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Wilderness Medicine CME Group Rescues and
Possibly Saves the Life of a German Trekker with Severe Altitude Sickness on
Everest Trek
Submitted by Rick Clark, M.D. Professor of Emergency Medicine at UCSD and
faculty for the Wilderness Medicine Everest Base Camp CME
Group April 2010
At around 6 pm on April 12, 2010 at our lodge just past Tengboche
(12,700 foot altitude), a 50 year German trekker (who was not part of our
CME group) was carried into the lodge by 2 porters. She was ataxic,
confused, short of breath and could barely speak. Her skin was cyanotic and
cold. Through her porter and some members of our group who spoke German, we
discovered that she had become progressively short of breath and weak over
the past 2 days and her porter had left the rest of her group to descend as
far as possible before sunset. We placed our finger pulse oximeter on her
and it registered around 55%, with a pulse of 110 bpm. On a cursory
examination, her lungs had some crackles throughout, her mucous membranes
were dry, and she had tachycardic heart sounds. She could not walk without
assistance. She had no other focal neurologic findings.
We diagnosed her with both HAPE and HACE. Her porter told us he was going
to continue his descent with her in the dark, but only to about 11,000 feet.
We asked him and the patient if we could help; noting that we were very
worried about her and that she would likely worsen over night. They agreed
to allow us to help. We recommended that she be given some medications and
placed in our Gamow bag overnight. We would then arrange helicopter
transport in the morning.
We administered her 12 mg dexamethasone IM, and 250 mg acetazolamide
orally. After getting permission from the lodge owner, we took her to the
top floor and opened our Gamow bag. We inflated it and placed her inside.
Once she was inside the bag, she immediately began to improve, with her
pulse ox increasing to 70's and finally 80's by the next day. Her mental
status improved all night and she was able to speak easily understandable
English within 2 hours. We maintained hour-long shifts monitoring her over
night, allowing her to be removed from the bag every hour and urinate. Each
of our porters also took turns on the foot pump to keep the bag inflated
overnight. She was ambulating almost without assistance by morning. We
orally hydrated her during the night and she received two more doses of
dexamethasone orally.
During the night we arranged for a helicopter rescue after sunrise. We
removed her from the bag around 0700, and walked her down to the nearest
helicopter landing site. The helicopter arrived soon after we did, and she
was easily loaded for transport. Prior to her loading, we found out she was
an oboe player in a symphony orchestra in Germany. She said she was "very
thankful for our help before she departed."
Editor note:
The Wilderness Medicine CME groups to Everest Base Camp always carry a Gamow
Bag, pulse oximeter, and of course, other emergency medications and
supplies. In the Spring of 2008, our Everest CME groups performed similar,
life-saving rescues of two different patients with severe altitude illness.
(HACE and HAPE).
Larry Moore, M.D. and Sheryl Olson, R.N were faculty for the 2008
Wilderness Medicine CME groups to Everest Base Camp. Moore and Olson headed
a humanitarian fund raising effort to purchase 6 Gamow Bags and deliver them
to various high altitude villages in the Everest region. They delivered
these potentially life-saving Gamow bags on our 2009 Everest Base Camp CME
trip.
Everest Base Camp CME participants
using Gamow bag to rescue German trekker
with High Altitude Pulmonary and
Cerebral Edema.
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