Sharing neat-o stuff, & hoping you think it's neat-o too
When Anna Bågenholm fell while skiing and became trapped in icy water, her body temperature plummeted and her heart stopped, but doctors were able to bring her back to life. Her extraordinary story has led to therapeutic hypothermia being used around the world.
Deep in the heart of northern Norway lies the Kjølen mountain range, a series of jagged peaks that line the Swedish border. This bleak Arctic wilderness, more than 100 miles from any major hospital, may seem an unlikely setting for an event that changed medical history but, 14 years ago, the miraculous survival story of Anna Bågenholm for ever redefined our understanding of the boundary between life and death.
Bågenholm, a trainee doctor, was skiing off-piste with two of her colleagues when she lost control during a steep descent, falling on to a layer of ice covering a mountain stream. A hole opened in the ice sheet and she was dragged head-first into the freezing meltwater. Trapped hopelessly beneath eight inches of ice, she was slowly freezing to death.
Normally your core body temperature is 37C but with immersion in ice-cold water, this plummets rapidly. Below 35C, the body enters the state of hypothermia, characterised by shivering and pale skin. Below 30C, most victims will lose consciousness and, when body temperature drops to 25C, cardiac arrest will almost certainly occur.
Although Bågenholm’s friends immediately called for aid, it would take an hour and a half for a mountain rescue helicopter to reach their location. After 40 minutes of desperate struggling, Bågenholm’s body went limp. Shortly afterwards her heart stopped.
Following cardiac arrest, the body enters a state known as “downtime”. This is the twilight zone in which the process of dying begins. Normally within a few minutes of downtime, without immediate medical intervention, death will follow.
By the time Bågenholm was brought to the University Hospital of North Norway in Tromso, her heart had stopped for well over two hours. Her core temperature had plunged to 13.7C. She was in every sense clinically dead.
However, in Norway, there has been an old saying for the past three decades that you’re never dead until you’re warm and dead. Mads Gilbert is the head of emergency medicine at the hospital and, from experience, he knew that there was a slim chance the extreme cold had actually kept her alive.
"Over the last 28 years, there have been 34 victims of accidental hypothermia with cardiac arrest who were rewarmed on cardiopulmonary bypass and 30% survived," he said. "The key question is, are you cooled before you have the cardiac arrest or are you first having a circulatory arrest and then getting cooled?"
While lowering the body temperature will stop the heart, it also reduces the oxygen demand of the body and, in particular, the brain cells. If the vital organs have been sufficiently cooled before the cardiac arrest occurs, then the inevitable cell death from the lack of circulation will be postponed, buying emergency services an extra time window to try and save the person’s life.
"Hypothermia is so fascinating because it’s a double-edged sword," Gilbert said. "On the one side it can protect you but, on the other side, it will kill you. But it’s all a question of how controlled the hypothermia is. Anna was probably cooled quite slowly but efficiently so that, when her heart stopped, her brain was already so cold that the oxygen need in the brain cells was down to zero. Good CPR can provide up to 30-40% of the blood circulation to the brain and in these cases that is often sufficient to keep the person alive for sometimes seven hours while we try to restart the heart."
Crucially the levels of potassium in Bågenholm’s blood were normal, a key indicator of the extent of cell damage in the body and the decision was taken to warm her up. If the potassium is beyond a certain threshold, the person has no chance of survival.
Four and a half hours after Bågenholm first fell through the ice, her heart was successfully restarted. She spent 35 days on a life support machine before being moved to intensive care and then a rehabilitation unit. From there, she began the slow process of training herself back to complete restoration.
Her extraordinary story has led to therapeutic hypothermia being introduced as a protective measure for victims of strokes, liver failure and epileptic seizures. Recent studies have also illustrated its effectiveness in newborn babies who have suffered a lack of oxygen at birth.
It is commonly used around the world in open heart operations where surgeons will cool the body down to as low as 10C, allowing them to cut off the arterial supply to the brain for up to 15 minutes without any notable brain damage.
Jasmin Arrich, of the Medical University of Vienna, researches the use of therapeutic hypothermia during or after resuscitation from cardiac arrest.
"In these cases, the patient’s body is cooled down to mild hypothermia (32-34C) for 12-24 hours," she said. "We do this because when this patient can be resuscitated and the circulation starts again, various pathophysiologic mechanisms are initiated and substances are formed that continuously keep on damaging the brain cells and other cells of the body. Mild hypothermia exerts its beneficial effects on many of these mechanisms and substances."
