Another Reason to Consider Learning about Wilderness Medicine

Submitted by Rick Clark, M.D. – Professor of Emergency Medicine at
...UCSD and faculty for the Wilderness Medicine Everest Base Camp CME Group

“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.

First EMIG Event - Dinner Sept. 14th at 6pm

EMIG-ers,

The first EMIG event this year will be a dinner held at Dr. Woodard's house. Dr. Woodard is a Quillen graduate, completed his residency at Vanderbilt, and is currently the emergency medical director at Bristol Regional Medical Center. He will be talking about careers and changes in the field of emergency medicine as well as effects of the health care reform on the practice of emergency medicine.

Dinner will be on Tuesday Sept. 14th at 6pm (hotdogs and hamburgers) with the discussion afterward. We are asking that everyone wanting to attend bring $3.00 to help pay for the dinner. Please RSVP for this event and give David Henley your money by Sept.13.

The address for this event is:

1000 Whittling Wood Drive
Johnson City, TN 37601

Hope to see you there!


Your EMIG officers