High altitude medicine & biology
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High Alt. Med. Biol. · Dec 2014
ReviewIs extracorporeal rewarming indicated in avalanche victims with unwitnessed hypothermic cardiorespiratory arrest?
International guidelines recommend using extracorporeal rewarming in all hypothermic avalanche victims with prolonged cardiac arrest if they have patent airways and a plasma potassium level≤12 mmol/L. The aim of this study was to evaluate outcome data to determine if available experience with extracorporeal rewarming of avalanche victims supports this recommendation. At Innsbruck Medical University Hospital, 28 patients with hypothermic cardiac arrest following an avalanche accident were resuscitated using extracorporeal circulation. ⋯ All other avalanche victims in the medical literature surviving prolonged hypothermic cardiac arrest suffered witnessed arrest after extrication with a core temperature below 24°C. Our results suggest that prognosis of hypothermic avalanche victims with unwitnessed asystolic cardiac arrest and a core temperature>24°C is extremely poor. Available outcome data do not support the use of extracorporeal rewarming in these patients.
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High Alt. Med. Biol. · Dec 2014
Symptom progression in acute mountain sickness during a 12-hour exposure to normobaric hypoxia equivalent to 4500 m.
The diagnosis and quantification of severity of acute mountain sickness (AMS) continue to be problematic. What symptoms should be included in a score and how to weigh any given symptom in the total score remain matter of debate. Seventy seven healthy male (n=43) and female (n=34) volunteers, aged between 18 and 42 years, were exposed to normobaric hypoxia (Fio2=12.6%≙4500 m) for 12 hours. ⋯ In conclusion, our findings confirm that headache plus one or more of the symptoms nausea, dizziness, and fatigue of at least mild to moderate severity are required for diagnosis of AMS. The inter-relationship between nausea, dizziness, and fatigue, however, raises the question whether each of these symptoms should be given equal diagnostic weighting. The time course of symptom progression within the first hours at altitude may provide clinically important information on the severity of subsequent AMS development and will support the decision to start therapeutic intervention.