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Hello from the Khumbu valley!

 
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We've now seen 276 patients as of last evening - a blistering pace set to break all previous clinic visitation records.  Folks ask why - is base camp even more populated than usual?  Are people sicker or taking bigger risks?  We think neither, but instead that more of base camp is relying on our care rather than bringing their own doctors.  But stay tuned for the final verdict ... 4 more weeks of action are expected, and we hear that ropes will be beginning to be fixed toward the South Col next week.

In the past week, we've cared for 3 rescued patients from the upper mountain with complaints ranging from complicated neurological issues to pneumonia with HAPE to HACE.  All patients improved before evacuation, and we've heard reassuring follow up about their care at lower altitudes.  We also saw our first case of frostbite in a Sherpa who took his gloves off at camp 1 in 100 mph winds.  It doesn't take long to injure skin at these kinds of extremes - even a few seconds of exposure can be enough - luckily this particular injury was very superficial, so no permanent damage should result.  Still it was a learning opportunity for this climber - frostbite is nearly always preventable, so let's take a few moments to remind ourselves about keys to preventing a cold injury?

Superficial frostbite injuries to 2nd, 4th and 5th fingers - superficial injuries by definition do not injure deeper structures like muscle, bone, blood vessels and typically recover well without permanent deficits.

Prevention is the key to avoiding frostbite. Here are some important reminders:
-Stay well hydrated and well fed to enable your body to generate heat!
-Avoid alcohol, which can impair your sensation (and judgment!)
-Avoid smoking, which will constrict your blood flow
-Don’t climb/trek under extreme weather conditions (wind, very cold)
-Avoid tight fitted clothing (eg no wrinkles in the socks)
-If your clothing/socks/gloves get wet from snow/rain or perspiration, DRY them quickly – including boot insoles
-Wear mittens rather than gloves in extreme cold and a liner glove underneath if you need quick temporary access to fingers (e.g. photography)
-Never ignore numbness – as an old professor once told me – 'if you feel your fingers and toes getting numb and you ignore it, that numbness might be the last thing you ever feel!' Numbness is a sign that you may be getting into trouble. If it doesn’t resolve by increasing activity, you need to get somewhere to take off your gloves/boots and rewarm yourself.
-Avoid rubbing frostbitten areas – beating on them only increases the chance of injury and doesn’t help them rewarm faster.
-IF you or your buddy has frostbite, get somewhere warm, but only rewarm the injured area if there is no chance it will refreeze. The quickest way to rewarm is to submerge in warm water (~104F, or the warmth of a hot tub, test the water first with a thermometer or an uninjured body part – a frozen hand can’t determine if the water is too hot!)
–keep the area padded and protected against further heat loss.
-Research suggests that a dose of ibuprofen may help prevent some of the inflammatory problems that result from frostbite

-Get to a doctor as soon as possible if there is frozen tissue or if normal sensation doesn’t return after rewarming.  New treatments, like some antiinflammatories and clot-busting drugs are TIME sensitive - and are only effective if given within 24 hours of thawing.