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Wilderness Medical Society - snowmass 2005 (Page 118)

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Wilderness Medical Society - snowmass 2005
Colin Grissom, M.D. "New Hope For Surviving the Avalanche"
Page
12
Figure 5. Assessment and Medical Care of Extricated Avalanche Burial Victims

Extrication from avalanche burial

Conscious?
yes

no


Breathing?
yes
no


Obvious fatal injuries?
yes
Cease efforts

no



Rhythm asystole?
no

yes
Burial > 1 hour?
no

yes
Core
temperature < 30 ░ C ?
no

yes

Air pocket and free airway?
no

yes
Treat for Hypothermia I (core temperature > 32 ░ C) or
Hypothermia II (28 to 32 ░ C): Clear the airway, provide oxygen,
dry warm insulation, hot drink containing sugar if awake,
medical transport to closest appropriate facility.
Treat for Hypothermia II (core temperature 28 to 32 ░ C) or
Hypothermia III (24 to 28 ░ C): Clear the airway, provide
oxygen, assist ventilations, consider intubation and ventilation
with heated and humidified oxygen, dry warm insulation, heated
IV fluid, medical transport to tertiary care facility.
Clear the airway, assist ventilations, provide oxygen, intubate, warm IV fluids, handle gently.
Check for pulse after ventilating and oxygenating. If no pulse start CPR. Check ECG.
Death from asphyxiation likely.
Resuscitation per ACLS
protocol. Cease efforts when
clinically indicated. May
continue resuscitation and
transport to the nearest
appropriate medical facility. A
K+ of greater than 12 meq/liter
suggests that resuscitation may
be futile and death has occurred
from asphyxiation
21
.
Treat for hypothermia III or IV (Core Temperature < 28 ░ C): Intubation, assisted
ventilation with warmed humidified oxygen, monitor ECG, CPR, warmed IV fluids, dry
insulation, medical transport to a facility capable of extracorporeal rewarming.
If rhythm is VF defibrillate a maximum of 3 times if core
temperature < 30 ░ C and hold ACLS drugs until rewarmed.
Treat for hypothermia III or IV as below.

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