31 Jan - 6 Feb 2014 #692

Don’t freeze to death

Dhanvantari by Buddha Basnyat, MD

The story about the rescue of a three-year-old girl, who fell into an icy fish pond in a little village in the Austrian Alps, defies belief. Her parents frantically jumped into the pool and it was a full 30 minutes before they found her at the bottom of the pool and brought her up and started CPR (cardiopulmonary resuscitation). When the rescue team arrived in eight minutes, her body temperature was 66 degrees Fahrenheit, she had no pulse or blood pressure, and her lungs were filled with water. Her pupils were dilated and unreactive to light indicating brain death.

Despite these findings, the medics continued CPR with one of them straddling her on the stretcher pumping her chest. She was air-lifted to the nearest hospital and immediately put on a heart-lung machine to help control her oxygen and temperature. After two hours, the girl’s body temperature rose and her heart began to beat.

Throughout the day and into the night, physicians in the intensive care unit suctioned off water and pond debris from her lungs with a fiberoptic bronchoscope. A day later, they finally put her on a mechanical ventilator.

Amazingly, all her organs - heart, kidneys, intestines, and lungs - recovered in the next couple of days, except her brain. The doctors performed a CT scan and discovered a generalised brain swelling which suggested no focal pathology. The team then drilled a hole into her skull and inserted a probe to monitor brain pressures based on which they were better able to deliver drugs and fluids to the body.

Then the miracle happened in the next few days. The young girl’s pupils started to react to light: she began breathing on her own and speaking in a thick and slurry voice. Two weeks after the accident, she was sent home. Two years of extensive physiotherapy and she was normal again by age five.

Three points stand out in her treatment. First, severe hypothermia (very low body temperatures) sustained in the icy fishpond effectively shut down the body; and realising this important fact, the caregivers went all out by initially continuing CPR. Second, a child’s body responds much more efficiently to prompt therapy as opposed to someone older. Third, a well-coordinated rescue operation can save lives even in the direst situation in a random hospital in the west.

Hypothermia takes place when the body loses heat faster than it can produce. Normal body temperature is 98.6 F and hypothermia occurs when the temperature passes below 95 F. At or below this temperature, the heart and the nervous system, as in the little girl’s case, cannot function properly.

While it will take a few decades to upgrade our emergency services to meet the high standards of Europe and America, prevention is always better than cure. Here are some simple tips to ward off hypothermia in the mountains.

If you are going trekking, it is imperative to wear proper gear including footwear. In the Himalayas, especially at high altitudes, daytime temperatures can be warm, balmy, and almost Tarai like. But don’t be fooled by it because once the sun goes down, temperature may drop dramatically and nights maybe subzero. This is when very warm clothing, like down jackets and sleeping bags, properboots, gloves, woolen hats, is absolutely necessary. Unfortunately, many travellers disregard such basic rules and try to ‘tough it out’, which can then turn deadly.