Ep. 12 - Resuscitation of the Buried Avalanche Victim, Part 1: Physiology
Jan 26, 2024
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Dive into the chilling physiology behind resuscitating avalanche victims. Understand how burial time and core temperature impact survival chances. Explore the stark realities of cardiac arrest from trauma versus hypoxia. Discover why CPR training is essential for outdoor enthusiasts and the intricate challenges of reviving those trapped under snow. Learn about the importance of assessing a victim's condition and the surprising role of potassium in treating severe hypothermia. Get ready for a complex yet crucial discussion on wilderness medicine!
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Quick takeaways
Understanding the physiology of an avalanche victim is crucial, as trauma, hypothermia, and asphyxia are primary causes of cardiac arrest.
Resuscitation efforts should focus on the victim's burial time and airway status, with specific protocols guiding interventions based on these factors.
Deep dives
Understanding Avalanche Physiology
The fundamental physiology of an avalanche victim's body is essential for understanding resuscitation strategies. During an avalanche, three primary causes can lead to cardiac arrest: trauma, hypothermia, and asphyxia. Trauma may damage the heart directly or cause significant bleeding, leading to insufficient blood circulation, while hypoxia arises when the airway is blocked, preventing oxygen intake. Asphyxia underlines the importance of recognizing the victim's burial state, as those with occluded airways face imminent death, while those with some airflow may survive longer depending on their available air pocket.
The Role of Hypothermia
Hypothermia presents a critical factor in the survival of avalanche victims and can complicate resuscitation efforts. Victims buried under snow rapidly lose body heat, with an average cooling rate of approximately 3 degrees Celsius per hour, with extreme cases potentially cooling up to 8.5 degrees. If a victim's body temperature drops below 30 degrees Celsius, they can exhibit signs of altered mental status and abnormal heart rhythms. For victims buried for less than 60 minutes, prolonged resuscitation efforts are discouraged unless hypothermia is the likely cause of arrest.
Resuscitation Protocols and Considerations
Resuscitation protocols in avalanche-related cardiopulmonary arrests focus on identifying the cause of the arrest and acting accordingly. For victims buried for under 60 minutes, hands-on CPR, including rescue breaths, is critical to counteract asphyxia, as it significantly enhances survival chances. If the burial time exceeds this and there is no airway occlusion, it suggests the victim may be experiencing severe hypothermia, warranting extended resuscitation until medical help can assist with rewarming. Understanding these protocols enables rescuers to make informed decisions in high-stakes situations, maximizing the chances of patient recovery.
This is part 1 of a multi-part series on the resuscitation of critically buried avalanche victims. In this episode we learn the physiology that we need to understand the resuscitation algorithm. To learn the necessary biology, we follow a rider as they are carried in an avalanche, subjected to traumatic injury, and are then buried and begin to asphyxiate and cool.
The background of this episode is useful to understand why: -Cardiac arrest from trauma is usually unsalvageable; -Arrest due to hypoxia can happen within minutes or be delayed more than an hour; -Why we care if someone is really, really cold; -Why potassium measurement is useful in the hospital treatment of severe hypothermia; -And why we can largely forget about that other gas, CO2.
Look out for the next episode, where I''ll dive into the ICAR Avalanche Victim Resuscitation Algorithm.
As always, thanks for listening to Wilderness Medicine Updates, hosted by Patrick Fink MD FAWM.