Brugger H, Durrer B, Adler-Kastner L
Mountain Rescue Service, South Tyrolean Alpine Association, Bruneck, Italy.
Resuscitation. 1996 Feb;31(1):11-6. doi: 10.1016/0300-9572(95)00913-2.
Asystole in avalanche victims is generally due to asphyxia and not primarily to hypothermia. Hence, on-site establishment of death by asphyxiation would avoid evacuation risks to the rescue party, as well as high costs of transport to, and treatment at, frequently distant specialist centres in cases with a hopeless prognosis. This paper presents a novel differential diagnosis scheme based on burial duration (critical time 45 min) and core temperature (critical level 32 degrees C) of the person on extrication, as well as the presence or absence of an air pocket, facilitating on-site identification of asphyxiated victims. When information regarding an air pocket is uncertain in victims buried longer than 45 min, determination of serum potassium (critical level 10 mmol/l) at the nearest hospital becomes an alternative criterion for triage. The proposed guidelines aim to clarify field decision-making for the emergency doctor with respect to discontinuation of resuscitation and limitation of transferral for cardiopulmonary bypass core rewarming to those patients with presumptive reversible hypothermia.
雪崩遇难者的心脏停搏通常是由于窒息，而非主要由体温过低导致。因此，现场判定因窒息死亡可避免救援人员面临撤离风险，以及在预后无望的情况下将患者转运至距离通常较远的专科中心并在那里进行治疗所需的高昂费用。本文提出了一种新颖的鉴别诊断方案，该方案基于救出时的掩埋时长（临界时间45分钟）、核心体温（临界水平32摄氏度）以及是否存在气袋，便于在现场识别窒息遇难者。当掩埋时间超过45分钟的遇难者气袋信息不确定时，在最近的医院测定血清钾（临界水平10毫摩尔/升）可作为分流的替代标准。拟议的指南旨在为急诊医生在停止复苏以及将体外循环核心复温的转运限制于疑似可逆性体温过低患者方面明确现场决策。
