibility of hypothermia. Rescuers must remain vigilant about the assessed conditions of the victim throughout the entire resuscitation process, including monitoring for any signs of life that could change the course of treatment.
Advanced Life Support (ALS) Considerations
ALS providers use a similar baseline algorithm but incorporate more advanced measures, including rhythm monitoring and temperature assessment. The treatment approach is contingent on burial duration, with specific guidelines for patients under 60 minutes and those over 60 minutes. For individuals who are profoundly hypothermic, CPR continues longer, and aggressive temperature management becomes vital. Decisions around defibrillation and epinephrine administration also adapt based on core body temperature and observed rhythms to optimize the chances of recovery.
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Rescue Algorithm for Critically Buried Avalanche Victims
In episode 17 of Wilderness Medicine Updates, host Patrick Fink delves into the ICAR resuscitation algorithm for buried avalanche victims. The episode reviews the physiology of avalanche burial and discusses critical determinants of survival, such as duration of burial, airway patency, signs of life, and lethal injuries. The Basic Life Support (BLS) and Advanced Life Support (ALS) algorithms are explained in detail, with a focus on the practical application for both amateur and professional rescuers.
The episode also includes two detailed case studies that illustrate the application of the resuscitation algorithm, providing listeners with practical scenarios to better understand the protocols. Key insights on the importance of quick action, hypothermia, and ongoing CPR are highlighted, making this episode essential listening for anyone involved in avalanche rescue operations.
Chapters: 00:00 Ep. 17 - Resuscitation of the Buried Avalanche Victim, Part 2 01:26 Review 08:52 BLS Algorithm 14:30 ALS Algorithm 25:30 Interlude 25:30 Case 1: Partner Rescue 31:01 Case 2: Professional Rescue 39:54 Conclusion/Outro
As always, thanks for listening to Wilderness Medicine Updates, hosted by Patrick Fink MD FAWM.