defibrillator?

[capulin overdrive]

How much would/could a portable defibrillator help in the BC to try and revive someone dug up after they've died?


Maybe a little heavy in a ski pack, but very doable on a sled.

[Meadow Skipper]

Defib doesn't work on someone that's DRT (dead right there). It's for ventricular tachycardia or ventricular fibrillation, aka "shockable rhythm," where there is some heart muscle movement.

If someone is asystolic - aka flatline - a de-fib unit won't help, you need to start CPR compressions. An Automatic External Defib unit will tell you if there is a shockable rhythm initially or after CPR compressions.

That said, there could be some application for a defib unit in an avy burial situation, but as noted, the problem is getting it there. But they don't bring dead people back - that's what CPR compressions are for. As always, the best solution is not to get buried and asphyxiated/beat to shit.

[snoqpass]

Defib doesn't work for trauma

[capulin overdrive]

Utah figures are 85.7% suffocation, 8.9% suffocation&trauma, and 5.4% trauma alone.


Trying to figure out if the defibrillator would help with the ones that don't get dug out quick enough?


Saying is that they aren't dead, until they're warm and dead.

Why aren't we getting some of them back with CPR on say a 20 or 30 minute burial? Not cold enough, fast enough to save the brain? Giving up too soon on CPR?

[BCMtnHound]

If you want to carry an AED on a sled, I say go for it. As said, even if there isn't a rhythm detected suitable for a shock, CPR is still advised. And some models can assist with assessing the quality of the CPR performed.
I'd be wary of the durability of the unit on a sled, battery considerations, etc., and of course they are still not chump change to purchase, but hey - another available tool in the first aid kit.
Anyone know if any operations are equipping their heli's with AED's? Potential source for effectiveness data...?

[PNWbrit]

If you want to carry an AED on a sled, I say go for it. As said, even if there isn't a rhythm detected suitable for a shock, CPR is still advised. And some models can assist with assessing the quality of the CPR performed.
I'd be wary of the durability of the unit on a sled, battery considerations, etc., and of course they are still not chump change to purchase, but hey - another available tool in the first aid kit.
Anyone know if any operations are equipping their heli's with AED's? Potential source for effectiveness data...?

North Cascade Heli have one on board their bird.

I doubt it's for avy victims though.. heli is used for fires in summer... probably more that?

[whatsupdoc]

An AED is of exceptionally low (pretty much zero) utility IMO for skiing/avalanche victims. Unless someone in your party has a cardiac event and a primary V tach/V Fib cardiac arrest, the AED is completely useless.

Trauma aside, avalanche death is from asphyxia and hypoxia (lack of oxygen). The only way to correct this is to reverse this insult. An AED won't help this at all. These victims are universally asystolic or in PEA. They're like drowning victims. As mentioned above, an AED is also useless to someone who died from trauma.

CPR is really intended to keep some degree of blood/oxygen flow to the brain (and coronary arteries) until the heart can be restarted so the patient doesn't suffer from irreversible brain damage (as well as to keep some blood flow to the heart so it is able to be restarted by some type of intervention). CPR in and of itself does nothing to actually restart the heart. You need to correct the underlying insult to do this.

Regarding hypothermia, avalanche victims die of hypoxia or trauma the overwhelming majority of the time, not hypothermia. By the time they're dead most victims haven't become significantly hypothermic, at least not to the point where it would cause a cardiac arrest. They died of hypoxia or massive trauma. Warming them will do nothing. It's similar to submersion in cold water versus immersion in cold water. If someone goes under cold water immediately and drowns then becomes hypothermic, their prognosis is dismal because they died of hypoxia. If they were immersed in cold water but were breathing, and then become profoundly hypothermic and had a resulting arrest, their prognosis is better if you can get them rewarmed quickly.

There is a nice review on hypothermia from the NEJM by Brown et al in 2012. They specifically address avalanche burial. They state that burials < 35 minutes are not going to cause life threatening hypothermia. You don't have enough cooling time. Victims who are dead with < 35 minute burials died of hypoxia or trauma. They suggest that if the victim has been buried for more than 35 minutes and the airway is packed with snow, the person is dead and from hypoxia and CPR is not really indicated. If the burial is > 35 minutes but the airway is not packed with snow, they suggest proceeding with CPR and rewarming. I guess if someone was using an Avalung this might be possible. That said, if they are pulseless in the field, the prognosis is dismal because you still need to get them to a hospital and rewarmed. But getting back to the AED, it's not going to be helpful because an AED is really only useful for ventricular fibrillation/ventricular tachycardia. Think primary cardiac problems, of which an avalanche burial is not one of them.

I was in a party where a victim was pulseless from a slide, I'd focus on initiating rescue breaths since it's a respiratory arrest. I would definitely do CPR as well right away, but if this doesn't work within a short period of time (which it probably won't), it's time to call it.

