From Stu in the USA office
22 April, 2011
Ben called in from IBC late yesterday to let us know that he had just successfully completed evacuating one of our members who had come down with suspected HAPE in the early morning hours of the 21st. She is already at this time back in Kathmandu and feeling much better. The rest of the team in doing well in ABC and waiting for Ben and Siddhi to return.
Evac recap
At around 4 am Pille awoke with a productive cough and poor presentation and Ben took immediate steps to ensure she got down to CBC as fast as possible. At that time in the morning there are few options and so Ben and Siddhi and Priit put considerable effort into carrying and assisting Pille out of ABC and all the way down through IBC to CBC. From what Ben shared it sounds like Siddhi carried Pille on his shoulder for a considerable portion of the evacuation giving further testament to his enormous strength and endurance. Thanks Siddhi!
Ben said that as Pille descended her condition improved markedly and she was under her own power by the time the reached CBC. After arriving at CBC a 4x4 jeep was arranged and Pille and Priit headed to the border which they reached by the end of the day.
Pille remained on oxygen throughout the evacuation as well as during the drive back to the border. One of the challenges of the drive is that one has to reascend on several passes and with no way to avoid that the best one can do is have oxygen as a precaution.Today they completed the trip back to Kathmandu and are resting up at our team hotel for a few days.
Meanwhile at ABC
Ben and Siddhi will both be back in ABC today and the team will get back to the work of moving gear and tests up to C1. Obviously both Ben and Siddhi will need a bit of rest after the effort to go all the way down to CBC and back to ABC but Keith and Sophie should be able to move on up to C1 with a carry in the morning. We'll have word from ABC in the next 24hours about the re vamped schedule and share that in our next dispatch.
We are sorry to have Pille and Priit have to leave the team as they were strong and positive members. They have some time ahead of them and our agent Nima will be helping them to arrange an alternative adventure once they have rested up and made a decision about what to do with their time.
About HAPE
High Altitude Pulmonary Edema (HAPE) is a medical condition in which fluid builds up in the lungs and blocks the body from bringing new oxygen into the blood stream causing a state of hypoxia. In some cases it can be severe enough to be fatal but typically with a rapid descent of several thousand feet the situation resolves and the body begins the process of reabsorbing the fluid that was building up in the lungs.
There are numerous signs and symptoms we look for in a suspected HAPE case and they can include a productive cough (progressing from clear to pink), lack of recovery after resting, cyanosis, breathsounds that have a gurgle or rattle to them and more. HAPE can present much like a chest cold, asthma or pneumonia but at altitude any difficulty breathing is assumed to be HAPE until otherwise proven.
Causes are varied but even a person taking good care to acclimatize on a reasonable schedule can succumb to HAPE. The treatments can included hyperbaric chambers and medications (niphedipine, dexamethasone, diamox and oxygen the most common) but there is nothing that is more important than a rapid descent. For some people this may be as little as 1000-2000ft but for others it may mean 4-5000ft or even a return all the way to see level. In our case the drop from ABC (5700m) to CBC(4900m) was approximately 800m or 2640ft and this was sufficient for symptoms to begin to subside.
In some cases climbers will feel considerably better after a few days down low and consider ascending again. This is obviously accepting a large degree of risk of contracting HAPE again but there are numerous cases of this happening even on 8000m peaks. For most people it makes best sense to stay where the air is thick and enjoy the Terai in Nepal, the Ganges and Varanassi in India, or the beaches and rock climbing in Thailand!
for more info on HAPE and altitude illness you can see a case study we have from a few years back on our site as well as visit any of the links below
ABC’s of HAPE and HACE – a case study in serious high altitude illness
http://en.wikipedia.org/wiki/High_altitude_pulmonary_edema
http://www.altitude.org/altitude_sickness.php
http://www.basecampmd.com/expguide/hape.shtml
http://www.high-altitude-medicine.com/
http://www.ismmed.org/np_altitude_tutorial.htm
http://www.altitudemedicine.org/index.php/altitude-medicine/learn-about-altitude-sickness/what-is-hape
