Point-of-care ultrasonography supports for decision-making during a complex mountain rescue operation of 10 h of a trauma patient complicated by multiple cardiac arrests: a case report.

BACKGROUND

Trauma care in remote mountain environments presents significant challenges due to low resources and difficult terrain. Point-of-care ultrasonography is a promising tool for decision-making in such settings, though its role in pre-hospital care is not yet routine.

CASE PRESENTATION: A 72-year-old male sustained a traumatic spinal cord injury during a fall at around 2400 m above sea level. Despite four episodes of cardiac arrest due to autonomic dysfunction, a 10-h rescue operation, and difficult terrain, the patient survived. Point-of-care ultrasonography was used to assess potential causes of cardiac arrest, excluding common conditions like pneumothorax or cardiac tamponade, and to guide management. Autonomic dysfunction due to spinal cord injury was suspected. The patient was treated with intramuscular adrenaline, which stabilized vital signs during transport.

CONCLUSIONS

This case describes the complexity of managing a severely polytraumatized patient with cardiac arrest in a remote and austere environment. The use of point-of-care ultrasonography was crucial to reduce the likelihood of common causes of traumatic cardiac arrest, and pointed to spinal shock as the most likely etiology, managed thanks to adapting skills of the medical and rescue team.