abstracts 2010 - Schweizerische Gesellschaft für Gebirgsmedizin

M 2
1.2 On-site assessment monitorized
• 1.2.1 ECG
Hypothermia HT IV or V ???
• 1.2.2 Coretemperature
M 3
1.2.2 Coretemperature
Tympanic: Pat. breathing
Walpoth B.H. et.al., assessment of HT with tympanic thermometer, J Clin Monit 10:91-6.
M 4
2. On-site triage
Asystolic, hypotherm victim:
Clinical parameters Monitored parameters
In favor of the patient:
Select HT IV patients with
survival chances!
Doc`s triage:
In favor of the rescuers:
Exclude HT V and 2 o HT
cases with no survival
chances
Sinus bradycardia
Prolonged P-R interval
Prolonged Q-T interval
Atrial flatter / fibrillation
Ventricular fibrillation
Asystole
1.2.1 ECG in HT:
" Osborn or J wave": Coretemperature < 30° C.
Extra deflection at the end of the QRS complex just
overlapping the beginning of the ST segment. (80%< 30° C)
12 lead ECG vs. 3 lead ECG in mountain rescue!
Nolan J, Soar J. Images in resuscitation: the ECG in hypothermia. Resuscitation 2005;64:133–134
M 3
1.2.2 Coretemperature
Esophageal: Pat.not breathing
Brugger H., Durrer B., et.al (2001). Field management of avalanche victims. Resuscitation 51:7-15.
1 o Hypothermia?
Non-Asphyxia:
2. On-site triage
Asystolic, hypotherm victim:
Exposure, immersion,
crevasse, avalanche with
airpocket
Best outcome!
2 o Hypothermia?
Asphyxia involved:
AAvalanche l h without ith t
airpocket, submersion.
Death due to cardiac
arrest (MI, trauma)
with secondary cooling
Outcome?
Locher Th.,Walpoth B.,et al., Kasuistik und Prognostik, Schweiz med Wschr 1991; 121:1020-8
2