Scenario posed to me by ICU nurse

[So. IL Medic]

This is a neat theory but even if you are suspended you still have a good blood pressure. Shouldn't have much venous pooling with proper heart function.

Not quite accurate. In effect, veins are passive capacity vessels unlike arteries which have an active musculature. Even a perfectly healthy person standing has a degree of venous pooling and it does reduce return to the heart. Think of the classic illustration of soldiers passing out while standing at attention for prolonged periods. The legs are not moving, the veins collect blood as they cannot passively move blood against gravity, venous return drops, the body compensates through increased heart rate, increased sympathetic arterial tone and blood pressure is maintained for a while. Eventually the compensation fails as more and more blood pools.

The position and amount of movement in extremities is important for suspension trauma. Just the act of hanging in a harness with little movement for 20-30 mins can cause an healthy, uninjured person to experience cardiovascular compromise and be at risk for reperfusion arrhythmias.

I once saw a reference that compared suspension trauma to crush injuries. While the patient may be compensating, the release of the compression may cause that compensation to fail.

 

[Dwindlin]

I think as other have said it's more likely this was some sort of vascular event. A spinal cord injury shouldn't cause asystole. Had it been a spinal cord issue could have caused the apnea, however it would been more likely to keep a pulse or see a PEA as even without the spinal cord the intrinsic conduction of the heart should have remained. From the story it sounds as if he went from concsious to asystole.

 

[VentMedic]

A spinal cord injury shouldn't cause asystole.

Actually high cord injures can cause symptomatic bradycardia and asystole which is why you may find some who have been treated with methylxanthines such as Aminophylline for an attempt to prevent this. For some patients this is effective and others do not respond to the treatment.