The Chief wrote: joynlife wrote: The Chief wrote:
joynlife wrote:Where does one start to think of altitude as a deterent? I feel it starts at 16,000 ft. If you feel the altitude at 12,000 or 13,000 ft you are doing something wrong.
I had a client die of HAPE, onset to full P/C Arrest, in 3.2 hours at 10,800', three weeks ago.
We have had several folks have to descend immediately from 9-10K due to severe symptoms of AMS.
And you as a guide should have seen on oncoming affects and had a backup guide to take them down as not to ruin the rest of the trip for the others.Some outfitters on Kilimanjaro have a main guide and usually 2 assistant guides if not 1 for this reason, on Aconcagua they usually have one head guide and one assist. Please The Chief if you have never been over 16,000 ft you really should`nt be talking about altitude, Keep the all knowning stuff to the clients of yours at the trail head and at the stream crossing rest stops.
We did have a TWO GUIDES. The Symptoms became observable were pronounced within a very short one hour time frame. We agreed on immediate descent and I was in process of assisting the client to an immediate emergency descent to below the mandatory 5K when he collapsed.
Final Official Autopsy results... C & P Arrest due to full onset of fluid in the lungs from altitude/lack of 02 intake (HAPE). Official time from onset to death, 3.2 hours. Obvious pronounced symptoms were observed only 38 minutes prior to his full collapse as he was descending. I administered CPR for 1 hour and 22 minutes before we pronounced him.
So far this season alone, 14 people have been officially evac'd in the Eastern Sierra due to severe AMS symptoms at 10-11K'.
According to Dr. Peter Hackett, HAPE & HACE can affect , become pronounced and become fatal from 8K' and above. He notified me that it is a complete misnomer within the Climbing Community that one has to be at 15K' and above to be affected by these two. Most recorded cases became pronounced at the 9-10K' level. He also advised me that I did everything by the book and this incident may be a record setter.
Anyone out there willing to play with the odds. My incident has clearly indicated that HAPE can be fatal if not attended to immediately. In this case, nothing could have been done to save this individuals life after the HAPE accelerated so quickly to the point of no return.
Your assessment from the armchair only serves to reveal a tasteless lack of compassion and good judgement. It also provides the very definition of " foot in mouth syndrome." Should have, would have, could have... An easy call from the sidelines eh?. How many deaths have you witnessed from Pulmonary Edema of any cause? How many cases have you handled medically ? Judging without the facts. Accusation from thousands of miles away and behind the safety of the keyboard. With your obvious lack of understanding of both the situ, AMS,HAPE and HACE, perhaps it is you who should "not talk about altitude." You may find a little Ketchup will help out with the poor taste left in your mouth the next time you insert both feet.
Again, good on you. I know how this situation tore you up. Been their myself. Early signs
of HAPE are difficult to discern at best. More often than not, it is the rapid onset of severe symptoms coupled with a crashing victim that leads to the diagnosis of HAPE. Sounds to me that the only chance your client had was IV Morphine and a butt load of Lasix with 100% O2 @ 12 - 15 LPM via non-re-breather with constant suctioning and probable intubation once unconscious. All EMT IV (paramedic) level skills. All available on the hill, right ?
Of course, all this followed by, or performed during rapid descent. Without the bird... Without the above mentioned treatment(s), I sincerely doubt that rapid descent alone would have saved this person once extremis
was accutely reached.
Diamox... I would agree that it may act as somewhat of an aid to acclimitization. At the same time, I would call this statement a bit of a misnomer. Taken prophylactically, it can help lessen or even prevent symptoms of AMS, HAPE or HACE. Taken on a treatment basis with the occurance of mild symptoms, it may offer relief. However, end treatment while spending time ( days ) high up, one may (and often will ) begin a deterioration or the return of symtoms being treated, especially as they move higher. In my mind, there is no substitute for : training and preparation , proper time spent high up to allow the body to compensate, proper hydration and diet, again and again, proper time allowing the body to acclimitize x 10...
Keep at it and don't let it get you down. I may be completely wrong, but it sounds to me that your body needs the time to build the stamina it takes to climb strenuous routes at altitude. Perhaps you can try to push yourself harder and faster on lesser routes at the same altitude ? Lather, rinse, repeat ? Slowly increase your difficulty range at the same time... and let's not forget, giving your body the amount of time it requires to adjust (perhaps the hardest thing of all). But I'm sure you've already considered and even practiced the above. Just some words of ecouragement.