Daniel Nicholas, Weinberg Nicholas, Carus Frank, Church Benjamin, Zafren Ken
Department of Emergency Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH.
Department of Emergency Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH.
Wilderness Environ Med. 2021 Mar;32(1):92-97. doi: 10.1016/j.wem.2020.10.007. Epub 2021 Jan 29.
A 34-y-old skier triggered a wind slab avalanche and was completely buried for over 2 h. After extrication by rescuers, the victim was breathing and conscious. Despite directions from the rescuers against standing up, the victim struggled to free himself and ultimately stood upright before collapsing in cardiac arrest. The rescuers performed cardiopulmonary resuscitation during transport to a nearby trailhead, where a helicopter emergency medical services crew found that the victim was in ventricular fibrillation. After further resuscitative efforts, including advanced life support, the victim was declared dead at the scene. Afterdrop and circumrescue collapse were the most likely triggers of cardiac arrest. This case highlights a need for rescuers, emergency medical services, and hospitals to be prepared to care for victims with hypothermia. To prevent circumrescue collapse, victims with hypothermia should be extricated gently, should not be allowed to stand, and should be placed flat. This may be difficult or impossible, as in this case. Hypothermic victims in cardiac arrest may require prolonged cardiopulmonary resuscitation, preferably with mechanical compressions, during transport to a hospital that has protocols for rewarming using extracorporeal life support. Resuscitation from hypothermic cardiac arrest should not be terminated before the victim has been rewarmed.
一名34岁的滑雪者引发了一场风积层雪崩，被完全掩埋超过2小时。被救援人员救出后，受害者仍有呼吸且意识清醒。尽管救援人员指示其不要站起来，但受害者挣扎着想要挣脱，最终直立起来，随后心脏骤停倒地。救援人员在将其送往附近步道起点的途中进行了心肺复苏，在那里，直升机紧急医疗服务人员发现受害者处于心室颤动状态。经过包括高级生命支持在内的进一步复苏努力，受害者在现场被宣布死亡。体温过低和救援后虚脱最有可能是心脏骤停的诱因。该案例凸显出救援人员、紧急医疗服务人员和医院需要做好照顾体温过低受害者的准备。为防止救援后虚脱，体温过低的受害者应被轻柔地救出，不应被允许站立，而应平躺。但就像这个案例一样，这可能很难做到甚至无法做到。处于心脏骤停状态的体温过低受害者在被送往有使用体外生命支持进行复温方案的医院的途中，可能需要长时间的心肺复苏，最好是进行机械按压。在受害者体温恢复正常之前，不应停止对体温过低导致的心脏骤停的复苏抢救。
