Rescue death

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Rescuedeath (or reflow syndrome) is a hypothesized fatal condition that can occur after blood pools in a part of the body for a prolonged period such as during suspension trauma. There are several proposed mechanisms for this phenomenon. One mechanism suggests that toxins build up in the pooled blood, and problems arise when this toxin-rich, oxygen-poor blood returns to the body when the patient is allowed to lie down. Another mechanism suggests that the sudden increase in preload causes acute heart failure. Although often discussed in lay publications on suspension trauma, several studies systematically reviewing the medical literature have concluded that there is no evidence of this phenomenon. [1] [2]

Suspension trauma type of medical trauma

Suspension trauma(Syn. "orthostatic shock while suspended"), also known as harness hang syndrome (HHS), suspension syndrome, or orthostatic intolerance, is an effect which occurs when the human body is held upright without any movement for a period of time. If the person is strapped into a harness or tied to an upright object they will eventually suffer the central ischaemic response. Fainting while remaining vertical increases the risk of death from cerebral hypoxia. Since there is no evidence that these effects are specifically due to trauma, or caused by the harness itself, climbing medicine authorities have argued against the terminology of suspension trauma or harness hang syndrome and instead termed this simply "suspension syndrome".

Preload (cardiology) end diastolic volume in the heart

In cardiac physiology, preload is the end diastolic volume that stretches the right or left ventricle of the heart to its greatest dimensions under variable physiologic demand. In other words, it is the initial stretching of the cardiomyocytes prior to contraction; therefore, it is related to the sarcomere length at the end of diastole. Parameters such as ventricular end diastolic volume or pressure are used to measure preload since the ideal length of the cardiac sarcomere cannot be measured. Passive filling of the (heart) ventricle and subsequent atrial contraction thus allows an echocardiographically volumetric measurement. Preload is theoretically most accurately described as the initial stretching of a single cardiomyocyte prior to contraction. This cannot be measured in vivo and therefore other measurements are used as estimates. Estimation may be inaccurate, for example in a chronically dilated ventricle new sarcomeres may have formed in the heart muscle allowing the relaxed ventricle to appear enlarged. The term end-diastolic volume is better suited to the clinic, although not exactly equivalent to the strict definition of preload. Atrial pressure is a surrogate for preload.

Heart failure condition in which the heart is unable to provide sufficient pump action

Heart failure (HF), also known as chronic heart failure (CHF), is when the heart is unable to pump sufficiently to maintain blood flow to meet the body's needs. Signs and symptoms of heart failure commonly include shortness of breath, excessive tiredness, and leg swelling. The shortness of breath is usually worse with exercise, while lying down, and may wake the person at night. A limited ability to exercise is also a common feature. Chest pain, including angina, does not typically occur due to heart failure.

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Treatment

In the past, preventing a patient from lying down following suspension trauma or any other situation where blood had pooled in the legs for an extended period of time was thought to be important; instead, it was recommended that a patient should be placed in a seated position so that the blood could gradually return to the body. However, recent medical guidelines have concluded that there is insufficient evidence to recommend deviating from standard first aid procedures in which an unconscious or hypotensive patient is placed in a supine position. [2] Instead, treatment should consist of removing a patient from suspension and providing basic trauma care, starting with airway management (which could theoretically be impeded by requiring a patient to be kept in a seated position)[ citation needed ].

First aid Emergency first response medical treatment

First aid is the first and immediate assistance given to any person suffering from a serious illness or injury, with care provided to preserve life, prevent the condition from worsening, or to promote recovery. It includes initial intervention in a serious condition prior to professional medical help being available, such as performing cardiopulmonary resuscitation (CPR) while awaiting for an ambulance, as well as the complete treatment of minor conditions, such as applying a plaster to a cut. First aid is generally performed by someone with basic medical training. Mental health first aid is an extension of the concept of first aid to cover mental health.

Supine position

The supine position means lying horizontally with the face and torso facing up, as opposed to the prone position, which is face down. When used in surgical procedures, it allows access to the peritoneal, thoracic and pericardial regions; as well as the head, neck and extremities.

See also

Reperfusion injury, sometimes called ischemia-reperfusion injury (IRI) or reoxygenation injury, is the tissue damage caused when blood supply returns to tissue after a period of ischemia or lack of oxygen. The absence of oxygen and nutrients from blood during the ischemic period creates a condition in which the restoration of circulation results in inflammation and oxidative damage through the induction of oxidative stress rather than restoration of normal function.

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Diabetic ketoacidosis potentially life-threatening complication in people with diabetes mellitus

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Airway management medical procedure ensuring an unobstructed airway

Airway management includes a set of maneuvers and medical procedures performed to prevent and relieve airway obstruction. This ensures an open pathway for gas exchange between a patient's lungs and the atmosphere. This is accomplished by either clearing a previously obstructed airway; or by preventing airway obstruction in cases such as anaphylaxis, the obtunded patient, or medical sedation. Airway obstruction can be caused by the tongue, foreign objects, the tissues of the airway itself, and bodily fluids such as blood and gastric contents (aspiration).

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Blunt trauma physical trauma caused to a body part, either by impact, injury or physical attack

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Permissive hypotension or hypotensive resuscitation is the use of restrictive fluid therapy, specifically in the trauma patient, that increases systemic blood pressure without reaching normotension. The goal blood pressure for these patients is a mean arterial pressure of 40-50mmHg or a systolic blood pressure less than or equal to 80. This goes along with certain clinical criteria. Following traumatic injury some patients experience hypotension that is usually due to blood loss (hemorrhage) but can be due to other causes as well. In the past, physicians were very aggressive with fluid resuscitation to try to bring the blood pressure to normal values. Recent studies have found that there is some benefit to allowing specific patients to experience some degree of hypotension in certain settings. This concept does not exclude therapy by means of i.v. fluid, inotropes or vasopressors, the only restriction is to avoid completely normalizing blood pressure in a context where blood loss may be enhanced. When a person starts to bleed the body starts a natural coagulation process that eventually stops the bleed. Issues with fluid resuscitation without control of bleeding is thought to be secondary to dislodgement of the thrombus that is helping to control further bleeding. Thrombus dislodgement was found to occur at a systolic pressure greater than 80mm Hg. In addition, fluid resuscitation will dilute coagulation factors that help form and stabilize a clot, hence making it harder for the body to use its natural mechanisms to stop the bleeding. These factors are aggravated by hypothermia.

Basic airway management

Basic airway management are a set of medical procedures performed in order to prevent airway obstruction and thus ensuring an open pathway between a patient’s lungs and the outside world. This is accomplished by clearing or preventing obstructions of airways, often referred to as choking, cause by the tongue, the airways themselves, foreign bodies or materials from the body itself, such as blood or aspiration. Contrary to advanced airway management; minimal-invasive techniques does not rely on the use of medical equipment and can be performed without or with little training. Airway management is a primary consideration in cardiopulmonary resuscitation, anaesthesia, emergency medicine, intensive care medicine and first aid.

References

  1. ↑ Thomassen; et al. (2009). "Does the horizontal position increase risk of rescue death following suspension trauma?". Emerg Med J. 26: 896–8. doi:10.1136/emj.2008.064931. PMID   19934143.
  2. 1 2 Adisesh, Lee, Porter (2011). "Harness suspension and first aid management: development of an evidence-based guideline". Emerg Med J. 28: 265–8. doi:10.1136/emj.2010.097246. PMID   20961926.
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