[tBatt]

When I refreshed my WFR last year, there were rumors that administering epinephrine was going to be protocol for drowning/avalanche victims in order to restart the heart. Anyone hear/know anything along these lines?

[BCMtnHound]

When I refreshed my WFR last year, there were rumors that administering epinephrine was going to be protocol for drowning/avalanche victims in order to restart the heart. Anyone hear/know anything along these lines?

I refreshed my 40hrs last fall, and I didn't hear anything authorizing epi for such, but we did spend some time practicing its administration with vial and syringe (instructor discretion perhaps?). Perhaps when I upgrade to the 80hrs later this summer, the protocol will be expanded?

[Meadow Skipper]

An AED is of exceptionally low (pretty much zero) utility IMO for skiing/avalanche victims. Unless someone in your party has a cardiac event and a primary V tach/V Fib cardiac arrest, the AED is completely useless.

Trauma aside, avalanche death is from asphyxia and hypoxia (lack of oxygen). The only way to correct this is to reverse this insult. An AED won't help this at all. These victims are universally asystolic or in PEA. They're like drowning victims. As mentioned above, an AED is also useless to someone who died from trauma.

CPR is really intended to keep some degree of blood/oxygen flow to the brain (and coronary arteries) until the heart can be restarted so the patient doesn't suffer from irreversible brain damage (as well as to keep some blood flow to the heart so it is able to be restarted by some type of intervention). CPR in and of itself does nothing to actually restart the heart. You need to correct the underlying insult to do this.

Regarding hypothermia, avalanche victims die of hypoxia or trauma the overwhelming majority of the time, not hypothermia. By the time they're dead most victims haven't become significantly hypothermic, at least not to the point where it would cause a cardiac arrest. They died of hypoxia or massive trauma. Warming them will do nothing. It's similar to submersion in cold water versus immersion in cold water. If someone goes under cold water immediately and drowns then becomes hypothermic, their prognosis is dismal because they died of hypoxia. If they were immersed in cold water but were breathing, and then become profoundly hypothermic and had a resulting arrest, their prognosis is better if you can get them rewarmed quickly.

There is a nice review on hypothermia from the NEJM by Brown et al in 2012. They specifically address avalanche burial. They state that burials < 35 minutes are not going to cause life threatening hypothermia. You don't have enough cooling time. Victims who are dead with < 35 minute burials died of hypoxia or trauma. They suggest that if the victim has been buried for more than 35 minutes and the airway is packed with snow, the person is dead and from hypoxia and CPR is not really indicated. If the burial is > 35 minutes but the airway is not packed with snow, they suggest proceeding with CPR and rewarming. I guess if someone was using an Avalung this might be possible. That said, if they are pulseless in the field, the prognosis is dismal because you still need to get them to a hospital and rewarmed. But getting back to the AED, it's not going to be helpful because an AED is really only useful for ventricular fibrillation/ventricular tachycardia. Think primary cardiac problems, of which an avalanche burial is not one of them.

I was in a party where a victim was pulseless from a slide, I'd focus on initiating rescue breaths since it's a respiratory arrest. I would definitely do CPR as well right away, but if this doesn't work within a short period of time (which it probably won't), it's time to call it.

Nice write-up. ER doc?

When I refreshed my WFR last year, there were rumors that administering epinephrine was going to be protocol for drowning/avalanche victims in order to restart the heart. Anyone hear/know anything along these lines?

I haven't heard anything about that. How would it be administered, IV? I guess compressions would get it to the heart, but hitting a vein could be a bitch on a cold/asystolic victim.

[raisingarizona13]

I started carrying aspirin in my little med kit this past season.

[mcski]

What about tampons?

[Meadow Skipper]

What about tampons?

Not much use for avy/cardiac arrest victims.

Thread drift, but I carry a tampon and aspirin in my patrol vest and personal FAK.

[raisingarizona13]

Not much use for avy/cardiac arrest victims.

Thread drift, but I carry a tampon and aspirin in my patrol vest and personal FAK.

I'm having a hard time trying to visualize the moment that a woman actually confides in a male patroller that she is in desperate need of a tampon. It must have happened to you at some point.

[Meadow Skipper]

I'm having a hard time trying to visualize the moment that a woman actually confides in a male patroller that she is in desperate need of a tampon. It must have happened to you at some point.

rotfl. It's actually for puncture wounds, but sometimes I'll throw it at someone that's acting bitchy.

More thread drift. I was running a wildfire in Alaska this one time, out in the middle of nowhere. One evening an Eskimo woman started beating the shit out of a guy on her crew by the campfire. After the crew broke it up, she told me in tears that she'd started her period and didn't have any products. I had a helicopter fly into the nearest village - Unalakleet - to get her some products. Probably cost $800.

[raisingarizona13]

rotfl. It's actually for puncture wounds, but sometimes I'll throw it at someone that's acting bitchy.

Oh wow cool. I haven't heard of that yet. And the throwing it at coworkers is hilarious!

