DieselRanger
Well-known member
Likely a less common scenario: I've been involved in rescuing two people who developed High Altitude Pulmonary Edema (HAPE).
First case was a gentleman in his 40's from Ohio who had been acclimatizing at about 8,000 feet for a few days prior to a volunteer trail building trip higher up. We had a short hike from 10,000 feet to about 10,800 feet, set up camp. Next morning, the first work day, he had a headache, which went away with hydration, food, and some ibuprofen. We always have everyone take it easy the first day, with lots of breaks, and we work as close to camp as we can, with the plan to work higher over the week as everyone acclimates. That evening, he felt OK, was jovial and engaged. 2nd morning, he had a headache again, and felt weak. This was when we *should* have hiked him out. We asked him to hang back at camp and take it easy. By the end of the work day (~2pm or so) he said he felt a little better, but not great. He ate lightly for dinner and turned in early. It rained heavily that evening and all night, so everyone was in their own tents. When we got up the 3rd morning, he was difficult to wake, had a wet cough, and once we got him up he was clearly disoriented with a weak, fast pulse and shallow breathing. He had said he couldn't get comfortable laying down at night, it felt like someone was standing on his chest while laying down. We immediately began evacuation. During the very slow walk out, he developed pink, frothy sputum (cough goo), and I ended up running 2 miles to a vehicle, driving down a rough 4x4 road to the nearest landline and calling rescuers while my co-leader piggyback-carried the patient to his car and drove to meet rescuers. When rescuers got to him, his SpO2 was 45%, equivalent to a climber at approximately 25,000ft of elevation, and they estimated he was within 2 hours of death. 15 minutes on a CPAP machine and he was awake, alert, and in good spirits and back up to about 85% as the mountain rescue then drove him to the hospital. He spent 3 days in the hospital on a CPAP machine. Lesson learned: carry a stethoscope and a pulse oximeter, and get a baseline from everyone in the group prior to starting off. I also ended up buying a DeLorme (now Garmin) InReach due to a separate close call a couple years later.
Second case was a Div III basketball player in his early 20's from Kansas. He had spent the week prior to the volunteer trip at sea level, rushed back home for the trip, drove all night to the rendezvous point at 9,000 feet. Toured around for the day, slept poorly that next night, then the next day carried a 45-lb pack from the trailhead at 10,000 feet, over a pass at 11,800 feet and down to the campsite at about 11,000 feet. Said he felt fine - no headache, no complaints. First work day, no hiking, but lots of rock work and digging doing campsite rehabilitation. He worked hard, like he was training - we asked him to take it easy and slow down. By 3pm he was visibly tired. Crashed in his tent for a couple hours, came out for dinner, ate like a horse, then puked it up about an hour later - headache and nausea. We sent him to bed and checked on him regularly. At 11pm I was woken by my co-leader who said he was in bad shape, but my co-leader needed rest, so I took over - brought the stethoscope. Patient had a dry, hacking cough, rattling chest that sounded like a broken harmonica, and was at the edge of consciousness, restless and moaning. My pulse oximeter's batteries had died sitting on the shelf at home, but I didn't need it to know he was exhibiting classic HAPE symptoms. I asked if he could get up, and he could barely keep his feet, so hiking out in darkness (never desirable) wasn't an option. Grabbed my InReach and flipped on the SOS and started coordinating with rescuers, who initially were going to hike in the same way we came, and stretcher him out via a longer trail, but one that didn't have a climb up. However, as the patient's vitals continued to deteriorate over the next couple hours, that became less of an option, and they arranged for a helicopter at first light. When they arrived, his SpO2 was 52%. He spent a week in the hospital.
The first case was more typical of HAPE victims. Per the rescuers in the first case, AMS (Acute Mountain Sickness - the headache, nausea, etc) generally develops within a few hours of exposure to altitude, and it generally disappears 24-48 hours afterward as the body acclimates. However, for reasons unknown, AMS symptoms may disappear while HAPE is developing. HAPE *usually* develops after about 72 hours of exposure to altitude. You can see the potential for a gap between AMS disappearing and HAPE developing - and the victim taking that as a sign to push on, higher and deeper into trouble, farther from easy rescue. In the second case, however, onset was so fast there was little we could do - from the first case, when I went to bed at about 8:30 pm I figured we had the night to let him rest and hike out the next morning. Nope. Rapid Onset HAPE is rare, but apparently there's a statistical correlation between it and age/fitness - the younger and more fit you are, the more likely that can happen. It may be that older people generally are more aware of their limits and are less likely to push into the "red zone," giving their body the time it needs to adjust, but the mechanisms by which the body acclimates aren't fully understood despite decades of study by the USAF, NASA, and academia.
