abstracts 2010 - Schweizerische Gesellschaft für Gebirgsmedizin
abstracts 2010 - Schweizerische Gesellschaft für Gebirgsmedizin
abstracts 2010 - Schweizerische Gesellschaft für Gebirgsmedizin
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M 2<br />
1.2 On-site assessment monitorized<br />
• 1.2.1 ECG<br />
Hypothermia HT IV or V ???<br />
• 1.2.2 Coretemperature<br />
M 3<br />
1.2.2 Coretemperature<br />
Tympanic: Pat. breathing<br />
Walpoth B.H. et.al., assessment of HT with tympanic thermometer, J Clin Monit 10:91-6.<br />
M 4<br />
2. On-site triage<br />
Asystolic, hypotherm victim:<br />
Clinical parameters Monitored parameters<br />
In favor of the patient:<br />
Select HT IV patients with<br />
survival chances!<br />
Doc`s triage:<br />
In favor of the rescuers:<br />
Exclude HT V and 2 o HT<br />
cases with no survival<br />
chances<br />
Sinus bradycardia<br />
Prolonged P-R interval<br />
Prolonged Q-T interval<br />
Atrial flatter / fibrillation<br />
Ventricular fibrillation<br />
Asystole<br />
1.2.1 ECG in HT:<br />
" Osborn or J wave": Coretemperature < 30° C.<br />
Extra deflection at the end of the QRS complex just<br />
overlapping the beginning of the ST segment. (80%< 30° C)<br />
12 lead ECG vs. 3 lead ECG in mountain rescue!<br />
Nolan J, Soar J. Images in resuscitation: the ECG in hypothermia. Resuscitation 2005;64:133–134<br />
M 3<br />
1.2.2 Coretemperature<br />
Esophageal: Pat.not breathing<br />
Brugger H., Durrer B., et.al (2001). Field management of avalanche victims. Resuscitation 51:7-15.<br />
1 o Hypothermia?<br />
Non-Asphyxia:<br />
2. On-site triage<br />
Asystolic, hypotherm victim:<br />
Exposure, immersion,<br />
crevasse, avalanche with<br />
airpocket<br />
Best outcome!<br />
2 o Hypothermia?<br />
Asphyxia involved:<br />
AAvalanche l h without ith t<br />
airpocket, submersion.<br />
Death due to cardiac<br />
arrest (MI, trauma)<br />
with secondary cooling<br />
Outcome?<br />
Locher Th.,Walpoth B.,et al., Kasuistik und Prognostik, Schweiz med Wschr 1991; 121:1020-8<br />
2