PULMONARY EDEMA, HEART MURMUR

Alaska, Mount McKinley

Alan Pohl (33) was a member of a four-man expedition called the Wyoming Boys Go Climbing. The expedition flew into the Kahiltna Glacier on April 22, 1982, to climb the West Rib of Mount McKinley. On April 30, after making a long eight- day approach in order to acclimatize, the party camped at the base of the West Rib (3100 meters). At the 3100-meter camp, Pohl started taking Diamox (30 mg) in order to acclimatize, although he didn’t seem to have any symptoms of altitude- related illness. He continued taking Diamox one or two times a day for the rest of the trip. He was also drinking six liters of water a day and eating regularly.

The party fixed lines up the steep snow slope on the West Rib; they spent two nights at the 4000-meter level and one night at the 4300-meter camp. On May 5, the party left the 4300-meter camp and started up the Rib to fix lines and move supplies to the balcony camp at 4900 meters. After caching the gear, they started to descend the route; at this time Pohl became extremely fatigued and experienced chest pains and a mild headache.

At 2000, the party reached their 4900-meter camp and Pohl took additional Diamox to try and alleviate his altitude-related symptoms. During the night, Pohl’s chest pain increased and he started Cheyne-Stokes breathing. At 0300 on May 6, Pohl started hearing a slight gurgling sound in his chest followed by coughing and more chest pain.

At 0920 Pohl radioed to the Kahiltna Base Camp to inform them that he had pulmonary edema and to request a helicopter rescue. Mountaineering Rangers Scott Gill and Jon Waterman were able to monitor the Kahiltna Base Camp transmission from the Talkeetna Ranger Station. At 0930, Doug Geeting of Talkeetna Air Taxi was contacted and asked to make a surveillance flight. At 0940, Chris Soloy Helicopters was notified of the situation and asked to stand by.

At 1025, Geeting and Waterman left Talkeetna in a Cessna 185 to evaluate the need for a rescue. At 1100, the Wyoming Boys were located and Waterman was informed of Pohl’s deteriorating condition. The party was advised to start moving down the route; they were also told that a helicopter was being requested but that a thick cloud cover moving in might preclude a flight that day.

At 1105, Chris Soloy was contacted and asked to fly to Talkeetna with a Hiller- Turbine 1100 helicopter. At 1225, both Gill and Soloy left Talkeetna for the Southeast Fork of the Kahiltna to meet Geeting and Waterman and to exchange oxygen systems with them. At 1310, Gill and Soloy were on their way to the West Rib with Waterman and Geeting flying cover.

At 1345, Soloy touched the front of his skids down at the 4900-meter level and hovered. Pohl was able to walk onto the helicopter and was secured before liftoff. Pohl was alert and oriented and, once on the aircraft, was immediately put on 02. At 1450, Pohl arrived in Talkeetna where he was observed by Gill and Waterman. There was a slight gurgling sound in his chest and he had a continuous cough. He was flown to Anchorage by Geeting and taken to Providence Hospital.

Pohl was hospitalized for one night. According to Dr. William Mills, he had fluid in his lungs and a mild case of pulmonary edema. Upon further examination, it was found that he had a heart murmur, which may have had some bearing on his getting pulmonary edema. It was recommended that he go to a cardiologist in Denver for further tests. (Source: Scott Gill, Mountaineering Ranger, Denali National Park)

Analysis

As Dr. Charles Houston points out in Going High: The Story of Man and Altitude, Diamox is “one promising medication with a rational scientific basis” when it comes to preventing high altitude pulmonary edema (HAPE). But, the data is not conclusive. In this situation, there were two exacerbating factors. First, the undiagnosed heart murmur could have some effect on Pohl’s adjustment to altitude, although there is no proof for this as yet. Second, he was predisposed towards concern about HAPE. (Source: J. Williamson)