"bubbly lungs"

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High Fructose Corn Spirit

Gym climber
Topic Author's Original Post - Dec 6, 2016 - 04:53pm PT
Use of this term - "bubbly lungs" - in a recent thread re climbing at high altitude caught my attention.

Obviously it is associated with, or else a symptom of, High Altitude Pulmonary Edema (HAPE).

I'm curious if anyone here has had first hand experience specifically with "bubbly lungs" either in the first person or third person... and would like to give some description of this condition.


PS

Is the term "bubbly lungs" a frequent term? in discussions of HAPE? Are the terms "girgling" and "gargling" also (correctly) used to describe the condition?

re: "rales" << Fr rattles
https://en.wikipedia.org/wiki/Crackles

So a main question I have is... Does "bubbly lungs" in HAPE sound more like rales (fine or course crackles) or the awful "death rattle"?

https://en.wikipedia.org/wiki/Death_rattle

(3) Does "bubbly lungs" assoc with HAPE progress in severity? over hours? days? eventually approaching the very dramatic loudness of the textbook "death rattle"?

(4) In HAPE and "bubbly lungs" is the cough reflex eventually lost with severity as it (often or always) is with the "death rattle"?

Thanks for any first-hand experience replies.
Ricky D

Trad climber
Sierra Westside
Dec 6, 2016 - 08:10pm PT
This isn't going to turn into one of those "How to kill your wife at altitude and get away with it" threads is it?
PSP also PP

Trad climber
Berkeley
Dec 6, 2016 - 09:00pm PT
Having dinner at At Tuolume lodge my friend announces that he has to leave because his lungs were filling up with water. They left immediately down the east side and he said they had to pull over several times to pee large amounts.
ontheedgeandscaredtodeath

Social climber
SLO, Ca
Dec 6, 2016 - 09:35pm PT
I've seen HAPE first hand. I'd describe it as gargling or rattley but from the chest as opposed from the throat if that makes sense. It sounds gnarly. The person in the situation I was involved with lived, to my surprise to be honest.
Brian in SLC

Social climber
Salt Lake City, UT
Dec 6, 2016 - 09:50pm PT
Frothy pink sputum.

Had it in Peru in 1986. Good times.

Rails. Ugh. Nearly no energy.
BuddhaStalin

climber
Truckee, CA
Dec 7, 2016 - 01:47am PT
bubbly lungs is a made up term. Adventitious lung sounds can come from many things including HAPE.

Death rattle is also a made up slang type term. Proper term is cheyne stokes breathing and occurs when someone is very near dying. Not the same. Not 'rattling' because of respiratory reasons. Because of pooling in the oropharynx.

The sounds associated with the conditions listed generally come from fluid and or inflammation leading to increased permeability, allowing fluid to fill in the lungs. this includes ARDS, HAPE, pulmonary hypertension and even simple pneumonia.

Its not a simple thing or simple black and white answer.
High Fructose Corn Spirit

Gym climber
Topic Author's Reply - Dec 7, 2016 - 08:32am PT
Thanks for the replies. I'm still unclear but I guess real clarity on this topic only comes commensurate w experience. A few years back I had a "bubbly lungs" event in my life (not me but another) and wished I had known more at the time. Thanks again.
fear

Ice climber
hartford, ct
Dec 7, 2016 - 08:49am PT
I've had bad pneumonia and been directly involved with rescuing two people with severe HAPE.

Either way the lungs "sound" really bad. I doubt there's a way to differentiate the initial stages very well. The HAPE victims eventually both deteriorated rapidly and were literally foaming at the mouth, something that doesn't happen with pneumonia to my knowledge.

Either way, if you're at altitude and suspect either one, get thee down asap.

FWIW, one man carried from ~18k in Africa we were sure was dead. He recovered fully once down to 4k within 2 days without hospital care (not that I'd recommend that). Simply amazing.

looks easy from here

climber
Ben Lomond, CA
Dec 7, 2016 - 09:58am PT
Death rattle is also a made up slang type term. Proper term is cheyne stokes breathing and occurs when someone is very near dying.

