LIFE-THREATENING PROBLEMS - Medicine for Mountaineering and Other Wilderness Activities - page 24

available) or to CPR and attempts to defibrillate after thirty minutes, resuscitation efforts
should be terminated.
Prolonged CPR may be justified in hypothermic individuals and, as mentioned, people
struck by lightning may require prolonged ventilatory support. Following drowning, par-
ticularly drowning in cold water, CPR should be started immediately after the person has
been recovered from the water unless submersion is known to have lasted for more than an
hour.Chestcompressionsmaybeappliedwhiletheindividualisbeingrecovered,although
cardiac compressions would be futile without a firm surface on which to place the person
( Chapter 28: Drowning ) . Individuals trapped in avalanches can sometimes be resuscitated
if they can be recovered promptly ( Chapter 30: Avalanche Injuries ).
FOOD ASPIRATION
A common cause of respiratory obstruction is the aspiration of food. Prior to the develop-
ment of the Heimlich maneuver, a procedure that usually dislodges impacted food and was
named for its originator, an estimated 4000 people died each year from this type of acci-
dent just in the United States. (Approximately 450,000 die each year from sudden cardiac
arrest.) Alcohol consumption is commonly associated with such events. Surprisingly large
food fragments can be impacted in the larynx and obstruct the passage of air, usually com-
pletely. Since no air can move through the larynx, the individual cannot speak, cough, or
breathe, a critical sign of such obstruction.
While eating, the person suddenly indicates choking, usually rises from a sitting posi-
tion, and—after a brief struggle—collapses. Because the food is jammed in the larynx, the
individual cannot speak. A signal has been devised for the individual to indicate choking
and consists of thrusting the V between the thumb and first finger against the throat ( Fig.
3-7 ) .
Figure 3-7. Signal that a person has choked on aspirated food, cannot speak, and needs assistance,
usually the Heimlich maneuver
Attemptstodislodgethefoodbyinsertingafingeroraspecialdevicedevelopedforthat
purposethroughthe mouth are rarely successful andmay onlyforce the foodfarther down.
Poundingonthebackmayhelpandshouldbetried,butnomorethanafewsecondsshould