Telemedicine in an emergency
As rounds were beginning, an emergency was brought in - a climber
who had been at Camp 4 (26,000 ft) for two nights had to return
because of severe respiratory distress, which continued to worsen
even though he returned to lower altitude. He arrived with a very
rapid breathing rate. A careful initial assessment by Dr. Kamler
confirmed the findings, along with the additional information
of : coughing up of sputum, a low-grade fever and absent breath
sounds in both lower lung fields. There was the dilemma of the
diagnosis being High Altitude Pulmonary Edema (HAPE), pneumonia,
or a combination of both. With the Yale physicians available for
consultation, preliminary therapy was begun. The diagnostic instruments
(Propaq for heart rate and oxygen saturation), digital stethoscope
so the physicians at Yale could also listen to the breath sounds,
I-STAT for immediate (within 2 minutes) results of blood tests
and ultrasound to look at the lungs (a substitute for X-rays),
was able to confirm that his blood oxygen was very low (77%, normal
is above 90%), there was not much air moving through the lower
part of either lung (consolidation). In consultation with the
radiologists at Yale, an ultrasound showed some fluid around the
left lung (effusion) and consolidation of both lungs with no evidence
of lung fluid (pulmonary edema), clarifying that the problem was
mainly that of pneumonia (along with some dehydration from not
drinking enough fluids). This allowed the proper treatment to
be started immediately. The level of care given was comparable
to that at a medical center emergency room, with necessary and
appropriate diagnostic equipment and timely (immediate) access
to consultation.
A review was then done of previous patients that had been seen
in the past 24 hours, with discussion and confirmation (though
data and photographs that had been sent to Yale) of the following:
A Sherpa with pneumonia (the digital breath sounds were reviewed
at Yale), snow blindness (photo of Dr. Grin treating the patient),
frostbite to both hands (photos of hands and fingers to assess
degree of injury).
The scientific studies continue to be very productive. A large
amount of ultrasound images and digital microscopy images were
received. In addition the first video streaming of microcirculation
at high altitude from the Cytometrics micro-camera was received.
Final data download from the PED vital signs monitors for the
descent from Camp 1 arrived. All this data is being entered into
the medical database.
The rounds concluded with a summary of what was known at that
time of the other expeditions attempting to summit. Last night
there was a terrible storm high on the mountain and avalanches
lower down. Apparently all the tents at Camp 2 were flattened
or destroyed from the wind and weight of the snow. There is an
attempt by all the other expeditions to account for all of their
team members, and it is anticipated that the severe weather will
drive many of the climbers back down the mountain (at least temporarily).
Today's participants include Drs. Peter Angood (moderating),
Rick Stahl, Jim Brink, Leslie Scoutt, Vladmir Naleska, and Gary
Stilwell, Charles Doarn, Dimitry Albert, Norman Stewart and Richard
Korn (Totally Remote Communications - to converse with Jim Bruton).
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