Death rattle would be more closely described as agonal respiration, imo.

Cheyne-Stokes is a specific pattern of increasing to decreasing to increasing respiration depth and speed.


(Cheyne-Stokes is still bad, but not as bad as agonal respiration.)


Back on-topic, in 13 years in EMS I've never heard the phrase "bubbly lungs" (and we have nicknames for about every condition anyone might encounter), with the caveat that my entire career has been within about 400 feet of sea level.
Brian in SLC

Social climber
Salt Lake City, UT
Dec 7, 2016 - 10:17am PT
I got "diagnosed" by a British military doctor from around 50 feet away...

Once I descended from our ABC (Pisco) down to Huarez and started on Diamox, I cleared up in 5 or so days. Probably foolish, but, went up and climbed Huasaran after that.

Been a lot more careful since.

Glad that at least for me, and mostly I think especially HAPE is a young man's game.
Mark Force

Trad climber
Ashland, Oregon
Dec 7, 2016 - 01:17pm PT
Cheyne-Stokes breathing can show up in some otherwise healthy people while sleeping at altitude at night while asleep. I can get it when sleeping ~10,000 feet or up.
Reilly

Mountain climber
The Other Monrovia- CA
Dec 7, 2016 - 01:21pm PT
'Bubbly lungs'? I've seen somebody blowing pink bubbles out of his mouth.
Not pretty, especially in the middle of the night. A big dose of Lasix
probably saved his life and tided him over until a helo could get to him.
wbw

Trad climber
'cross the great divide
Dec 7, 2016 - 02:01pm PT
Death rattle is also a made up slang type term. Proper term is cheyne stokes breathing and occurs when someone is very near dying.

That is not even close to the truth. While Cheyne-Stokes breathing is certainly a symptom of "altitude sickness", and a very uncomfortable one at that, it does not occur when someone is very near death. I've had it multiple times trying to sleep above 17,000 ft., after not acclimating lower for the proper amount of time.

Mark Force

Trad climber
Ashland, Oregon
Dec 7, 2016 - 09:42pm PT
The mention of Cheyne-Stokes breathing being near death has a grain of truth in that people that are near death - totally unrelated to HAPE - can develop it a few hours to a few days before death.

Rales (crackles) are lighter tinkling or crackling sounds - some people liken the sound to velcro coming apart - deeper in the lungs that can be heard with a stethescope or your ear against the rib cage.

Rhonchi are snoring-like or rattling-like sounds that you may are may not be able to hear without a stethescope or ear to the rib cages. When severe, you can definitely hear with the "naked" ear. It will often clear up temporarily after coughing.

HAPE lung signs will proceed from rales to rhonchi to the coughing up of frothy/bubbly mucus/blood.

Cheyne-Stokes is a result of degnerative changes in the brainstem that prevents normal triggering of breathing by rising CO2 levels. I probably get it at such a relatively low level (~10, 000 feet or more) while sleeping as a result of Listeria meningitis in Honduras in 2010. There is a continuum from cyclical breathing and Cheyne-Stoke and, arguably, my apnea at night may be relative rather than absolute and not quite meet the criteria for being Cheyne-Stokes.
High Fructose Corn Spirit

Gym climber
Topic Author's Reply - Dec 8, 2016 - 08:33am PT
Thanks, Mark.

Curious about the "pink" in the froth(ing), which seems to be a standard sign along the process. Is it actually traces of what is intuitive, in other words, blood? Can you or anyone confirm?

From injured alveoli, perhaps?

Actually...