[whatsupdoc]

Nice write-up. ER doc?

Yep

[raisingarizona13]

rotfl. It's actually for puncture wounds, but sometimes I'll throw it at someone that's acting bitchy.

More thread drift. I was running a wildfire in Alaska this one time, out in the middle of nowhere. One evening an Eskimo woman started beating the shit out of a guy on her crew by the campfire. After the crew broke it up, she told me in tears that she'd started her period and didn't have any products. I had a helicopter fly into the nearest village - Unalakleet - to get her some products. Probably cost $800.

But the best move for her and the crews safety I'm guessing!

[sfotex]

North Cascade Heli have one on board their bird.

I doubt it's for avy victims though.. heli is used for fires in summer... probably more that?

More likely for rich dentist clients that have a heart condition and might collapse on a run..

[whipski]

Epinephrine is given in every cardiac arrest when a route is available. Defib after 2 minutes of effective CPR except if it is a witnessed arrest then immediately with CPR. The exception might be hypothermia. If I recall correctly the threshold is around 87-88 degrees core temp where the heart wont respond to defib. The studies have shown that excellent CPR is the key to survivable arrest. Push hard push fast. The tempo is at or a little faster than Stayin Alive from Saturday Night Fever by the Bee Gees. (and some say their music was worthless). Pretty sure I saw an AED on the Powdercat at Monarch.

[summit]

OP: The idea of an individual buying and carrying an AED in the backcountry for use in case of avalanche is a nice thought but completely impractical and probably useless.

Whatsupdoc, well written post! I had a few things that add to it that you might be interested in.

An AED is of exceptionally low (pretty much zero) utility IMO for skiing/avalanche victims. Unless someone in your party has a cardiac event and a primary V tach/V Fib cardiac arrest, the AED is completely useless.

I agree, and also worth noting many AEDs won't shock VT in certain regimes.

There is a nice review on hypothermia from the NEJM by Brown et al in 2012. They specifically address avalanche burial. They state that burials < 35 minutes are not going to cause life threatening hypothermia. You don't have enough cooling time. Victims who are dead with < 35 minute burials died of hypoxia or trauma. They suggest that if the victim has been buried for more than 35 minutes and the airway is packed with snow, the person is dead and from hypoxia and CPR is not really indicated. If the burial is > 35 minutes but the airway is not packed with snow, they suggest proceeding with CPR and rewarming.

The 35 minute data that Brugger et al used back in his 2001 was always questioned (I remember hearing Dr. Peter Hackett say his thoughts on this back in 2004 in Silverton). The issue was cooling rates were phenomenally fast and some examples were from crevace fall victims not avalanche victims, although the IKARMEDCOM algorithmn with the 35 minute cutoff remained in the April 2015 Resuscitation article. However the updated ERC Guidlines in October 2015 recognized this and went with the 60 minute cutoff.



So the latest IKAR MEDCOM with the updated algorithm (Kotter et al) can be found in this PDF:
http://www.alpine-rescue.org/ikar-ci...0107001909.pdf
Sorry not in English....



My organization has adapted these into a simplified prehospital/SAR algorithm.
also using findings from 2016 AJEM Serum potassium concentration predicts brain hypoxia on computed tomography after avalanche-induced cardiac arrest

In summary... wouldn't it be nice to have an AutoPulse/Lucas2 and a helo with an i-stat and a waiting ECMO center?

When I refreshed my WFR last year, there were rumors that administering epinephrine was going to be protocol for drowning/avalanche victims in order to restart the heart. Anyone hear/know anything along these lines?

No. Not a chance. Nope. Just, no. Not worthy of discussion. Do good CPR and get help. CPR works.

[ts01]

rotfl. It's actually for puncture wounds, but sometimes I'll throw it at someone that's acting bitchy.
...

Even more thread drift - my training for puncture wounds was stabilize the object and transport. Maybe there was some fine print but I can't recall - under what circumstance would you yank and tampon?

[mtaylor]

Even more thread drift - my training for puncture wounds was stabilize the object and transport. Maybe there was some fine print but I can't recall - under what circumstance would you yank and tampon?

It's more for an object that has come and gone, your training is still right. Keep in place unless that otherwise jeopardizes the safety of you or the patient.

There are far more useful things to have in a first aid kit than an AED.

[Meadow Skipper]

Even more thread drift - my training for puncture wounds was stabilize the object and transport. Maybe there was some fine print but I can't recall - under what circumstance would you yank and tampon?

I'm not gonna yank, it's just for an open puncture. Something like a ski pole tip might cause. I've never used one, but they're small and seem like a good idea to carry. And you might have missed it in the things that piss you off thread, but I came across a loaded pistol in the middle of a run a month or so ago.

The joke potential alone makes it worthwhile.

[ts01]

All makes sense, thanks.

Except losing loaded pistol part, but I can only hope the careless skier had backup weapons and ammo. You can't be too safe.