Rounds began with a few case reviews. The patients from yesterday
with lung problems are both improved. The first one with pneumonia
and gram positive bacteria (probable sreptococcus) has improved
breath sounds, less consolidation, and only a few wheezes. The
second patient is walking around, completely well, which is compatible
with mild high altitude pulmonary edema (HAPE). The follow-up
on the two patients with eye problems is that the one with snow
blindness continues to recover, and the retinal hemorrhages are
unchanged in size or character.
Two new patients arrived; one was a Sherpa with increasing knee
pain, especially upon weight bearing, and which would "lock-up"
on him. Last year he had an injury to that knee. The Xray at that
time was negative (it took almost a year for him to get his Xray
report back). A real-time ultrasound was performed in which fluid
around the knee was clearly demonstrated, and a possible tear
of his meniscus. These findings are quite subtle, and Dr. Brink,
the Yale radiologist was not able to confirm that diagnosis because
the resolution was not quite high enough. This ultrasound will
be sent as store and forward, and be available for interpretation
for tomorrow morning rounds. The other patient was a Sherpa complaining
of upper abdominal pain nausea and light stools (questionable?).
On exam he did have mild right upper quadrant tenderness, but
no guarding or rebound and there seemed to be a possible yellow
to the eyes, though it is not certain if this was his natural
color. He was afebrile. The real-time ultrasound revealed a normal
gall bladder, no stones seen and no thickening of the wall. In
addition the common bile duct, liver and pancreas were entirely
normal. Dr Brink indicated that the quality of ultrasound was
excellent, nearly as good as if it were done back at Yale. It
is not certain if he had possibly passed a gallstone, however
there was no significant disease at this time and he was allowed
to return to work.
A very interesting Sherpa arrived at the camp with a slight cough
(the "Khumbu cough"). He had just returned from the summit, where
he had incredibly spent 21 hours without the use of supplemental
oxygen. Preliminary examination was completely normal, and no
ultrasound was needed.
There continues to be a somber note and concern at not hearing
from 2 separate climbers attempting to summit 2 days ago from
2 different expeditions. No definite news yet.
Today's participants: Dr. Rick Satava (moderating), Dr. Jim
Brink, Gary Stilwell, Dmitry Albert, and Norman Stewart.
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