Respiratory Failure and Spontaneous Hypoglycemia During Noninvasive Rewarming From 24.7°C (76.5°F) Core Body Temperature After Prolonged Avalanche Burial
This case report documented the sequence of events after a 42-year-old male backcountry skier was buried in an avalanche under 1.8 m of snow for 2 hours 7 minutes. After extraction by search and rescue, his initial Glasgow Coma Scale score was 10, his core body temperature was 24.7°C (76.5°F), and he was protecting his airway. He was transferred in full body insulation with an aluminum foil blanket and a rescue bag to the closest hospital in Bolzano, Italy.
The patient was transferred to the intensive care unit and was actively rewarmed with noninvasive external techniques using convective warm air and warm normal saline solution. He developed atrial fibrillation that resolved without complication at 30.0°C (86.0°F). After 75 minutes of rewarming, the patient's temperature reached 30.6°C (87.1°F), and he exhibited respiratory failure. He was diagnosed with acute pulmonary edema requiring intubation and mechanical ventilation. After 5 hours of rewarming his core temperature reached a normal body temperature of 37.0°C (98.6°F). While intubated, the patient had severe glycemic imbalance and developed hypoglycemia that was treated with 33% glucose solution and stabilized with parenteral nutrition. The patient also had a brief episode of hypotension requiring inotropic drugs, but his blood pressure later stabilized. The patient was extubated on day 2. After a complete recovery, the patient was discharged from the hospital on day 3.
This case report highlighted important complications associated with rewarming after severe hypothermia using noninvasive external techniques. The authors emphasized that practitioners should carefully monitor hypothermic patients during rewarming and be aware of possible cardiac arrhythmias, hypotension, pulmonary edema, and hypoglycemia.
This case exemplifies the benefit of using a hypothermia wrap during transport and only starting active rewarming in the setting of a definitive care facility that is capable of active monitoring and intervention.
(Ann Emerg Med. 2012;60(2):193–196). G Strapazzon, M Nardin, P Zanon, M Kaufmann, M Kritzinger, H Brugger
Prepared by Matthew Stewart, MD, University of Utah Emergency Medicine Resident, Salt Lake City, UT, USA