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Are we too hasty in declaring avalanche victims dead?

post #1 of 10
Thread Starter 

Avalanches will bury some people this winter. Some of them will be declared dead after being recovered in the field or in the hospital. After listening to a recent interview with the neurosurgeon Sanjay Gupta, I am wondering if there is now any movement in the professional world of first responders and critical care givers to re-evaluate when it is proper to declare an avalanche victim dead? His account of the Norwegian x-c skier who who was found “dead”- drowned in a cold mountain stream –with no heartbeat, no blood pressure and who had a body temperature of about 55 F after the two hours in the water, would make her comparable to “dead” avalanche victims not killed by trauma, wouldn’t it? And yet, because of the care she was given, essentially she was allowed to warm up very slowly, her heart eventually came back to life on its own and she is alive and works as a doctor today. Any thoughts from the professionals out there on the newest understanding of the asphyxiation and hypothermia relationship and treatments? Avy victims aren’t being pronounced dead prematurely are they?

post #2 of 10
 Google for the work of "genius award" recipient Mark Roth. It may add an interesting light to the discussion...
post #3 of 10

The old adage is, "They're not dead until they're warm and dead."

That said, avalanches tend to happen in the backcountry, far from medical centers.  In most situations, it isn't realistic to expect one's partners to continuously perform CPR until help arrives.

Also, in situations where a victim is dug out expeditiously, but remains pulseless and unresponsive, hypothermia is unlikely to be the cause. 
 

post #4 of 10
Quote:
Originally Posted by FreddyOneski View Post

Avalanches will bury some people this winter. Some of them will be declared dead after being recovered in the field or in the hospital. After listening to a recent interview with the neurosurgeon Sanjay Gupta, I am wondering if there is now any movement in the professional world of first responders and critical care givers to re-evaluate when it is proper to declare an avalanche victim dead? His account of the Norwegian x-c skier who who was found “dead”- drowned in a cold mountain stream –with no heartbeat, no blood pressure and who had a body temperature of about 55 F after the two hours in the water, would make her comparable to “dead” avalanche victims not killed by trauma, wouldn’t it? And yet, because of the care she was given, essentially she was allowed to warm up very slowly, her heart eventually came back to life on its own and she is alive and works as a doctor today. Any thoughts from the professionals out there on the newest understanding of the asphyxiation and hypothermia relationship and treatments? Avy victims aren’t being pronounced dead prematurely are they?


First responders do not declare death - CPR should be continued on a unresponsive victim/patient until the the responders are to exhausted to continue. Which is probably only a few minutes per responder.
post #5 of 10
As an ex paramadic I will add my 2p's worth

Drowning is normally simple Annoxia, total removal of oxygen. Couple this with immersion in cold water which will trigger the diving reflex and hypoerthermia which means the body shuts down and reduces its requirements for oxygen tremendously, hence we have these semingly miraculus recovieries after long periods of immersion. Yes we are taught, "they are not dead till they are warm and dead"

An avalanche victim however is a different case, they dont die of Annoxia, but of CO2 poisoning (If the trauma doesnt do it first) , which is long term acting and not immediately reversible. They also are wearing insulated clothing and therefore are not cooled rapidly, the divers reflex is probably not invoked (requireds cold water to the sinus area of the face). Therefore it is much more likely that should breathing suspend that its not so reversable

Having said that CPR should be started immediately, Oxygen would be the best treatment for the CO2 poisoning. If they are cold I wouldnt be too worried about warming them up. CPR should be continued until Medically qualified staff take over or your life is a risk.
post #6 of 10
 I carry a CPR face mask in my ski jacket.  I think a lot of backcountry users don't think much beyond recovery.
post #7 of 10
Thread Starter 
For anyone interested, here's the link to the website with the interview so you can either listen to it or read the transcript. Lots of interesting things- lots we don't know yet about when death actually is permanent- including brain death, which may have implications for avalanche victims

New to me, and very important for not only saving skier lives but lives of heart attack victims and many others, was the news  that CPR can and should be simplified to just pressing the chest 100 times a minute to circulate the blood. According to Dr. Gupta research is now showing that chest compressions alone are actually more effective in saving lives than full CPR. That's good news because people are generally much more willing to do chest compressions than to try full CPR - and from an endurance point of view, keeping going with chest compressions until medical help arrives is more doable over longer periods of time.
post #8 of 10
 Suffocation isn't the only way avalanche victim die many have suffered massive trauma that may be enough to kill them without being buried in the snow.
post #9 of 10
Its been an argument for a long time. as when you are doing chest compressions you do pump air out of the lungs, BUT there is insufficient time for a lot of air to get back in the lungs between compressions

Having done CPR for real probably a hundred times or so over 12 years on an ambulance I would say

a) If done properly its is effective at re-oxegenating the blood and circulating it (you should see colour return very quickly, regardles of the state of the patient)
b) Even on your own you can do CPR at 15/2 for an hour fairly easily if your technique is ok. BUT needs practive and you need to be in a position that minimises movement betwween compression and breathing (Kneel by shoulders at right angles)
c) 2 up doing 5:1 its very straight forward to keep going for long times
d) 15/2, 5/1, 30/2 etc ALL work
e) Most people dont realise how hard or how fast you need to do ECM, and how critical the exact position is. If the colour doesont improve change your technique
f) Always turn you head sideways or move it away from the mouth between breaths, one thing they never tell you in training is they ALWAYS puke if your succesful.
g) Dont expect to do 3 breaths and them magically to sit up (It does accasionbally happen) Normally you will be doing CPR untill the victim is handed over
h) Make sure the lungs are expanding with each breath, if they are not, EXTEND THE AIRWAY!. if that doesnt work, look for an obstruction. The better your airway extension, the easier inflations are and the less air you will push into their stomach
i) Some times you can be lucky and when you extend the neck, your hear a big sigh, and they start breathing
j) Straight into recovery position if you get them breathing again, do NOT stop monitoring them
Edited by madmole - 12/20/09 at 7:17am
post #10 of 10
Quote:
Originally Posted by madmole View Post

As an ex paramadic I will add my 2p's worth

Drowning is normally simple Annoxia, total removal of oxygen. Couple this with immersion in cold water which will trigger the diving reflex and hypoerthermia which means the body shuts down and reduces its requirements for oxygen tremendously, hence we have these semingly miraculus recovieries after long periods of immersion. Yes we are taught, "they are not dead till they are warm and dead"

An avalanche victim however is a different case, they dont die of Annoxia, but of CO2 poisoning (If the trauma doesnt do it first) , which is long term acting and not immediately reversible. They also are wearing insulated clothing and therefore are not cooled rapidly, the divers reflex is probably not invoked (requireds cold water to the sinus area of the face). Therefore it is much more likely that should breathing suspend that its not so reversable

Having said that CPR should be started immediately, Oxygen would be the best treatment for the CO2 poisoning. If they are cold I wouldnt be too worried about warming them up. CPR should be continued until Medically qualified staff take over or your life is a risk.

  Excellent post.  Also Steve2ski's point about first responders not declaring death.  
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