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  1. #1
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    Why an air pocket during burial matters

    Not sure as this has been posted, but just came across this from some Scandinavian emergency medicine guys. They originally posted it last summer.

    It's terrifying to read, and morbid as fuck, but also relevant. Basically the survival time calculated from heart rate monitors worn by the victims, it's a serious buzzkill.

    http://www.scancrit.com/2013/08/27/h...es-avalanches/
    Quote Originally Posted by iceman View Post
    This is kinda like the goose that laid the golden egg, but shittier.

  2. #2
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    That is really freaky to read. A very small sample size, but I think it is clear to see that you are virtually always going to be better off with an air pocket all other things equal.

  3. #3
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    Perhaps an interesting feature of the BD Jetforce pack: It runs in reverse after a set amount of time, hopefully making an air pocket.

  4. #4
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    Quote Originally Posted by goldenboy View Post
    Perhaps an interesting feature of the BD Jetforce pack: It runs in reverse after a set amount of time, hopefully making an air pocket.
    By the time it reverses, you are incased in snow though, not much anything can do to move it. The air it releases will find its way into the space the balloon used to occupy, so behind your head/back. It probably isn't close enough to help with snow around your mouth, and the subsequent ice mask from forming. It could be of limited use if there were a channel between your face and it but that seems unlikely to happen.

  5. #5
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    ^^ Overall, I'd agree but thought I'd bring it up as something to ponder. It is summer, after all.

  6. #6
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    Quote Originally Posted by angrysasquatch View Post
    By the time it reverses, you are incased in snow though, not much anything can do to move it. The air it releases will find its way into the space the balloon used to occupy, so behind your head/back. It probably isn't close enough to help with snow around your mouth, and the subsequent ice mask from forming. It could be of limited use if there were a channel between your face and it but that seems unlikely to happen.
    Yeah, would work better if used in a RAS Protection style bag. Much higher chance of a channel between your mouth and the bag.

  7. #7
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    Quote Originally Posted by angrysasquatch View Post
    By the time it reverses, you are incased in snow though, not much anything can do to move it. The air it releases will find its way into the space the balloon used to occupy, so behind your head/back. It probably isn't close enough to help with snow around your mouth, and the subsequent ice mask from forming. It could be of limited use if there were a channel between your face and it but that seems unlikely to happen.
    I'll disagree somewhat in theory. If there is a true ice mask formed, really no better than an obstructed airway, I'd wager the outcomes would be no different. However, if even a small air pocket exists (and air pockets do NOT have to be big), a close proximity a large air pocket is certainly going to help with diffusion.

    Now, practically, the primary purpose of balloon packs is to prevent burial. They achieve this in virtually all instances where they are deployed and not destroyed. If you aren't burried, except perhaps being face down, a deflating pack would make little difference.
    Last edited by Summit; 07-03-2014 at 04:44 AM.
    Quote Originally Posted by blurred
    skiing is hiking all day so that you can ski on shitty gear for 5 minutes.

  8. #8
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    Quote Originally Posted by powtario View Post
    Not sure as this has been posted, but just came across this from some Scandinavian emergency medicine guys. They originally posted it last summer.

    It's terrifying to read, and morbid as fuck, but also relevant. Basically the survival time calculated from heart rate monitors worn by the victims, it's a serious buzzkill.

    http://www.scancrit.com/2013/08/27/h...es-avalanches/
    I've seen both of the case reports before and they have been discussed at a few of the avalanche and medical conferences I've attended. For an EM blog, they don't sufficiently emphasize the effects of hypothermia (which they mention once in passing) and hypercapnea (which they don't even mention), focusing solely on hypoxic etiology. The case study had a more balanced presentation than the blog.

    ALSO THE SECOND EXAMPLE IS PROBABLY BASED ON ERRONEOUS DATA:

    Please see this commentary: http://circ.ahajournals.org/content/126/10/e157.extract

    Quote Originally Posted by Dr Pettit et al
    ... more plausible explanation is that these flat lines represent artifact, a very common cause of flat lines on heart rhythm recordings... This is important because international guidelines on avalanche rescue are based on low-grade evidence such as case reports and case series.3 However, we agree with the authors that avalanche victims extricated in cardiac arrest with an unobstructed airway should be treated optimistically, with full resuscitation including extracorporeal rewarming.
    I agree with Dr Pettit et al as did the experts in emergency and mountain medicine with whom I discussed the issue.
    Quote Originally Posted by blurred
    skiing is hiking all day so that you can ski on shitty gear for 5 minutes.

