Wilderness First Aid Slideshow Template The following Slideshow is a Bare Bones template which covers the minimum information set by the 2010 WFA Curriculum and Doctrine Guidelines. This slideshow version was intended to be used as a minimalist alternative to our standard slideshow and can be used as a template for building a new slideshow to better suit the the instructor’s lecturing style. Version 1 May 2018

Altitude Illness BSA Elective Class 20 min Elective Class Skip Page(s) BSA WFA Curriculum and Doctrine Guidelines 35 ECSI Wilderness First Aid Field Guide 25-27 ARC WRFA Emergency Reference Guide 26

Altitude Illness Objectives Wanna climb that imposing and spooky mountain? The one with all those WARNING signs? What could go wrong? Cavan Scott. An Egg-Cellent Adventure. Titan’s Adventure Time Magazine. Issue 21 Altitude Illness Objectives Define altitude illnesses including acute mountain sickness (AMS), high altitude cerebral edema (HACE), and high altitude pulmonary edema (HAPE). List the signs and symptoms of AMS, HACE, and HAPE. Describe the emergency treatment of and long-term care for AMS, HACE, and HAPE. Describe the prevention of AMS, HACE, and HAPE, including, briefly, the process of acclimatization. Describe situations that would require an evacuation versus a rapid evacuation. Participants can read Course Objectives at home Prior to lecturing, instructors should review the most up to date Wilderness & Environmental Medicine (WEM) guidelines related to their talk: Prevention and Treatment of Acute Altitude Illness: 2014 Update December 2014 [Hidden Intro Cartoon Image] WFA Curriculum and Doctrine Guidelines Prevention and Treatment of Acute Altitude Illness: 2014 Update December 2014

Altitude Illness Altitude Illness – Intro At high altitude, climbers encounter hypobaric hypoxia The higher you ascend, the thinner the air becomes Your body can compensate for higher elevations, but this takes time Physical fitness is NOT an indicator of how well you will acclimatize [Read Slide]

Altitude Illness Altitude Illness – Acclimatization Begins within minutes of ascent Requires several weeks to complete Slow accent key Drinking plenty of fluids important [Read Slide] UpToDate high-altitude-illness-physiology-risk-factors-and-general-prevention

Altitude Illness Acute Mountain Sickness Considered an early stage of High Altitude Cerebral Edema (HACE) Common at sleeping elevations >2000m (6500ft) Resembles alcohol hangover [Read Slide] UpToDate acute-mountain-sickness-and-high-altitude-cerebral-edema UpToDate high-altitude-illness-physiology-risk-factors-and-general-prevention

Altitude Illness Acute Mountain Sickness – Treatment Acetazolamide – Helps with Acclimatization Dexamethasone treats symptoms, but NOT acclimatization Portable hyperbaric therapy (Gamow (gam off) bag) = ↓2500m Supplemental oxygen will make them feel much better Avoid alcohol and other respiratory depressants Avoid further ascent until better (usually 24-48 hours) Optional - descending 500-1000m (1600-3300’) Must NOT ascend to higher altitudes for sleeping = HACE [Read Slide] UpToDate acute-mountain-sickness-and-high-altitude-cerebral-edema UpToDate high-altitude-illness-physiology-risk-factors-and-general-prevention

Altitude Illness High Altitude Cerebral Edema (HACE) Elevations > 3000-3500m (9800-11500’) Generally already has acute mountain sickness (AMS) Life Threatening Thought to be caused by ↑ permeability in blood brain barrier Lafuente JV, Bermudez G, Camargo-Arce L, Bulnes S. Blood-Brain Barrier Changes in High Altitude. CNS Neurol Disord Drug Targets. 2016;15(9):1188-1197. UpToDate acute-mountain-sickness-and-high-altitude-cerebral-edema UpToDate high-altitude-illness-physiology-risk-factors-and-general-prevention

