pathophysiology:LOC , hang upside down?

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kaisardog

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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?
 
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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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.
 
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.
 
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...
 
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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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?
Click to expand...

Suspension trauma is the bigger issue.
 
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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