title: Successful resuscitation after multiple injuries in the wilderness.
abstract: BACKGROUND
  Survival of blunt trauma associated with hypothermic and hemorrhagic cardiac arrest in wilderness areas is extremely rare.
  
  
  METHODS
  We describe a case of a 19-year-old female college sophomore who, while glissading down Mt. Adams, had a 400-pound boulder strike her back and left pelvis, propelling her 40 feet down the mountain to land face down in the snow at 7000 feet. It took 4 h from the time of injury until the arrival of the helicopter at our Emergency Department and Trauma Center. The patient lost vital signs en route and had no CO(2) production. A cardiothoracic surgeon was the trauma surgeon on call. The patient was taken directly from the helipad to the operating room, where cutdowns enabled initial intravenous access, median sternotomy and pericardiotomy open heart massage, massive transfusion, chest and abdominal cavity irrigations with warm saline, correction of acid base imbalances and coagulopathies, and epicardial pacing that led to a successful reanimation of the patient. The patient was rewarmed without extracorporeal membrane oxygenation or heat exchangers. The ensuing multiple organ failures (heart, lungs, kidneys, intestines, brain, and immune system) and rhabdomyolysis led to a 2-month intensive care unit stay. She received over 120 units of blood and blood products. The patient regained cognitive function, mobility, and overcame multiple organ failure.
  
  
  CONCLUSIONS
  This report is presented to increase awareness of the potential survivability in hypothermia, and to recognize the heroic efforts of the emergency services personnel whose efforts saved the patient's life.
authors.affiliation: Cardiothoracic and Trauma Surgery, Legacy Emanuel Shock Trauma Center, Legacy Emanuel Medical Center, Portland, Oregon, USA.
authors.forename: Jonathan G
authors.initials: JG
authors.lastname: Hill
authors.forename: Savanna J
authors.initials: SJ
authors.lastname: Hardekopf
authors.forename: Jefferson W
authors.initials: JW
authors.lastname: Chen
authors.forename: James C
authors.initials: JC
authors.lastname: Krieg
authors.forename: Raymond B
authors.initials: RB
authors.lastname: Bracis
authors.forename: Raymond J
authors.initials: RJ
authors.lastname: Petrillo
authors.forename: William B
authors.initials: WB
authors.lastname: Long
authors.forename: Julie A
authors.initials: JA
authors.lastname: Garrison
authors.forename: Richard F
authors.initials: RF
authors.lastname: Edlich
mesh_terms: D000137:Acid-Base Imbalance / Q000628:therapy; D017732:Air Ambulances; D001803:Blood Transfusion; D001930:Brain Injuries / Q000150:complications; D002304:Cardiac Pacing, Artificial; D003080:Cold Temperature; D004632:Emergency Medical Services; D005260:Female; D006323:Heart Arrest / Q000628:therapy*; D006336:Heart Massage; D006470:Hemorrhage / Q000628:therapy; D006801:Humans; D007035:Hypothermia / Q000628:therapy*; D009051:Mountaineering; D009102:Multiple Organ Failure / Q000628:therapy; D009104:Multiple Trauma / Q000628:therapy*; D010492:Pericardiectomy; D017694:Rewarming; D012206:Rhabdomyolysis / Q000628:therapy; D056346:Sternotomy; D055815:Young Adult