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Wilderness Medicine

Medicine and the Spirit of Adventure

Wilderness Medicine, Medicine and the sprit of adventure

WILDERNESS MEDICINE CME PARTICIPANTS INVOLVED IN DRAMATIC LIFE-SAVING RESCUES

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.













Mt. Everest Region, Nepal May 2008

A group of American doctors attending the 2008 Wilderness Medicine Educational Conference in the Mount Everest Region of Nepal last month were expecting to learn emergency medicine through lectures, discussions, and demonstrations. They were not expecting to practice their newly learned skills by performing dramatic rescues of live patients in life- threatening situations.

Twenty-eight physicians from the USA signed up to take a two week continuing medical education course while on a professionally guided trek to Everest Base Camp in the Nepal Himalayas last month.

The course was offered by www.wilderness-medicine.com. Lectures and discussions on medical problems encountered in remote environments are given each morning and evening while on the trek. . Topics include trauma, altitude related illness, hypothermia, travelers illnesses, expedition medicine, and many other topics. Faculty included Tim Erickson, M.D., Professor of Medicine from the U. of Illinois, Larry Moore, MD, and Sheryl Olson, R.N. The head guide for the trip was Kyle Allred, from Ashland, Oregon.

There were two separate incidents where the Continuing Medical Education course doctors were involved in dramatic life-saving rescues.

The first was on day 9 of the trek, , at 17,000 feet elevation. The group encountered a comatose Nepali sherpa lying by the trail. A probable diagnosis was made of High Altitude Cerebral Edema (HACE) a life -threatening emergency. The group had an extensive medical kit and were able to treat the victim with Intravenous Decadron and a portable hyperbaric chamber called a Gamow bag. After extensive resuscitative efforts, the patient regained consciousness and was able to be evacuated to a lower elevation where he recovered. Without the emergency treatment, it is quite likely that the patient would have died.

The second, separate incident took place on day 12 of the trek, at about 12,300 feet. The group encountered a trekker from India in severe respiratory distress. A probable diagnosis of High Altitude Pulmonary Edema (HAPE) was made, also a life-threatening emergency. The group treated the patient with Nifedipine and other drugs, and further resuscitated him in the Gamow bag. He improved dramatically and was then evacuated by helicopter to Kathmandu, where he made a full recovery.

www.wilderness-medicine.com offers the Everest Base Camp Continuing Medical Education course every April and May. They also offer similar CME courses for physicians and nurses and their guests to Kilimanjaro (Africa), the Inca Trail (Peru), the Amazon, Antarctica, and Patagonia. Courses are fully accredited with world class faculty and guides. For more information please contact www.wilderness-medicine.com or call 800-522-8747