"What causes pink frothy sputum?"
https://en.wikipedia.org/wiki/Pulmonary_edema

"The overwhelming symptom of pulmonary edema is difficulty breathing, but may also include symptoms such as coughing up blood (classically seen as pink, frothy sputum)..."
looks easy from here

climber
Ben Lomond, CA
Dec 8, 2016 - 09:28am PT
Pulmony edema (and associated pink, frothy sputum) around sea level is usually connected to too much pressure inside the capillaries in the lungs, caused by conditions like congestive heart failure, forcing fluid and blood cells across the capillary-alveolar walls (in healthy individuals normally only gas exchange occurs across that barrier).

At high elevation pulmonary edema is caused by low atmospheric pressure outside that is insufficient to keep blood and fluid from being pushed into the alveoli by normal internal pressure.

Slight diversion, insufficient atmospheric pressure to push O2 through the alveolar and capillary walls is an even bigger influence on difficulty breathing at altitude that the fact that there are physically fewer oxygen molecules taken in per breath.
Al Barkamps

Social climber
Red Stick
Dec 8, 2016 - 09:45am PT
Slight diversion, insufficient atmospheric pressure to push O2 through the alveolar and capillary walls is an even bigger influence on difficulty breathing at altitude that the fact that there are physically fewer oxygen molecules taken in per breath.

atmospheric pressure has almost nothing to do with "difficulty breathing". You can simulate "high altitude" at sea level pressure by simply reducing 02 partial pressure, by removing 02, as in a hypoxic tent, or, re-breathing a few times into a plastic shopping bag.
High Fructose Corn Spirit

Gym climber
Topic Author's Reply - Dec 8, 2016 - 10:00am PT
Thanks Al and LEFH...

Interesting, Al. In your case as posted, with reduced O2 at sea level you wouldn't get fluid and blood crossing capillary and alveoli (thus for eg no pink frothy sputum) according to above mechanism. So it seems the "difficulty breathing" would come primarily from CO2 buildup (in the case of breathing in a bag) and its detection. I think this is right.

I've learned from sources (eg cardiologist and further research) that the sense of breathlessness in a closed compartment is due to C02 sensing (a buildup) and not O2 sensing (any reduction). Learning that was pretty interesting.

This could mean, in a closed compartment, for eg, if somehow the carbon dioxide were drawn off (eg Co2 scrubber), a person might just get increasingly sleepy with falling O2 and just go to sleep. The so-called "sweet death".

In any case, thanks for the greater clarity.
Al Barkamps

Social climber
Red Stick
Dec 8, 2016 - 10:21am PT
Interesting, Al. In your case as posted, with reduced O2 at sea level you wouldn't get fluid and blood crossing capillary and alveoli (thus for eg no pink frothy sputum). So the "difficulty breathing" would come primarily from CO2 buildup (in the case of breathing in a bag) and its detection. I think this is right.

You can get pulmonary edema at sea level for many different medical reasons, not including outright injury to alveoli. Hypoxic tents simply lower the partial pressure of 02 by scrubbing some of it out. (let's NOT use CO2 as an example because CO2 is not inert and initiates distinct physiological responses, unlike nitrogen).

There's nothing linking the effort of unobstructed "difficult breathing", like gasping for air, for example, with pulmonary edema. In the simplest of terms, rupturing the thinnest of capillaries, like those deep in the lungs, requires an extreme pressure gradient, either positive or negative. To take two extreme examples, pinch off your nose, and put a compressed air hose in your mouth and fire away! Or....put a vaccuum cleaner hose in your face. Either should rupture your alvoeli.

edit- Moose, capillaries don't expand unless the heart and the rest of the plumbing system is doing weird sh#t.
looks easy from here

climber
Ben Lomond, CA
Dec 8, 2016 - 10:33am PT
atmospheric pressure has almost nothing You can simulate "high altitude" at sea level pressure by simply reducing 02 partial pressure, by removing 02, as in a hypoxic tent, or, re-breathing a few times into a plastic shopping bag.

That's a "low oxygen atmosphere", different than a "low pressure atmosphere". Both are examples of insufficient oxygen pressure gradient, but the details of the mechanics vary slightly.
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