Page 11 - 1994 AMA Summer

ARMY MOUNTAINEER
A CAUTIONARY TALE
A case o f high altitude pulmonary oedema captain rdm Weekes ramc
was helping one of these when the word was passed up to me that the girl had collapsed. I unclipped from the rope and glissaded
Climbing high mountains is not without it’s perils. Those of
avalanche and the weather are commonly recognise, but the
threat of altitude related illness is perhaps less understood. Thisdown the steep slope, the most unconventional route to a casual­
anecdotal account aims to raise awareness of the dangers, and to suggest methods of prevention and treatment.
August 1993 saw a group of sixteen arrive in Kathmandu to attempt to climb Pacheramo, a 20,000 foot mountain in the Nepalese Rolwaling Himal. The group contained a range of dif­ fering experience, fitness and stamina and included both males and females. After the usual sorting out of kit a bus was taken to Dalakha at 4,000 feet, north west of Jiri. From there we trekked up into the foothills following the Tamba Kosi river for five days through rain forest infested with leeches up into the alpine zone above 10,000 feet. We climbed steadily until the last point of habitation was reached at Na, 13,720 feet. Thus we climbed about 10,000 feet in 7 days. We rested at this height, and accli­ matised for a day, before climbing on up onto the Trakarding glacier to establish Base Camp at Gauri Shankar, 15,7000 feet, at the snout of the Drolambo glacier. Four days were spent here,
practising ice clim bing techniques and acclim atising further in the thinning air.
At 15,700 feet five members of the group developed Acute Mountain Sickness (AMS). Their symptoms included headache, nausea and Cheyne-Stokes breathing (a condition where the per­ son experiences a ragged breathing pattern during sleep where long periods of not breathing at all are followed by a period of deep sighing breaths). This is caused by the low oxygen concen­ tration in the air and the associated changes in body chemistry. All five responded well to treatment with diamox (a mild diuret­ ic) and to rest for a day or two. They were able to resume their ascent after four days at base camp. People who fail to respond to this regime should descend the mountain in order to recover fully before resuming the ascent. Failure to do this can have seri­ ous results as we were about to find out!
On 18 August the group ascended the ice fall at the snout of the Drolambo glacier to establish advanced base camp at 17,500 feet. This was at the foot of the Teshi Lapcha pass, and below Pacheramo, the mountain we had come to climb. A further two days were spent at this height, and two more people, one of them a porter, developed AMS, and were successfully started on treatment.
On 20 August we climbed an un-named peak on the western side of the glacier, at 19,800 feet. This involved a long steep ice and snow pitch, perhaps a thousand feet, and so we roped into teams of four and donned crampons, harnesses and ice axes. Two hun­ dred feet short of the summit one of the girls complained of exhaustion and said she would wait for us at that height. The remainder went on, reached the summit and began to descend. When we reached the girl she was breathless and giddy, so we quickly began to descend the snow and ice pitch. Thick snow began to fall, balling the crampons badly and several of the less experienced members of the group found the going daunting. I
ty I have yet used. On my arrival she had indeed collapsed, there were no signs of breathing, and no palpable heart beat. Mouth to mouth followed a vigorous precordial thump and she slowly regained consciousness. After a short while she was able to cooperate with our efforts to get her down oft the slope. Thirty feet from the bottom the same thing happened again, and mouth to mouth again proved effective. We were now on a rocky shelf, with a steep rocky slope below down to the surface of the glaci­ er. Our sherpa had been sent ahead to fetch the oxygen supply from advanced base camp and had shot off like the wind. We decided to stabilise the girl here, and got her into dry clothes and inside both sleeping and bivi bags as it was still snowing and get­ ting very cold. She was very confused and uncooperative, fight­ ing our efforts to get her dry and warm. This exhausted her and she collapsed once more. Shortly afterwards, and in less time
than really seemed possible, our sherpas arrived bringing oxy­ gen, tent and brew kit. The oxygen worked wonders for her, as did a cup of tea for us, although we had difficulty keeping the mask on her face, and I was able to give her some diuretic. With the aid of the oxygen and of the sherpas we got her back to camp, arriving just before night fall. A stag roster was organised to watch her through the night, and she passed a restless eight hours slipping into unconsciousness and being revived with oxygen.
It was clear that we had to get her to a lower altitude, and more oxygen as soon as possible. A difficult choice confronted us however. Behind us. the way that we had come, lay the steep ice fall, two glaciers and a trek of at least ten days before a radio could be reached. Ahead lay the Teschi Lapcha pass, higher than we were at 18,500 feet, but beyond that the ground fell steeply to Thame below the helicopter ceiling at 12,500 feet, and only two days march away. We opted to go on, leaving at the crack of dawn the next day. With the aid once again of the sherpas and the oxygen we got over the pass and the following day to Thame. With descent the girl improved rapidly, but it was not for several days safely in Namche Bazaar that she realised how ill she had been. She later confessed to having had quite severe headache
and nausea at advanced base camp, but had not revealed this in case she was not allowed to climb higher.
The girl had developed High Altitude Pulmonary Oedema (HAPO). In this condition the lungs begin to fill with fluid, and this coupled with the low oxygen concentration in the air had lowered the oxygen in her bloodstream to the point at which she had collapsed. She then suffered a respiratory arrest. HAPO affects up to 15% of people who ascend rapidly to high altitude, and can occur as low as 8,000 feet. Young people are more at risk, especially young males, In people who had sur­ vived one episode the risk of reoccurrence is put at 60% on reascent to altitude. Mortality is put at 44% without descent or treatment, and 11% overall. The best way to avoid high alti­ tude illness is to limit the rate of ascent, and thus allow accli­ matisation. The Himalayan Rescue Association recommend the following regime: com.
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