However, there has been some controversy over the introduction of therapeutic hypothermia as a mainstream procedure for certain conditions based on unsubstantial evidence. A group of Swedish scientists have released a new paper questioning the levels of hypothermia that are applied as a protective measure to the unconscious survivors of cardiac arrest.
"We have to be careful because hypothermia is also dangerous to the body," Gilbert said. "It is upsetting the enzyme system, the cellular membrane balance and the integrity of the cells. And in trauma, we know there is a linear relationship between the degree of hypothermia in the trauma patient and the mortality rate. The clotting mechanisms are greatly influenced by hypothermia in a negative way. Anna was able to survive for so long because she didn’t have a trauma. She didn’t have any bleeding anywhere."
Fourteen years on, Bågenholm now works as a senior radiology consultant in the very hospital where her life was once in the balance. Nobody before or since has been so cold and lived to tell the tale. These days, she once again partakes in extreme skiing in the mountains of north Norway, a living reminder of the human body’s capacity for endurance.
Helper dogs are often used by blind, deaf and disabled people to aid them in their daily tasks, and we’ve even seen the animals put to good use in hospitals such as Amsterdam’s VU University Medical Center, where they sniff out infections. Now a UK laundry company has developed Woof to Wash, a machine adapted for easy use by dogs to wash their owner’s clothes. READ MORE…
A man faces an aggravated robbery charge after being accused of ordering several tacos from a Mexican restaurant in San Antonio, then pulling out a sword and refusing to pay.
Flashlight Fish and its incredibly bright flashlight.
There’s luminescent bacteria in there! It’s a good thing most bacteria don’t light up like this, we’d all be horrified at just how much of them there really is. There would be no such thing as darkness.
This fish is too cool for school
Smartphones may offer consumers a vast array of benefits, but they could be killing the atmosphere in restaurants. So much so that the Abu Ghosh restaurant in Jerusalem is encouraging diners to turn off their devices in return for a generous 50 percent discount. READ MORE…
I already posted this once, but I’ll share or again in hopes that the idea might spread to restaurants over here!
Finally somewhat Utopian cops a nation can be proud of!
In a stunning turn of events today in Thailand, riot police yielded to the peaceful protesters they were ordered to harass and blocked. They police removing barricades and their helmets as a sign of solidarity.
The protesters explain that their goal is to destroy the political machine of former Prime Minister Thaksin Shinawatra, who is accused of widespread corruption and abuse of power. Thaksin’s sister, Prime Minister Yingluck Shinawatra, is currently in power, and is seen as a puppet of her brother.
Suthep Thaugsuban, the leader of the widespread protests that have been going on in Thailand, told his supporters to storm the Bangkok Metropolitan Police Bureau. This was one of the primary buildings they vowed to take over in their vow to topple the Shinawatra government.
The move by police has surprised many, and marks a turning point in the protests and a potential shift in power.
I hope this product fails miserably..
(image by Jake Simkin)
War, Taliban, violations of human rights: unfortunately these are the things most associated with Afghanistan today. And yet in a society that has no place for them, 70% of the population of this country is made up of children.
Enter Australian skater Oliver Percovich, who first visited Afghanistan in 2007 with three skateboards in tow. It didn’t take long before he was surrounded by children eager to learn how to skate and his mission became clear. Since then, Olly has permanently relocated to Kabul and dedicated his life with his team to creating Skateistan, a non-profit NGO and full-functioning school where children can not only come to learn in a brand new skatepark facility, but in classrooms where they can choose to explore anything from creative arts to environmental health topics.
Regrettably, there are evident obstacles to teaching girls in a country such as Afghanistan but this NGO has worked closely with the local community and government to gain their full consent and support. It turns out, Afghans largely consider skateboarding a suitable activity for girls, but to respect the local law, they are taught on separate days to boys at the skatepark, by an all-female staff. Skateistan also arranges transport for the girls to make it easier and safer for them to attend.
Above is only an excerpt of something wonderful…
The folks behind Skateistan have opened branches in Pakistan and Cambodia as well. Check out the full article for a rundown of the organization’s history, plus an awesome trailer for their eponymous film that won the 2011 Cinema for Peace Berlin award for Most Valuable Documentary!
Major kudos all around.