ILLNESS–COLITIS

Alaska, Mount McKinley, West Buttress

At 1825 on May 19, Christopher Allewell (age unknown) was assisted into the 14,200-foot NPS medical tent by his teammates. His chief complaint was severe abdominal pain and a mild headache. Upon examination, pain was localized in his mid quadrant, bilaterally, with a severity of ten on a scale of one to ten, ten being the most painful. Pain was not associated with vomiting or fever. However, Allewell expressed extreme tenderness and guarding of his abdomen. Symptoms occurred suddenly and had been apparent for approximately six prior to his arrival at the NPS medical tent. Past medical history did not indicate a cause. Bowel sounds were present and urination was clear. Allewell's pain was mildly relieved when he lay in a left lateral recumbent position. After conferring with Dr. Jennifer Dow, NPS volunteer Steve Stein started an IV Two liters of intravenous fluids were given. No pain medications were administered at this time.

By the morning of May 20, Allewell’s pain had increased in his upper right quadrant and had radiated into his back. Though his headache was relieved, Allewell's abdominal pain persisted, dramatically affecting his mobility. At 1257, Dr. Jennifer Dow authorized 30mg of Toradol for pain relief and recommended an immediate evacuation. At 1500, Allewell was transported to the 7,200-foot basecamp by the NPS contract helicopter and then flown to Regional Hospital in Anchorage by the LifeGuard helicopter.

Analysis

In the hospital, Allewell was diagnosed with colitis, an inflammation of the gut wall. Colitis requires surgery only when infectious. Lack of oxygen (i.e. altitude) can cause an infection, and therefore Allewell remained under observation in the hospital for several days.

Unfortunately, Allewell could not have predicted or prevented his condition or need for evacuation. However, Allewell’s situation did reflect the difficulty of treating abdominal pain while in the backcountry. Determining the source of the pain can be extremely difficult. In Allewell’s case, duration and severity indicated the need to evacuate. Extreme tenderness, guarding, the inability to move, and pain threshold were the key elements used to assess the severity of his condition. As a rescuer, patient assessment is a critical skill in order to determine acute abdominal pain and the need for immediate evacuation. (Source: Ranger Karen Hilton)