Altitude Illness High Altitude Cerebral Edema – Signs and Symptoms Encephalopathic symptoms and signs Ataxic gait (uncoordinated movements) Severe lassitude (lack of energy) Progressive ↓ mental function and consciousness Irritability Confusion Impaired mentation Drowsiness Stupor Finally coma [Read Slide] Encephalopathy = brain disease that alters brain function UpToDate acute-mountain-sickness-and-high-altitude-cerebral-edema UpToDate high-altitude-illness-physiology-risk-factors-and-general-prevention

Altitude Illness High Altitude Cerebral Edema – Treatment Requires Immediate Intervention Descent is the definitive treatment Descent of ~1000m is usually lifesaving If can’t Descend right away Dexamethasone initially 8-10mg oral/IM/IV then 4mg every six hours Supplemental oxygen Hyperbaric therapy Delay in descent may result in patient needing to be carried out Systemic hypotension will cause cerebral ischemia - AVOID at all costs Give 4-5L fluid daily (HACE different than Hyponatremia edema) [Read Slide] UpToDate acute-mountain-sickness-and-high-altitude-cerebral-edema UpToDate high-altitude-illness-physiology-risk-factors-and-general-prevention

Altitude Illness High Altitude Pulmonary Edema Exaggerated and uneven pulmonary vasoconstriction (pulmonary hypertension) Disruption of the alveolar-capillary barrier High molecular weight proteins, cells, and fluid leak into alveolar space Generally occurs above 2500m (8000’) [Read Slide] UpToDate high-altitude-pulmonary-edema UpToDate high-altitude-illness-physiology-risk-factors-and-general-prevention

Altitude Illness High Altitude Pulmonary Edema – Signs and Symptoms HAPE almost never develops after a week at the same altitude Subtle, nonproductive cough Shortness of breath with exertion Difficulty walking uphill Progression from dyspnea with exertion to dyspnea at rest Cough can become productive of pink, frothy sputum and may produce frank blood [Read Slide] UpToDate high-altitude-pulmonary-edema UpToDate high-altitude-illness-physiology-risk-factors-and-general-prevention

Altitude Illness High Altitude Pulmonary Edema - Treatment Rapidly reversible with descent or sometimes administration of oxygen Prompt reduction of pulmonary artery (PA) pressure Limiting physical exertion and cold exposure Providing supplemental oxygen via tank or concentrator Evacuation to a lower altitude Simulating descent using hyperbaric therapy Nifedipine – very limited benefit 30 mg of a slow release formulation every 12 hours When HAPE is diagnosed early and treated, many climbers go on to reascend slowly after two to three days of recovery Others will need Rapid Evac to lower altitude medical facility [Read Slide] UpToDate high-altitude-pulmonary-edema UpToDate high-altitude-illness-physiology-risk-factors-and-general-prevention

Altitude Illness High Altitude Sickness - Prevention Staged Ascent First camp ≤ 8,000’ If first camp > 9,000’, spend 2 nights prior to accent Ascend max 1,000 to 1,500’ per night Higher daytime ascent is fine, but return to lower elevation for sleep (climb high, sleep low) High-Carbohydrate Diet: ≥70% carbs if at ≥ 16,000‘ starting 2 days prior Carbs produce more CO2 than fats or proteins and ↑breathing rate Appropriate Exercise Level: exercise moderately until acclimatized Hydration: ↑ fluid losses at high altitudes Stay well-hydrated metabolism of carbohydrates produces a larger quantity of CO2 than the metabolism of proteins or lipids The increased CO2 production from carbs it thought to provide an added stimulus to the respiratory centers Taylor AT. High-altitude illnesses: physiology, risk factors, prevention, and treatment. Rambam Maimonides Med J. 2011 Jan 31;2(1):e0022

Altitude Illness Questions pexels.com 94604 Great Horned Owl on Nest – Eastern Washington Pot Holes Area pexels.com 94604