Surviving 20 Hours of Critical Avalanche Burial and a Core Temperature of 22.5  °C

B. Wallner, Hannes Lienhart, E. Cools, Peter Paal
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Abstract

A 24-year-old male snowboarder was buried in an avalanche for 20 h and rescued on the next day at a depth of 2.3 m below the snow surface. A large air pocket was noted in front of his mouth and nose. He was responsive but moved restlessly and uncoordinatedly. The epitympanic temperature was 22.5 °C. He was bradycardic (35/min), and a right bundle branch block with Osborn waves was noted. Rewarming (1 °C/h) was initiated with continuous hemodialysis; core temperature raised to 29.8 °C within 4 h. At 30 °C he became conscious. With rewarming, the heart rate increased to 90 beats per minute and the ECG changes disappeared; nonfreezing cold injuries were noted. On the next day, his pulmonary function deteriorated—fluid overload of 9 L since admission was diagnosed. With spontaneous diuresis, the situation improved. On Day 4, the neurologist reported subtle polyneuropathy in both legs secondary to hypothermia, without tendency to regress. This case occurred more than 20 years ago but has not been reported yet. To this day, this is the third-longest critical avalanche burial ever reported. We discuss the circumstances of this accident, the clinical course, and how treatment has changed since 2000.
在关键的雪崩埋藏期和 22.5 °C的核心温度下存活 20 小时
一名 24 岁的单板滑雪男运动员在雪崩中被埋了 20 小时,第二天获救时,他被埋在雪面下 2.3 米深处。他的口鼻前有一个大气囊。他的反应灵敏,但行动不安且不协调。咽上温度为 22.5 °C。他心动过缓(35/分),右束支传导阻滞伴有奥斯本波。通过持续血液透析开始复温(1 °C/h);核心体温在 4 小时内升至 29.8 °C。30 °C时他开始清醒。复温后,他的心率上升到每分钟 90 次,心电图变化消失,并出现了非冰冻性冷伤。第二天,他的肺功能恶化,诊断为入院以来液体超负荷达 9 升。经过自发利尿,情况有所好转。第 4 天,神经科医生报告说,继发于低体温的双腿细微多发性神经病变,没有消退的趋势。该病例发生在 20 多年前,但尚未见报道。时至今日,这是迄今为止报告的第三长的雪崩危重埋葬病例。我们将讨论这次事故的情况、临床过程以及自 2000 年以来治疗方法的变化。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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