abstracts 2010 - Schweizerische Gesellschaft für Gebirgsmedizin

2. On-site triage
Lower limits of reversible coretemperature ??
No hypotherm victim is dead
until warm and dead!!
Dead or apparently dead ??
The most important diagnosis in
human life !
Prof. Dr.med. Ueli Zollinger, IRM Universität Bern
< 13,7 O CELSIUS ?
< 9 O CELSIUS ?
Gilbert M, Busund R. et al., Lancet 2000; 355 (9201): 375-6
• Coretemperature
32-13? C
• Chest compression
possible
• 1 o HT or avalanche
victim with airpocket
M 5
Continue CPR
→ Rewarming
Hughes et al.. Full neurological recovery from profound (18.0°C) hypothermia: Emerg Med J 2007;24:511-2
2. On-site triage:Asystolic hypotherm:
Riskmanagement for rescuers
Triage: Victim declared dead
→ Trsp. without CPR
→ Risk ↓↓ for rescue staff !
Durrer B., Brugger H.et al. Advanced changes in Resuscitation Hypothermia. Resuscitation. 2001; 50:243-246
Triage: Trauma and HT IV/V
HT IV and non lethal trauma?
versus
Lethal trauma and secondary cooling?
• Reversible
hypothermia (HT IV)
or lethal trauma ?
• CPB possible only
with heparin-coated
systems !
Von Segesser LK et al., J Thoracic Cardiovasc Surg 1992 Apr; 103 (49:790-8; 798-9
• Lethal injuries, signs of
decomposition
Stop CPR on-site
ACLS
• Frozen body/ mouth or nose
blocked byy ice
• Coretemperature: > 32
• Coretemperature: < 13?
• 2 o HT? No airpocket
M 6
•Farstad M, et al. Rewarming from accidental hypothermia . A retrospective study. Eur J Cardiothorac Surg 2001;20:58-64
• CPR ongoing
• No IV Line necessary
• Ventricular fibrillation:
1-3 Defibrillation with
max.energy
• Transport to hospital
for active rewarming
CBP / FASR / CWD?
3. On-Site treatment of HT IV
Headdon WG et al. The management of accidental hypothermia. BMJ 2009; 338() :b2085
Wadhwa et al. , New circulating-water devices, Anesth Analg Dec 2007; 105(6) :1681-7,
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