Hypercapnia Effect on Core Cooling and Shivering Threshold During Snow Burial

Grissom, Colin K.; McAlpine, J. C.; Harmston, Christopher; Radwin, Martin I.; Giesbrecht, Gordon G.; Scholand, Mary Beth; Morgan, J. Scott

doi:10.3357/asem.2261.2008

Cited by 30 publications

(38 citation statements)

References 18 publications

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“…Exercise rewarms a person more rapidly than shivering, but may increase afterdrop (Giesbrecht and Bristow, 1997;Grissom et al, 2008). Warm, sugar-containing, nonalcoholic drinks may be given providing swallowing is possible.…”

Section: Stage I: Patient Alert and Shiveringmentioning

confidence: 97%

“…In 2001, a human experiment demonstrated that during breathing into artificial air pockets in snow, hypoxia and hypercapnia occur with a concomitant respiratory and metabolic acidosis within a few minutes, and the degree of hypoxia depends on the volume of the air pocket, snow density, and unidentified individual characteristics (Brugger et al, 2003). The combination of hypoxia, hypercapnia (Grissom et al, 2000(Grissom et al, , 2004(Grissom et al, , 2008, and hypothermia was termed ''triple H syndrome'' (Brugger et al, 2003). The cooling rate during snow burial is still debated.…”

Section: Air Pocket and Hypothermiamentioning

confidence: 98%

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Prehospital Resuscitation of the Buried Avalanche Victim

Brugger

Paal

Boyd

2011

High Altitude Medicine & Biology

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In North America and Europe, approximately 150 people die of avalanches per year, and fatalities are presumed to be many times higher in developing countries. Four factors are decisive for survival: grade of burial, duration of burial, presence of an air pocket and a free airway, and severity of trauma. According to Swiss data, the overall mortality rate with avalanche burial is 23%, but it largely depends on the grade of burial. While the mortality rate is 52.4% in completely buried (head below the snow) victims in the Swiss population, it is only 4.2% in partially buried (head free) victims. Additionally, survival in completely buried victims drops to 30% within the first 35 min, initially due to death from lethal trauma, followed by asphyxia in 20-35 min. Thereafter, survival decreases more gradually and victims who are not fatally injured and are able to breath under the snow slowly succumb to hypoxia, hypercapnia, and hypothermia. In the absence of fatal injuries, rescue strategies depend on the duration of burial and the victim's core temperature. With a burial time<35 min, survival depends on preventing asphyxia by rapid extrication, adequate airway management, and cardiopulmonary resuscitation. With a burial time>35 min, tackling hypothermia is of utmost importance. Therefore, gentle extrication and continuous core temperature and electrocardiogram monitoring are recommended. Pulseless victims with a patent airway and a core temperature<32°C should receive uninterrupted cardiopulmonary resuscitation and be transported to a hospital with extracorporeal rewarming facilities.

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Section: Stage I: Patient Alert and Shiveringmentioning

confidence: 97%

Section: Air Pocket and Hypothermiamentioning

confidence: 98%

Prehospital Resuscitation of the Buried Avalanche Victim

Brugger

Paal

Boyd

2011

High Altitude Medicine & Biology

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“…Survival of buried victims beyond this ‘asphyxiation phase’ requires the presence of a patent airway and of an air pocket surrounding the victim's upper airway as this will allow for some degree of oxygenation 17. While evading immediate asphyxia, buried victims with a patent airway will instead face gradually developing hypoxia, hypercapnia and hypothermia; termed the ‘triple H syndrome’ 18. The rate at which these changes occur depends on the volume of the air pocket and on snow density, but may start occurring within minutes 19.…”

Section: Resultsmentioning

confidence: 99%

“…Nevertheless, it is a common complication and a medical emergency that must be anticipated and treated aggressively 30. Avalanche victims may develop hypothermia rapidly, with documented mean cooling rates ranging from 0.8°C/h to 3°C/h,18 31 although individual case studies report extreme cooling rates of up to 9°C/h 24 32 33. The presence of hypercapnia will increase the rate of cooling, primarily by inducing hyperventilation and respiratory heat loss 18 34.…”

Section: Resultsmentioning

confidence: 99%

The prehospital management of avalanche victims

Kornhall

Martens-Nielsen

2015

J R Army Med Corps

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Avalanche accidents are frequently lethal events with an overall mortality of 23%. Mortality increases dramatically to 50% in instances of complete burial. With modern day dense networks of ambulance services and rescue helicopters, health workers often become involved during the early stages of avalanche rescue. Historically, some of the most devastating avalanche accidents have involved military personnel. Armed forces are frequently deployed to mountain regions in order to train for mountain warfare or as part of ongoing conflicts. Furthermore, military units are frequently called to assist civilian organised rescue in avalanche rescue operations. It is therefore important that clinicians associated with units operating in mountain regions have an understanding of, the medical management of avalanche victims, and of the preceding rescue phase. The ensuing review of the available literature aims to describe the pathophysiology particular to avalanche victims and to outline a structured approach to the search, rescue and prehospital medical management.The most frightening enemy was nature itself…. entire platoons were hit, smothered, buried without a trace, without a cry, with no other sound than the one made by the gigantic white mass itself.

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“…Improvised and commercial methods for preventing further body heat loss are being developed. [70][71][72][73][74][75] Arteriovenous anastomoses rewarming with or without negativepressure devices could offer a technique to rapidly rewarm severely hypothermic patients in the fi eld. [76,77] Resuscitation protocols for hypothermia and cardiac arrest have long engendered controversy, because of the resources that are required and the dismal recovery statistics.…”

Section: Hypothermiamentioning

confidence: 99%