Otto Christian, Hamilton Douglas R, Levine Benjamin D, Hare Craig, Sargsyan Ashot E, Altshuler Peter, Dulchavsky Scott A
Department of Emergency Medicine, University of Ottawa, Ottawa, Canada.
Wilderness Environ Med. 2009 Fall;20(3):283-9. doi: 10.1580/08-WEME-BR-228R2.1.
Mountaineers face a variety of health risks at altitude including pulmonary edema; portable ultrasound may be used to diagnose high altitude pulmonary edema. This report tests the functionality of electronic equipment in a hypobaric test environment and the ability of remotely guided nonexperts to use ultrasound to evaluate respiratory status on Mt Everest.
Two ultrasound devices and associated video equipment were tested in a cooled (4 degrees C-5 degrees C) hypobaric chamber to 27000 feet (8230 m) before travel to Mt Everest. The ultrasound system was connected via satellite phone to a video streaming device and portable computer to stream video through the Internet for remote guidance of a novice user by an expert. Pulmonary interstitial fluid was quantified by the presence of "comet tail" artifacts.
There was no notable degradation in equipment performance in cold, hypobaric conditions; ultrasound confirmation of increased comet tails was noted in the chamber despite oxygen supplementation and the very brief exposure. Two pulmonary surveys of asymptomatic participants were completed by novice operators within 25 minutes on Mt Everest. The remote expert was able to guide and identify comet tails suggestive of intermediate pulmonary interstitial fluid. Image quality was excellent.
The tested ultrasound devices functioned nominally in cold, hypobaric conditions; acute changes in lung fluid content were noted in these conditions despite normoxia. We successfully used a satellite telemedical connection with a remote expert to guide thoracic ultrasound examinations at Advanced Base Camp on Mt Everest. Coupling portable ultrasound with remote expert guidance telemedicine provides a robust diagnostic capability in austere locations.
登山者在高海拔地区面临多种健康风险，包括肺水肿；便携式超声可用于诊断高原肺水肿。本报告测试了电子设备在低压测试环境中的功能，以及远程指导的非专业人员使用超声评估珠穆朗玛峰上呼吸状况的能力。
在前往珠穆朗玛峰之前，两台超声设备及相关视频设备在温度为4摄氏度至5摄氏度的低压舱内测试至27000英尺（8230米）高度。超声系统通过卫星电话连接到视频流设备和便携式计算机，以便通过互联网传输视频，由专家对新手用户进行远程指导。通过“彗尾”伪像的出现对肺间质液进行定量分析。
在寒冷、低压条件下设备性能无明显下降；尽管进行了氧气补充且暴露时间极短，但在舱内仍观察到超声证实彗尾增加。新手操作员在珠穆朗玛峰上25分钟内完成了对两名无症状参与者的两次肺部检查。远程专家能够指导并识别提示中度肺间质液的彗尾。图像质量极佳。
经测试的超声设备在寒冷、低压条件下正常运行；尽管处于常氧状态，但在这些条件下仍观察到肺液含量的急性变化。我们成功地利用与远程专家的卫星远程医疗连接，在珠穆朗玛峰前进营地指导胸部超声检查。将便携式超声与远程专家指导远程医疗相结合，可在艰苦地区提供强大的诊断能力。
