# pathophysiology:LOC , hang upside down?



## kaisardog (May 20, 2013)

http://www.dailymail.co.uk/news/art...d-spending-night-hanging-upside-mountain.html

It  is  lore   in  mountaineering  that  climbers who  accidentally flip  upside  down in  their harnesses  and  hang  there too long  eventually  lose  consciousness,  then  die if  not  rescued. (In  the  case  above,  hypothermia  from  being  upside  down in  water overnight  certainly  contributed  to  the  death.)   but  heated  discussion  at  our climbing  site  yesterday  had  one ranger  claiming  that  an  upside - down  climber  would  get 'compartment  syndrome'  leading  to  LOC  and  death.  another  thought  that the  increased blood flow  to  the  brain, and  increased  ICP,  from  head  being  lower  than  heart ,  eventually  would  cause  LOC. A  climber 'flipping',  (becoming   suspended  upside  down,   with  the  waist  harness leg   straps  cutting  off circulation  to  the legs)  is an event  that  can  occur  from  inattention  or bad rope  technique. Unfortunately,  since  most  climbing  sites  are  wilderness  locations, rescue  may  be  hours  away. 

what  are  your  thoughts  on  the  pathophysiology  of  what  is  going  on  when a  climber  is  upside-down for  a  long  time,  say  longer  than 1/2  hour?


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## Arovetli (May 20, 2013)

Assuming your cardiovascular system is healthy, nothing about being upside down is inherently fatal.

If you are thinking about changes in pressure, a healthy body can adapt quite well. Think about the pressure changes a body is under in space or underwater and can remain there for quite some time.

Interesting story: http://www.dailymail.co.uk/health/article-2197422/Woman-hang-upside-heart-stops.html

I would be more concerned about being stuck somewhere weird with no food, water, or shelter from the elements.


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## VFlutter (May 20, 2013)

Hanging upside down impedes venous drainage from the brain. Instead of working with gravity you are now having to pump against it. Veins, unlike arteries, are not very muscular and do not function well with increased resistance. I would assume there would also be some degree of valvular regurgitation when hanging upside. 

The brain is very sensitive to hypo/hyper perfusion and has a regulatory system to maintain homeostasis. I am not going to get into it but Google "Cerebral autoregualtion" if you don't understand it. 

As mentioned, in a healthy person the body should accommodate for the changes in pressure and blood flow. But after an extended period of time those systems will eventually fail and you will have hyperperfusion of the brain and most likely some type of encephalopathy.


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## emtbls (May 20, 2013)

Good discussion already, but I'd like to add an increased blood flow to the head may also bring a pt out of syncope by providing the brain with needed blood flow.


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## Luno (May 21, 2013)

There is actually a cardiac emergency with this kind of inversion, and if I remember it correctly it does involve compartment syndrome and release of toxins secondary to crushing, I have to find it again, more to follow...


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## Luno (May 21, 2013)

http://www.ncbi.nlm.nih.gov/pubmed/21377125

This isn't what I was looking for, but this will get you a start, what I am looking for was regarding industrial harnesses and inversion that we studied while putting our plan together for working at heights and rescues for ski lift mechanics.  I think it was the cardiac arrest after the release of toxins after crush injuries.  I'll post more when I find what I was looking for.

Here's another interesting article...
http://www.caves.org/section/vertical/nh/56/ProlongedSuspensionInAnAlpineHarness.pdf


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## Christopher (May 22, 2013)

kaisardog said:


> http://www.dailymail.co.uk/news/art...d-spending-night-hanging-upside-mountain.html
> 
> It  is  lore   in  mountaineering  that  climbers who  accidentally flip  upside  down in  their harnesses  and  hang  there too long  eventually  lose  consciousness,  then  die if  not  rescued. (In  the  case  above,  hypothermia  from  being  upside  down in  water overnight  certainly  contributed  to  the  death.)   but  heated  discussion  at  our climbing  site  yesterday  had  one ranger  claiming  that  an  upside - down  climber  would  get 'compartment  syndrome'  leading  to  LOC  and  death.  another  thought  that the  increased blood flow  to  the  brain, and  increased  ICP,  from  head  being  lower  than  heart ,  eventually  would  cause  LOC. A  climber 'flipping',  (becoming   suspended  upside  down,   with  the  waist  harness leg   straps  cutting  off circulation  to  the legs)  is an event  that  can  occur  from  inattention  or bad rope  technique. Unfortunately,  since  most  climbing  sites  are  wilderness  locations, rescue  may  be  hours  away.
> 
> what  are  your  thoughts  on  the  pathophysiology  of  what  is  going  on  when a  climber  is  upside-down for  a  long  time,  say  longer  than 1/2  hour?



Suspension trauma is the bigger issue.


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## patzyboi (May 22, 2013)

Doesnt all the blood rush to your head, and less to your core?


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## kaisardog (May 25, 2013)

thanks  for  the  replies  and  in  particular  the link  for  compartment  syndrome.  webmd  briefly  discusses  this  issue:

...Another form of compartment syndrome, called chronic compartment syndrome, develops over days or weeks. Also called exertional compartment syndrome, it may be caused by regular, vigorous exercise. The lower leg, buttock, or thigh is usually involved. 

Abdominal compartment syndrome almost always develops after a severe injury, surgery, or during critical illness. Some conditions associated with abdominal compartment syndrome include: 

Trauma, especially when it results in shock
Abdominal surgery, particularly liver transplant
Burns
Sepsis (an infection causing inflammation throughout the body)
Severe ascites or abdominal bleeding 
Vigorous overtraining utilizing eccentric abdominal exercises (ie: situps on a back extension machine in weight rooms)...As the pressure in the abdominal compartment rises, blood flow to and from the abdominal organs is reduced. The liver, bowels, kidneys, and other organs may be injured or permanently damaged...."  

I  seems  to  me  that  hanging  upside  down  in a  harness  for  a  long  time   will  certain  increase  the abdominal  compartment pressure..  and  since  we  now  know know  that such a  position compromises   venous  return,    it  stands  to reason  that  this syndrome  can  get  much  worse  with  time. 

so  there  are  good  reasons  to  not  flip  upside  down  and  hang  there..


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