This April Fool's joke was on us when we returned to visiting with the Everest ER team again last night. The group of American trekkers had returned from Base Camp and were staying at the Himalayan Hotel (our usual Internet and Everest Beer haunt). We saw them across the tea house dinning room and were hoping they did not recognize us. Either they didn't or they didn't want to speak to us again because they came to the door of the aid post and told Arjun and the other doctor that a member of their team was descending with HAPE and would arrive just after midnight.
The second guide which had bought all the antibiotics and one of the people who he had treated empirically arrived a little before 1am looking exhausted. The guide had smartly put the patient on oxygen and began quick descent on foot which had taken over eight hours. It is best not to have HAPE patients exert themselves, but sometimes that is the only option. He had also given the patient two doses of Viagra which has been shown to have some benefit in HAPE. Although much more heavily marketed for one of sildenafil's "side effects", it was originally designed for heart disease and pulmonary hypertension which plays a role in HAPE pathophysiology.
We continued the patient on oxygen with plans for evacuation in the morning. Once again, the guide wanted us to organize the evacuation. After a long discussion about potential delays and expectations, they agreed. This second guide and patient were much more relaxed, and probably predictably it went much smoother and more quickly. It was, however, a little disconcerting when the helicopter took a group of tourists on a sight-seeing mountain tour before evacuating our patient (same helicopter and pilot.) Ironically, the two wealthy young hotshots from the same group also caught a helicopter out of town before the patient.
H&C
April 2, 2013
In pic: Hill in blue chatting with disembarking trekkers. Near chopper: Arjun negotiating with pilot. Pretty typical scene for helicopter evacuation of patient out of Pheriche. The helipad is constructed of white stone adjacent to the river.
The second guide which had bought all the antibiotics and one of the people who he had treated empirically arrived a little before 1am looking exhausted. The guide had smartly put the patient on oxygen and began quick descent on foot which had taken over eight hours. It is best not to have HAPE patients exert themselves, but sometimes that is the only option. He had also given the patient two doses of Viagra which has been shown to have some benefit in HAPE. Although much more heavily marketed for one of sildenafil's "side effects", it was originally designed for heart disease and pulmonary hypertension which plays a role in HAPE pathophysiology.
We continued the patient on oxygen with plans for evacuation in the morning. Once again, the guide wanted us to organize the evacuation. After a long discussion about potential delays and expectations, they agreed. This second guide and patient were much more relaxed, and probably predictably it went much smoother and more quickly. It was, however, a little disconcerting when the helicopter took a group of tourists on a sight-seeing mountain tour before evacuating our patient (same helicopter and pilot.) Ironically, the two wealthy young hotshots from the same group also caught a helicopter out of town before the patient.
H&C
April 2, 2013
In pic: Hill in blue chatting with disembarking trekkers. Near chopper: Arjun negotiating with pilot. Pretty typical scene for helicopter evacuation of patient out of Pheriche. The helipad is constructed of white stone adjacent to the river.
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