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graniteclimber
Trad climber
Nowhere
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Jul 30, 2009 - 06:18pm PT
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"It was HAPE, not an MI as every assumes that I was dealing with."
If there was not an MI, why were you giving CPR? Or do you mean you were giving CPR without the C?
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John Moosie
climber
Beautiful California
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Jul 30, 2009 - 06:28pm PT
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Chief, did you call it in as HAPE?
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Ken M
Mountain climber
Los Angeles, Ca
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Jul 30, 2009 - 11:40pm PT
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If you go back and read my post, you will realize that I did know that HAPE was the pathology involved.
Cardiac Arrest as an end result of HAPE is essentially untreatable in the field. CPR does not work. If you don't understand the pathology of HAPE, you will probably not understand why, but that is the truth.
http://books.google.com/books?id=inud-udaRFwC&pg=RA1-PA1122&lpg=RA1-PA1122&dq=HAPE+CPR&source=bl&ots=7ExI3r5ERg&sig=h8oLO4cDtmtXmA3F2Vp_LHYJdEo&hl=en&ei=kmFySuaBGYTYsQPt_dzZCA&sa=X&oi=book_result&ct=result&resnum=4#v=onepage&q=HAPE%20CPR&f=false
The ONLY thing (but very unlikely) that might have altered the course of things was to STOP. Increasing exertion at altitude to try to get back to the trailhead did not help the situation. On the trail where this happened, to get out, one must go UPHILL to get to the TH, unless one knows the old alternate route out to the road, which is all downhill.
Could the use of nifedipine have made a difference, pre-arrest? Perhaps. However, that would not be a commonly carried medication, even by a guide.
Increased exertion to attempt to hike out was undoubtedly an aggravating factor (as I understand happened), exertion raises pulmonary artery pressure, worsening the illness.
http://www.high-altitude-medicine.com/AMS-medical.html#HAPE-therapy
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rincon
Trad climber
SoCal
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Jul 31, 2009 - 09:30am PT
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Was the HAPE victim being guided?
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whatmeworry2
Mountain climber
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Jul 31, 2009 - 05:41pm PT
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While not specifically related to this incident or other time-critical incidents in any way, there is a tendency within the various official bureaucracies to be inwardly looking. The politics (e.g., "We can do this on our own and don't need any outside help.") often get in the way until many hours have been squandered.
Mutual aid is always a good option. There are a number of very capable SAR teams and resources in the state but it takes a request from the local official agency in charge, usually the Sheriff's office, to make the request (the idea of calling LASD directly to try and get Air-5 isn't going to get you very far). A mutual aid response can always be cancelled, but if you've got help rolling and you need them they will be that much closer....
Getting people to the Eastern Sierra does take some time but you'd be surprised about how quickly resources can get on scene. Some teams will drive through the night to arrive at the incident command post, etc. at 4 or 5 a.m. ready to put a dozen trained people (who've slept on the drive) in the field.
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rincon
Trad climber
SoCal
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[url="http://www.ksrw.sierrawave.net/eastern-sierra-news/2335-search-and-rescue-handles-two-deaths-injury-and-altitude-sickness]http://www.ksrw.sierrawave.net[/url]
The Chief, good on you for trying to save the dude. Was he your partner or was he soloing? Just trying to figure this out.
If he was with a guide service, do you know which one? Lucky someone had a Sat phone, not that it helped though.
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whatmeworry2
Mountain climber
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It will definitely be interesting to read The Chief's detailed account of what happened. I am encouraged to hear that he is open to sharing information from a very difficult situation - Thanks.
I'm very curious if some of the early signs of AMS were appearing well before the trip actually began at the TH. Signs that the subject may have ignored or not been readily apparent to those on the trip once the approach hike started.
I've seen at least one case where the progression of symptoms was extremely rapid (~30 minutes) running from the mild (headache)to severe(ataxia)in the intervening time. In that case the elevation gain from symptom onset (reported by subject) to "emergency" (observed ataxia, rales, altered mental status) was a couple hundred feet. Two of us were experienced mountain rescuers and immediately went into DIYSAR mode and assisted (e.g., almost carrying) the subject down. Waiting was not an option. The deterioration was astonishingly rapid. We were lucky - our friend was small and we had a pure descent to deal with vs. any uphill.
Dropping ~2,000 feet almost totally resolved the situation but the incident pretty much ended that trip. Pretty scary stuff.
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