First case was a gentleman in his 40's from Ohio who had been acclimatizing at about 8,000 feet for a few days prior to a volunteer trail building trip higher up. We had a short hike from 10,000 feet to about 10,800 feet, set up camp. Next morning, the first work day, he had a headache, which went away with hydration, food, and some ibuprofen. We always have everyone take it easy the first day, with lots of breaks, and we work as close to camp as we can, with the plan to work higher over the week as everyone acclimates. That evening, he felt OK, was jovial and engaged. 2nd morning, he had a headache again, and felt weak. This was when we *should* have hiked him out. We asked him to hang back at camp and take it easy. By the end of the work day (~2pm or so) he said he felt a little better, but not great. He ate lightly for dinner and turned in early. It rained heavily that evening and all night, so everyone was in their own tents. When we got up the 3rd morning, he was difficult to wake, had a wet cough, and once we got him up he was clearly disoriented with a weak, fast pulse and shallow breathing. He had said he couldn't get comfortable laying down at night, it felt like someone was standing on his chest while laying down. We immediately began evacuation. During the very slow walk out, he developed pink, frothy sputum (cough goo), and I ended up running 2 miles to a vehicle, driving down a rough 4x4 road to the nearest landline and calling rescuers while my co-leader piggyback-carried the patient to his car and drove to meet rescuers. When rescuers got to him, his SpO2 was 45%, equivalent to a climber at approximately 25,000ft of elevation, and they estimated he was within 2 hours of death. 15 minutes on a CPAP machine and he was awake, alert, and in good spirits and back up to about 85% as the mountain rescue then drove him to the hospital. He spent 3 days in the hospital on a CPAP machine. Lesson learned: carry a stethoscope and a pulse oximeter, and get a baseline from everyone in the group prior to starting off. I also ended up buying a DeLorme (now Garmin) InReach due to a separate close call a couple years later.
Second case was a Div III basketball player in his early 20's from Kansas. He had spent the week prior to the volunteer trip at sea level, rushed back home for the trip, drove all night to the rendezvous point at 9,000 feet. Toured around for the day, slept poorly that next night, then the next day carried a 45-lb pack from the trailhead at 10,000 feet, over a pass at 11,800 feet and down to the campsite at about 11,000 feet. Said he felt fine - no headache, no complaints. First work day, no hiking, but lots of rock work and digging doing campsite rehabilitation. He worked hard, like he was training - we asked him to take it easy and slow down. By 3pm he was visibly tired. Crashed in his tent for a couple hours, came out for dinner, ate like a horse, then puked it up about an hour later - headache and nausea. We sent him to bed and checked on him regularly. At 11pm I was woken by my co-leader who said he was in bad shape, but my co-leader needed rest, so I took over - brought the stethoscope. Patient had a dry, hacking cough, rattling chest that sounded like a broken harmonica, and was at the edge of consciousness, restless and moaning. My pulse oximeter's batteries had died sitting on the shelf at home, but I didn't need it to know he was exhibiting classic HAPE symptoms. I asked if he could get up, and he could barely keep his feet, so hiking out in darkness (never desirable) wasn't an option. Grabbed my InReach and flipped on the SOS and started coordinating with rescuers, who initially were going to hike in the same way we came, and stretcher him out via a longer trail, but one that didn't have a climb up. However, as the patient's vitals continued to deteriorate over the next couple hours, that became less of an option, and they arranged for a helicopter at first light. When they arrived, his SpO2 was 52%. He spent a week in the hospital.
The first case was more typical of HAPE victims. Per the rescuers in the first case, AMS (Acute Mountain Sickness - the headache, nausea, etc) generally develops within a few hours of exposure to altitude, and it generally disappears 24-48 hours afterward as the body acclimates. However, for reasons unknown, AMS symptoms may disappear while HAPE is developing. HAPE *usually* develops after about 72 hours of exposure to altitude. You can see the potential for a gap between AMS disappearing and HAPE developing - and the victim taking that as a sign to push on, higher and deeper into trouble, farther from easy rescue. In the second case, however, onset was so fast there was little we could do - from the first case, when I went to bed at about 8:30 pm I figured we had the night to let him rest and hike out the next morning. Nope. Rapid Onset HAPE is rare, but apparently there's a statistical correlation between it and age/fitness - the younger and more fit you are, the more likely that can happen. It may be that older people generally are more aware of their limits and are less likely to push into the "red zone," giving their body the time it needs to adjust, but the mechanisms by which the body acclimates aren't fully understood despite decades of study by the USAF, NASA, and academia.
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