Pulmonary Edema Evacuation from Base Camp
May 9, 1997
By Howard Donner
A Malaysian team Sherpa was evacuated from Base Camp by helicopter this morning, due to a
combination of pneumonia and high altitude pulmonary edema. The Sherpa had apparently just
come up to Base Camp from a lower elevation, and was weak and short of breath. The Malaysian
Doctor, Saye Khoo, examined the patient during the night and measured a blood oxygen
saturation of 20%. Because this is such an alarmingly low reading, it is doubtful that
this represents a true saturation; however, his oxygen saturation level was obviously low
enough to warrant an immediate evacuation.
Examination revealed a high fever and crackles in both lung fields, which suggests there was
fluid in both lungs. The Sherpa also had diminished sounds over his left lung field, causing
Dr. Khoo to wonder whether there was a partial lung collapse. The patient appeared to be
suffering from either bilateral pneumonia, or high altitude pulmonary edema, or both. At
these altitudes, missing one or the other diagnosis can be fatal. Therefore, Doctor Khoo
opted to treat for both, using both hyperbaric treatment (in a Gamow bag) plus supplemental
oxygen and potent intravenous antibiotic. By morning the patient's saturation had
improved to 85 - 90%, on four liters of oxygen per minute.
Often the differentiation between HAPE (high altitude pulmonary edema) and an infectious
process such as pneumonia can be made only after a day or two of resolution at lower
altitude (i.e. pneumonia will persist following descent, whereas HAPE will typically
resolve fairly quickly following descent). Hospital x-rays, sputum cultures, and additional
blood work will also help to differentiate HAPE from an infectious process. Although the
Sherpa was carried by an inflatable stretcher to the makeshift helicopter pad at Base Camp,
he was able to walk, with assistance, the last few steps from the stretcher to the helicopter.
Last year, a Sherpa came off Everest very sick with HAPE and unfortunately died
while being treated in Kathmandu.
Current weather forecasts continue to predict high winds aloft, and our climbers (David
Breashears, Jangbu Sherpa, Pete Athans, David Carter, and Ed Viesturs) are now opting to
wait out the high winds in the relative comfort at Base Camp. Ed, who spent the night at
Camp II, is coming down to Base Camp to rest with his team mates. Along with the high-tech
weather forecasts received from the U.K., a simple glance up the Lhotse Face reveals
persistent snow plumes extending from the summit ridge.