AVALANCHE EMERGENCIES PATHOPHYSIOLOGY & ON-SITE TREATMENT

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AVALANCHE EMERGENCIESPATHOPHYSIOLOGY & ON-SITE TREATMENTH. Brugger5th European Congress on Emergency MedicineMunich 15-18 September 2008150 fatalities in Europe and North America**Valla F, Meister R, International Commission of Avalanche Rescue, 2003MORTALITY RATESFatal dropsSURVIVAL FUNCTIONCompletely buried persons in free areas (n = 638)Completely buried persons in free areas (n = 638)SURVIVAL PHASEUNTIL 18 MINUTES AFTER BURIALSURVIVAL FUNCTIONASPHYXIA PHASE18-35 MINUTESFATAL DROP FROM 91% TO 34%Completely buried persons in free areas (n = 638)SURVIVAL FUNCTIONLATENT PHASE35-90 MINUTESSURVIVAL WITH AN AIR POCKETCompletely buried persons in free areas (n = 638)SURVIVAL FUNCTION7% LONG TERM SURVIVALWITH AN OPEN AIR POCKETCompletely buried persons in free areas (n = 638)SURVIVAL FUNCTIONBrugger et al, Resuscitation 2003TRIPLE H SYNDROMEHYPOXIA, HYPERCAPNIA, HYPOTHERMIA IN AVALANCHE VICTIMS WITH A CLOSED AIR POCKETTRIPLE H SYNDROMEHYPERCAPNIA HASTENS COOLING RATEHYPOTHERMIA INCREASES HYPOXIA TOLERANCE*Grissom CK et al. , J Appl Phys 2004CAUSES OF DEATH FROM AVALANCHE~ 85% ACUTE ASPHYXIATION~ 5-10% TRIPLE H SYNDROME~ 5-10% FATAL TRAUMA (EASTERN ALPS, UTAH-USA)**Hohlrieder et al. 2006, McIntosh et al. 2007, Brugger et al. 2008*FIELD MANAGEMENT OF AVALANCHE VICTIMSICAR MEDCOM RECOMMENDATION NR 013 www.ikar-cisa.orgBrugger H et al, Resuscitation 2001; High Alt Med Biol 2003 DOCS AND DOGS!TO THE SITE OF THE AVALANCHEORGANISED RESCUE OPERATIONS < 35 MIN: ASPHYXIA ? RAPIDITY !? 35 MIN: HYPOTHERMIA ? GREAT CARE!DURATION OF BURIAL 35 MINUTES AIRWAY MANAGEMENT BLS - ALS PROTECTION AGAINST COLDA) DURATION OF BURIAL ? 35 MINUTESTRANSPORT TO THE NEAREST HOSPITAL WITH ICUA) DURATION OF BURIAL ? 35 MINUTESB) DURATION OF BURIAL > 35 MINUTES WATCH FOR AIR POCKET FREE AIRWAY GENTLE EXTRICATION TREATMENT OF HYPOTHERMIAAIR POCKETANY SPACE SORROUNDING MOUTH AND NOSE, NO MATTER HOW SMALL, IN ADDITION TO AN OPEN AIRWAYAIRWAYBLOCKEDNOSURVIVALB) DURATION OF BURIAL > 35 MINUTESAIRWAYPATENTSUSPECTTRIPLE-H-SYNDROMEB) DURATION OF BURIAL > 35 MINUTESTREATMENT OF SUSPECTED TRIPLE-H-SYNDROME OXYGEN AVOID UNNECESSARY MOVEMENTS ECG- AND CORE TEMPERATURE READING