PubMed · 5568083
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R H Brumfield. 1971. Snow skiing.. https://pubmed.ncbi.nlm.nih.gov/5568083/
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CONTEXT: Injury is a major public health problem in Alaska, and alcohol consumption and injury death are associated. OBJECTIVE: To determine the association between injury death, particularly alcohol-related injury death, and alcohol availability in remote Alaska. DESIGN, SETTING, AND PARTICIPANTS: Survey using death certificate data and medical examiner records to compare mortality rates for total injury and alcohol-related injury during 1990 through 1993 among Alaskans aged 15 years and older who had resided in remote villages of fewer than 1000 persons. MAIN OUTCOME MEASURES: Rate ratios of injury death among residents of wet villages (ie, those without a restrictive alcohol law) as compared with injury death among residents of dry villages (ie, those with laws that prohibited the sale and importation of alcohol). RESULTS: Of 302 injury deaths, blood alcohol concentrations (BACs) were available for 200 deaths (66.2%). Of these, 130 (65.0%) had a BAC greater than or equal to 17 mmol/L (> or =80 mg/dL) and were, therefore, classified as alcohol related. The total injury mortality rate was greater among Alaska Natives from wet villages (rate ratio [RR],1.6; 95% confidence interval [CI], 1.3-2.1), whereas this difference was not present for nonnatives (RR, 1.1; 95% CI, 0.3-3.8). For Alaska Natives, the alcohol-related injury mortality rate was greater among residents of wet villages (RR, 2.7; 95% CI, 1.9-3.8) than among residents of dry villages. The strength of this association was greatest for deaths due to motor vehicle injury, homicide, and hypothermia. CONCLUSIONS: Although insufficient data existed to adjust for the effects of all potential confounders, residence in a wet village was associated with alcohol-related injury death among Alaska Native residents of remote Alaska villages. These findings indicate that measures limiting access to alcoholic beverages in this region may decrease alcohol-related injury deaths.
During the years 1980-1990, 49 patients (38 men and 11 women) were treated in the department for various electrical injuries. The average age was 27 years (2-78 years). Thirty-nine had suffered low voltage (less than 1000 volts) accidents and ten had suffered high voltage (more than 1000 volts) accidents. The incidence and type of cardiac arrest/loss of consciousness on the scene of the accident, myoglobinuria, acute fasciotomies, surgical interventions, amputations, cardiovascular complications and outcome is reported. The most important finding was that no cardiac abnormalities were seen even with the patients with a clinical primary cardiac arrest. In spite of this finding 18 of the patients were initially brought to a medical department for electrocardiographic monitoring. This could clearly delay surgical intervention, though it did not seem to affect the final outcome (with some reservations). It was concluded that only abnormal ECGs should indicate electrocardiographic monitoring. Otherwise an electrical injury is a surgical matter.
BACKGROUND: Cardiopulmonary bypass has been used to rewarm victims of accidental deep hypothermia. Unlike other rewarming techniques, it restores organ perfusion immediately in patients with inadequate circulation. This study evaluated the long-term outcome of survivors of accidental deep hypothermia with circulatory arrest who had been rewarmed with cardiopulmonary bypass. METHODS: Deep hypothermia (core temperature, <28 degrees C) with circulatory arrest was found in 46 of 234 patients with accidental hypothermia. In 32 of the 46 patients, rewarming with cardiopulmonary bypass was attempted, resulting in 15 long-term survivors. In most of these patients, deep hypothermia developed after mountaineering accidents or suicide at tempts. After an average (+/-SD) of 6.7+/-4.0 years of follow-up, we obtained the patients' medical histories and performed neurologic and neuropsychological examinations, neurovascular ultrasound studies, electroencephalography, and magnetic resonance imaging of the brain. RESULTS: The average age of the patients was 25.2+/-9.9 years; seven were female and eight were male. The mean interval from discovery of the patient to rewarming with cardiopulmonary bypass was 141+/-50 minutes (range, 30 to 240). At follow-up there were no hypothermia-related sequelae that impaired quality of life. Neurologic and neuropsychological deficits observed in the early period after rewarming had fully or almost completely disappeared. One patent had cerebellar atrophy on magnetic resonance imaging with mild clinical signs, a condition that may have been caused by hypothermia. Other clinical abnormalities were either preexisting or due to injuries not related to hypothermia CONCLUSIONS: This clinical experience demonstrates that young, otherwise healthy people can survive accidental deep hypothermia with no or minimal cerebral impairment, even with prolonged circulatory arrest. Cardiopulmonary bypass appears to be an efficacious rewarming technique.