PubMed · 5553203
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J L Luke. 1971-05-13. Conjunctival petechiae.. https://doi.org/10.1056/nejm197105132841916
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A series of investigations on the pathophysiology and management of persons buried in an avalanche has been undertaken over the past few years in response to increased awareness of the importance of emergency medical treatment of avalanche victims and the fact that the high mortality rate has not decreased in spite of the improvement in rescue techniques. This paper is the very first review of the problems encountered in avalanche disasters. The developments over the past 20 years, in particular, are summarized and discussed. Furthermore, current opinions and recommendations on optimal rescue procedure, as well as the prevention of such emergencies are presented. Precise assessment of the survival probability after burial under an avalanche and recognition of the prognostic importance of an air pocket, but only limited role of hypothermia, provide the basis for new concepts governing therapy and triage by the emergency doctor. Resulting guidelines have been endorsed by the Emergency Medicine Subdivision of the International Commission of the Alpine Rescue Services (ICAR) and these recommendations are intended for implementation by organised rescue teams in order to reduce secondary deaths following successful extrication of victims from the avalanche masses. However, the chance of being rescued alive depends primarily on the rapidity of extrication, i.e. how quickly the rescue teams are alerted and transported to the disaster area in the first instance, then how quickly the victims are located and extricated. In order to reduce the mortality additional preventive measures must be introduced to avoid complete burial if possible, or appreciably hasten the rescue procedure. The very steep drop ("fatal kink") in survival probability as from 15 minutes after burial underlines the absolute necessity of the mastery of efficient rescue procedure by uninjured companions. Improvement of the technical developments for the avoidance of total burial (avalanche air bag) and optimization of the electronic location (transceiver) of buried skiers by uninjured companions are essential future requirements. Nonetheless, primary prevention remains of paramount importance in governing decision making by offpiste skiers. Correct assessment of the inherent risks according to the prevailing circumstances and strict adherence to safety rules take precedence over all other considerations.
OBJECTIVE: To describe the risk of unexpected death in infants who are placed in suspended rocking cardles. MAIN OUTCOME MEASURES: Ten cases of sudden infant death and 5 cases of infant asphyxia with successful resuscitation reported to the Consumer Product Safety Commission were analyzed. The death scene investigation reports and autopsy material were made available for evaluation. All 15 cases implicated a suspended head-to-toe rocking cradle. RESULTS: Infants were aged 3 months or younger and were found in the facedown prone position when discovered. The cradle was tilted at greater than 5 degrees, and the head was wedged at one end of the cradle. A locking pin was not used in 14 cases. Ten of the 15 infants died. The autopsy reports listed sudden infant death syndrome as the cause of death. CONCLUSIONS: Suspended rocking cradles represent a potentially lethal sleeping environment and should not be used without a locking pin in place. Infants should be placed in the supine position for sleep.
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