Got Oxygen?

Yesterday we were very busy. We had two Nepali porters with pneumonia and HAPE and also had our sickest HACE patient yet. This young Australian man and his new friend who he had met at Namche Bazaar only three days beforehand, made some poor decisions and wound up lost on a less traveled path and stranded on a glacier overnight without proper camping or even survival gear. He had also skipped both of the usual acclimatization days and had had AMS symptoms for days. Ignoring the signs, he continued. Luckily, he had chosen a slightly smarter and less altitude illness susceptible companion named Felix. Felix is from Batopilas, Mexico which ironically Chris and I have been to on our own backpacking misadventure with Trevor and Kelly about eight years ago. (It's a REALLY small world.)

Felix arrived at the aid post to warn us of the patient's arrival and to tell the story of their night on the glacier. They had not taken a guide and had gotten lost. Neither had a tent and the had only one sleeping bag. The patient was getting slower and unable to keep up, so Felix had taken the patient's bag and left his own (including his large sombrero) on the glacier. A little while further, the patient had become confused and ataxic (stumbling and uncoordinated) and could not continue. Felix left him with all the warm gear hey had (which wasn't much) and went for help. He found two porters who were willing to try to help find him for a fee. Felix had taken photos which he showed us of where he had left his pack and the patient, but the photos were at night, on the background of a glacier, and had a generic looking rock cairn (extremely abundant here). I'm not sure how they could have helped. But somehow against all odds, they found him alive, and he was being helped to the aid post.

Hill and I decided to walk up the valley to determine how far away he was and found that he was being carried on the back of a porter, since he could not walk straight on his own. We ran back to the aid-post, retrieved a stretcher and an oxygen tank, and ran back up the valley. He was really out of it and it took about eight of us to get him to the aid post. He was disoriented, hypothermic, and hypoxic...and he couldn't pee. Chris and Penny managed to place a foley after formulating their own lubricant/anesthetic concoction. He also got a good dose of dexamethasone (a steroid), hot water bottles, and of course more oxygen. He required a sitter for the first few hours because he kept trying to get out of bed, so we ate in shifts. Finally he was asleep and his oxygen saturation improved. We hunkered down by the yak dung stove still unsure if the batteries would hold with three patients on oxygen.

This morning, the patient and one of the porters descended by chopper to Kathmandu around 7:30 am. Unfortunately, somehow the Australian patient's bags, with his money, medical notes, and passport were left in Lukla, where they stopped to let off the porter. On top of that Arjun tried to run his card for the charges accrued at the aid post and the credit card was denied. So it was a comedy of errors that we think is working out. Chris talked talked to the patient on the phone and he sounded much more coherent and the tests run on him down in KTM did not reveal anything substantial or scary about his condition. We will follow up tomorrow.

H+C

Chris and Chris return from an evacuation with the oxygen tank.