APPARENT DEATH WITH ACCIDENTAL HYPOTHERMIA

SUMMARY A case is described of hypothermia following barbiturate overdose in a young woman. The conditions which led to the patient being initially thought dead, and then found to be alive, and the subsequent management which led to complete recovery are described and discussed. Induced alkalosis is thought to have contributed to survival by protecting the myocardium against development of severe ventricular arrhythmia CASE REPORT A case is described of a 23-year-old woman who took an overdose of short- and medium-acting barbiturates and then lay on a beach for about 10 hours exposed to a ground temperature of 10°C but partly sheltered from the wind (strength 20 m.p.h.). She was fully clothed and had not been immersed. She was certified dead at 9.05 ajn. and then covered with a tarpaulin. An hour later, but still prior to removal to the mortuary, it was observed that there were no obvious signs of violence on the exposed parts of the body, and rigor mortis was not present At 10.25 ajn. the rectal temperature was 27.2°C, a figure at variance with an earlier report. In the mortuary at 11.15 ajn. the rectal temperature was measured again and found to be 26.0°C. Of the three cardinal signs of death, namely algor (cooling), rigor (stiffening) and livor (staining), only algor had been observed, rigor was still absent, and livor could not be assessed since the rlmhing was still in place. Attention was now focused on the possibility of life and it was observed that the features were still "fresh coloured", and that the usual drying of secretions had not occurred. There was saliva within the mouth, the eyes were not glazed, and a tear was observed to have formed. Pulsation was now seen in the neck and it became apparent that the patient was taking an occasional shallow breath. During the ambulance journey from the mortuary to hospital spontaneous respiration ceased, and at the time of admission there was no longer palpable or visible pulsation, and no heart sounds were heard. At 11.45 ajn. the rectal temperature was 25°C Resuscitative measures were commenced including cndotracheal intubation and hand ventilation with oxygen, and an infusion of 200 m.equiv sodium bicarbonate given. External cardiac massage was performed for approximately 10 minutes, by which time the patient had been