title: Respiratory failure and spontaneous hypoglycemia during noninvasive rewarming from 24.7°C (76.5°F) core body temperature after prolonged avalanche burial.
abstract: Clinical reports on management and rewarming complications after prolonged avalanche burial are not common. We present a case of an unreported combination of respiratory failure and unexpected spontaneous hypoglycemia during noninvasive rewarming from severe hypothermia. We collected anecdotal observations in a 42-year-old, previously healthy, male backcountry skier admitted to the ICU at a tertiary care center after 2 hours 7 minutes of complete avalanche burial, who presented with a patent airway and a core body temperature of 25.0°C (77.0°F) on extrication. There was no decrease in core body temperature during transport (from 25.0°C [77.0°F] to 24.7°C [76.5°F]). Atrial fibrillation occurred during active noninvasive external rewarming (to 37.0°C [98.6°F] during 5 hours), followed by pulmonary edema and respiratory failure (SaO(2) 73% and PaO(2)/FIO(2) 161 mm Hg), which resolved with endotracheal intubation and continuous positive end-respiratory pressure. Moreover, a marked spontaneous glycemic imbalance (from 22.2 to 1.4 mmol/L) was observed. Despite a possible favorable outcome, clinicians should be prepared to identify and treat severe respiratory problems and spontaneous hypoglycemia during noninvasive rewarming of severely hypothermic avalanche victims.
authors.affiliation: EURAC Institute of Mountain Emergency Medicine, Bolzano, Italy. giacomo.strapazzon@eurac.edu
authors.forename: Giacomo
authors.initials: G
authors.lastname: Strapazzon
authors.forename: Michele
authors.initials: M
authors.lastname: Nardin
authors.forename: Peter
authors.initials: P
authors.lastname: Zanon
authors.forename: Marc
authors.initials: M
authors.lastname: Kaufmann
authors.forename: Meinhard
authors.initials: M
authors.lastname: Kritzinger
authors.forename: Hermann
authors.initials: H
authors.lastname: Brugger
mesh_terms: D000328:Adult; D055875:Avalanches; D001831:Body Temperature; D045422:Continuous Positive Airway Pressure; D004190:Disasters; D004632:Emergency Medical Services; D006801:Humans; D007003:Hypoglycemia / Q000209:etiology*; D007035:Hypothermia / Q000150:complications / Q000628:therapy*; D007362:Intensive Care Units; D007442:Intubation, Intratracheal; D008297:Male; D011654:Pulmonary Edema / Q000209:etiology; D012131:Respiratory Insufficiency / Q000209:etiology*; D017694:Rewarming / Q000009:adverse effects*