One Sunday afternoon I received an urgent call from the Ski Rescue Service on the nearby mountain resort stating that a 17-year-old girl had ‘collapsed’. Her problems were headache, tightness in the chest, dizziness, and difficulty with speech, walking and breathing. The first aid attendant thought she had ‘mountain sickness’ (hypothermia). Her condition was deteriorating despite treatment, yet she was still conscious.
There was a blizzard on the mountain where the task of transporting her 56 km to my clinic began. She was placed on a special stretcher and towed by a snowmobile to the chairlift. The stretcher was hitched to the lift and, with difficulty, the patient was carefully and slowly lowered to the chairlift base where a special Forests Commission vehicle transferred her to a waiting ambulance. With great drama, police escort and entourage, she arrived in my surgery about five hours after the distress call.
Examination revealed an agitated, prostrate, attractive girl who could not offer a coherent history. Her vital signs were temperature 36.5 °C, pulse 124 and regular, respiration 26/min, and BP 120/75. There were no neurological abnormalities but she indicated that she had paraesthesiae of the extremities and around the mouth.
The provisional diagnosis was acute anxiety and ‘hysteria’ with hyperventilation. We gave her a lot of positive reassurance and encouraged her to breathe into a paper bag. After 10 minutes she sat upright, looking very normal and enthusiastically accepted an offer of a cup of tea. The stunned countenances of her anxious entourage were a sight to behold. One of these embarrassed characters was the enterprising young stud who was responsible for provoking this startling chain of events by threatening the patient’s virginity within the snowbound confines of their chalet.
DISCUSSION AND LESSONS LEARNED
The hyperventilation syndrome, which is a relatively common problem, can have many subtle manifestations and may not present as a carpopedal spasm. It is important that all personnel in first aid situations receive appropriate training in its recognition and management.
The installation of a phone line to the first aid centre at the resort now provides direct communication, and better and more economical first aid management. Ideally, medical personnel should be manning busy resort areas.
The other pitfall was that our thinking had been misdirected to the most likely situational problems: altitude sickness, hypothermia or exposure. Tunnel-vision diagnosis is a common trap.
Diane, aged 30, was a very intelligent and attractive primary schoolteacher who was a regular attender at my practice with a variety of complaints. Her diagnostic list included tension headache, irritable bowel syndrome, anxiety state and infertility. She had an episode of endogenous depression at the time I took over the practice some 12 months previously. She and her husband had been investigated ...