KK: What happened to the guy who came in by horseback?
Explore This IssueACEP Now: Vol 34 – No 07 – July 2015
RS: He was stable overnight. He was a bit hypoxic. One interesting point is that people’s oxygen saturation is routinely between 80 percent and 90 percent, but that’s normal. He was hypoxic relative to what I would expect for that altitude, so he was on oxygen overnight. There are no cars because there are pretty steep trails that go through this whole region. Transportation is either by foot, horse, or helicopter; a lot of goods are transported via yaks.
KK: Certainly some unique trans-portation challenges. If I had to choose between the yak and the horse, I think I’d have to go with the yak. It’s a smoother ride, from what I hear.
RS: I never did get the chance to ride on a yak. I’ll have to save that for my next trip to Nepal.
KK: How did you plan to care for all these people, and did you have enough resources to do it?
RS: We had a three-bed hospital: one bed where we would see active patients and complete evaluations and two beds that were considered inpatient beds, which essentially were two stretchers in a small room. An ancient ultrasound machine was the only imaging modality that we had. We had the ability to do IVs. Even then, we only had 20 bags of normal saline.
KK: Your imaging modality was only an old dinosaur ultrasound machine. Did you also do lung scans to looking for pneumothoraces?
RS: We did the EFAST [Extended Focused Assessment with Sonography for Trauma] on the first patients who came in that night. During the mass casualty itself, we used ultrasound to make sure it wasn’t a pneumothorax as long as I didn’t think a patient was having a tension pneumothorax and getting hypotensive from that or tamponade. Because there was such a high volume of patients, we really had to limit our time with each one.
KK: Tell me about the sickest or most challenging patient you took care of.
RS: The first one that comes to mind was a climbing Sherpa, I guess a Nepali, who had what appeared to be isolated head trauma. He was about a Glasgow Coma Scale of nine, and he was protecting his airway, but he was very combative. He actually came down from Everest Base Camp. I think the only reason we were very successful at what we did was because of the amazing work that they did at the Everest Base Camp. They were the first responders, pronouncing the deceased in their tents.