PULMONARY EDEMA—Alaska, Mt. McKinley. Edward Guleke (29) was a member of an expedidon which was organized privately and then contacted Alaska Mountain Guides (Ray Genet) for a guide to lead them up the West Buttress. They were flown in on June 20, 1976 and by June 28 had reached 14,200 feet. Guleke felt fine there and the group moved up the mountain. Guleke felt quite tired and stopped at the camp at 16,400 feet with his guide, a doctor, and most of his group. Ray Genet, leading other parties, continued up to 17,200 feet. Guleke and his group rested at 16,400 feet on the 29th, and Guleke appeared to be in satisfactory condition. That night and the morning of the 30th, the weather was bad. The group planned to move up to 17,200 feet late on the 30th and up until 6 or 7 p.m. Guleke felt okay. However, he soon developed distinct signs of pulmonary edema (cough, gurgling chest sounds, weakness). He was given Lasix intravenously at this time and the decision was made to move him to the 14,000 foot level. The following morning Ray

Genet and others were able to move Guleke to 14,200 feet, arriving there about 12:30 p.m. in very poor weather. A doctor at 14,200 feet who examined him at that time stated that he was unconscious, had frothy, bloody sputum, bubbling rales in his chest, a pulse of 140 and that he appeared to be terminal. As Guleke continued to deteriorate, and without oxygen or the possibility of a helicopter evacuation (because of bad weather), the doctor at 14,200 administered a small dose of Lasix to Guleke, although the doctor stated later that he questioned the use of Lasix in these cases. Guleke died approximately two hours after arriving at 14,200 feet. (Source: Bob Gerhard, McKinley Park.)

Analysis. The use of Lasix in high altitude pulmonary edema is being questioned (see Off Belay magazine, April 1975, article by Herbert Hultgren, M.D.). Whether it helped Guleke, had no effect, or was detrimental to him probably won’t be known. In taking nine days to reach 14,200 feet the group was climbing slowly enough for most people to acclimatize. However, Guleke had had pulmonary edema before (at a lower elevation in the Colorado Rockies), and apparently his guides were not informed of the fact. Guleke should not have been on the climb in the first place. (Source: Bob Gerhard, McKinley Park.)