Morning rounds began with Dr. Rick Stahl moderating from Yale
and Dr. Butch Rosser linking from Long Island. Dr. Ken Kamler
reported that the climber who was "admitted" to the E3 clinic
yesterday with a diagnosis of respiratory distress/pneumonia was
doing significantly better. Dr. Chris Macedonia stayed in the
medical tent and observed him through the night. This morning,
the climber was "discharged" with improved oxygen saturation and
clear lungs. The Olympus microscopic digital image of the sputum
sample transmitted to Yale showed gram + cocci, supporting the
diagnosis of streptococcus pneumonia. Dr. Jennifer Grin reported
that the team member who had suffered retinal hemorrhage was stable
and that she noticed no further progression of bleeding after
dilating the eye yesterday. In addition, the patient she had previously
treated for snow blindness was doing well.
Dr. Kamler provided an update on the frostbite victim whose hands
he had treated the day before. Apparently, the patient has been
evacuated by helicopter in order to receive further medical attention.
Ken expects additional cases of frostbite to present to the clinic
as climbers descend in harsh conditions. Dr. Leslie Scoutt, Yale
radiologist, suggested that the E3 doctors attempt Doppler imaging
of future frostbite cases. Though a question was raised as to
whether imaging can be performed on the distal extremities, they'll
give it a try.
Drama returned during rounds to the E3 clinic as 2 climbers presented
with respiratory difficulties requiring immediate attention. The
first patient (age?) complained of shortness of breath and fatigue
following his successful summit of Everest 2 days ago. On presentation,
vital signs included a temperature of 99.1º and O2 sat at 70%
on room air. Dr. Kamler's examination revealed decreased breath
sounds and crackles at the lung bases bilaterally as well as the
possibility of fluid in the left lung. A view of the left lung
by ultrasound was simultaneously assessed by Dr. Kamler and Dr.
Scoutt and interpreted as consolidation with a possible fluid
collection, raising the concern of pulmonary edema. (Imaging of
the right lung revealed a small effusion and consolidation.) Citing
the patient's fever, Dr. Stahl offered pneumonia to the differential.
Treatment was directed to both pulmonary edema and pneumonia.
The patient reported that he was no longer feeling "air hunger"
within 30 minutes.
The second climber (age?) had ascended to Everest's south summit
only to turn around when he encountered significant difficulty
breathing. He reported shortness of breath and trouble sleeping
on his descent, as he was unable to breathe in a prone position.
Past medical history is significant for asthma. On presentation,
vital signs included a temperature of 96.1º and O2 sat at 79 to
84% on room air. Physical exam revealed coarse rales in right
upper lung field. Blood pH was 7.35 as recorded by the I-STAT.
The patient responded well to oxygen and an inhaler. He will remain
overnight in the medical tent with the first patient and a member
of the E3 medical team for observation. Both climbers will be
reevaluated in the morning. (Coincidentally, the second patient
is a doctor who treated Scott Hamilton on his 1994 expedition
to Everest's North Face.)
Research Developments: Dr. Scoutt remarked that the Doppler
tracings of the Sherpa subject were significantly different from
those of the E3 team. Specifically, the Sherpa had a "whopping"
diastolic flow through the posterior tibial artery. Dr. Macedonia
responded that he had noticed the same phenomena last year, particularly
with ethnic Sherpas. The storm that ripped through Camp 2 also
crushed the E3 climbing team's plans to ascend to Camp 2, therefore
further testing will occur in excursions to other mountains in
the area. Dr. Macedonia courageously ingested the orange-colored
contrast fluid, pulled up his shirt, and had images of his aorta,
celiac, and superior mesenteric arteries transmitted live to the
Yale audience. Medical student Jennifer Kreshak operated the transducer
(with lots of gel) under the guidance of Dr. Scoutt. Dr. Scoutt
suggested that Chris hold his breath in order to improve the image
quality; Chris replied that breath holding is something that the
E3 team members can identify with while in the thin air setting.
Dr. Stahl reminded Scott Hamilton of the educational teleconferences
coming up this Monday and Tuesday evening (Tuesday and Wednesday
mornings at Base Camp). Scott replied that the team had already
given the program a lot of thought and had drafted a script, which
demonstrates the numerous medical activities
Today's participants: Dr. Rick Stahl (moderating), Dr. Peter
Angood, Dr. Butch Rosser, Dr. Leslie Scout, Gary Stilwell, Dmitry
Albert, and Norman Stewart.
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