1. 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

2. 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

3. 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

4. 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]

5. 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

6. 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

7. 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 hours)
Optional - descending m ( ’)
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

8. Altitude Illness High Altitude Cerebral Edema (HACE)
Elevations > m ( ’)
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):
UpToDate acute-mountain-sickness-and-high-altitude-cerebral-edema
UpToDate high-altitude-illness-physiology-risk-factors-and-general-prevention

9. 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

10. 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

11. 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

12. 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

13. 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

14. 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 Jan 31;2(1):e0022

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