  9. #9
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    Regarding the second case and death apparently at the time of extrication--some years ago there was a young man buried by a roof slide up on Donner Summit. After being dug out he was up walking and talking and then collapsed and died. This was in the newspaper so no medical detail but my guess would be cardiac instability due to hypothermia.
    The Europeans have had occasional success resuscitating flat-line victims after prolonged burial without obstructed airway--rewarming by heart lung machine. CPR while the victim is still cold probably has no benefit. Rapid helicopter evacuation, common in the Alps, much less available in the US is also probably key to survival. Slow rewarming during a long sled evacuation and ambulance ride is probably going to be lethal.
    Many years ago as a medical student I helped care for a 2 year old girl who drowned in a pool in Michigan in November, probably about 20 minutes of immersion. After prolonged cpr in the ER she was pronounced dead. The team left the room while the chief resident tried to gather himself to tell the parents. While he stood there her heart started on its own. She left the hospital intact 2 weeks later. Today the phenomenon of survival after prolonged cold water drowning is well recognized. There is a saying "you're not dead until you're warm and dead."

    I wonder if anyone is aware of a successful resuscitation after prolonged burial in North America.
    Last edited by old goat; 07-19-2014 at 10:05 PM.

  10. #10
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    Quote Originally Posted by old goat View Post
    Regarding the second case and death apparently at the time of extrication--some years ago there was a young man buried by a roof slide up on Donner Summit. After being dug out he was up walking and talking and then collapsed and died. This was in the newspaper so no medical detail but my guess would be cardiac instability due to hypothermia.
    The Europeans have had occasional success resuscitating flat-line victims after prolonged burial without obstructed airway--rewarming by heart lung machine. CPR while the victim is still cold probably has no benefit. Rapid helicopter evacuation, common in the Alps, much less available in the US is also probably key to survival. Slow rewarming during a long sled evacuation and ambulance ride is probably going to be lethal.
    Many years ago as a medical student I helped care for a 2 year old girl who drowned in a pool in Michigan in November, probably about 20 minutes of immersion. After prolonged cpr in the ER she was pronounced dead. The team left the room while the chief resident tried to gather himself to tell the parents. While he stood there her heart started on its own. She left the hospital intact 2 weeks later. Today the phenomenon of survival after prolonged cold water drowning is well recognized. There is a saying "you're not dead until you're warm and dead."

    I wonder if anyone is aware of a successful resuscitation after prolonged burial in North America.
    Are there standard protocols across all hospitals and EMS teams based on these recognized events?
    Terje was right.

    "We're all kooks to somebody else." -Shelby Menzel

  11. #11
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    so the young girls heart started up randomly after prolonged CPR ...

    was the warming of the body the trigger ???

    curious to giving up on CPR and the time frame to heart start up ...
    We, the RATBAGGERS, formally axcept our duty is to trigger avalaches on all skiers ...

  12. #12
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    Quote Originally Posted by DasBlunt View Post
    Are there standard protocols across all hospitals and EMS teams based on these recognized events?
    I don't know. The skiing examples I'm aware of-and I read this stuff a long time ago--were isolated case reports in medical journals, and I can't recall if there was a standard protocol they were following or if they ad libbed. And I don't know the current state of the art. As for cold water drowning protocols, again I don't know. If a hypothermia victim is to be treated by rewarming the technique will depend on whether or not cardiopulmonary bypss (heart lung machine) is available. Many hospitals, especially small ones, don't have the machines since they don't do heart surgery. Other techniques are warming with warm fluids instilled into the abdomen and chest through tubes. Warming with heat applied to the skin I doubt would ever work with a victim with no heartbeat--no way for the heat to get to the heart to rewarm it. And once again I'm not up on the current state of the art. Incidentally, hypothermic arrest and rewarming occurs every day in US hospitals during particularly challenging heart operations.

    As I recall, at least some of the cases from the alps were recovered from crevasses, where the odds on having an air pocket are probably higher.

    Quote Originally Posted by Shadam View Post
    so the young girls heart started up randomly after prolonged CPR ...

    was the warming of the body the trigger ???

    curious to giving up on CPR and the time frame to heart start up ...
    I would assume the warming was the trigger. I'm not sure the timing. I didn't see her until after she was in the ICU. BTW--not the only case of someone pronounced dead recovering that I've seen. Took care of a middle age guy who was flat line, cpr called off, ventilator kept working while they looked for the key to turn it off, meanwhile his heart started. Home intact in two weeks. I also had a guy who claimed to have woken up inside a body bag during the Korean War. He could have been bull shitting me. (Ya think?)

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