Travel Reference
In-Depth Information
way may be challenging in the limited space of a snow hole while the person is being ex-
tricated. Improved shoveling strategies have addressed this issue by creating a platform to-
ward the airway.
After an adequate airway and breathing are established and supplemental oxygen
provided, the circulation should be assessed. A conscious individual should be assumed to
have a perfusing rhythm, and further treatment should be directed at treating mild hypo-
thermia and traumatic injuries. A person who is unconscious but has an obtainable pulse
may have moderate or severe hypothermia and should be handled gently to avoid precipit-
ating ventricular fibrillation.
If a pulse is not detectable after opening the airway, ventilating, and full extrication of
the individual, cardiopulmonary resuscitation (CPR) should be considered. Before CPR is
initiated, however, careful evaluation for the presence of a pulse should be carried out. In-
dividuals who have been buried by an avalanche with an air pocket may be hypotherm-
ic, which causes peripheral vasoconstriction and makes the pulse difficult to palpate. In
addition, moderate to severe hypothermia depresses respiration and slows the heart rate,
which can simulate full cardiopulmonary arrest. Before initiating CPR, palpation for a
pulseshouldbedoneforatleastafullminuteaftertheairwayisopenedandassistedventil-
ationhasbegun.Thepulsemaybeeasiertodetectafterafewrescuebreaths.Astethoscope
for determining the presence of a heartbeat is much more sensitive. CPR for a severely hy-
pothermicpersonwhoactuallyhasanundetectableperfusingrhythmmaycauseventricular
fibrillation. Therefore, once CPR is initiated in a potentially hypothermic individual (long
burial time, core body temperature less than 86°F [36°C] if available, and the presence of
an air pocket), it must continue until transport to the medical facility.
Figure 30-2. Assessment and care of persons buried in an avalanche
Automatic external defibrillators (AEDs) are available to members of the ski patrol in
ski resorts. An AED applied to the chest can determine whether the person has a cardiac
rhythm or is fibrillating. If the rhythm is ventricular fibrillation, only one defibrillation
should be attempted if an esophageal probe or tympanic membrane thermometer can de-
termine that the individual has a body temperature below 86°F (30°C). If this is unsuc-
cessful,furtherattempts atdefibrillation shouldbemadeonlyafterrewarminginamedical
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