1. Lesson 15: Altitude Sickness

2. Objectives
Define altitude illnesses, include acute mountain sickness (AMS), high altitude cerebral edema(HACE) and high altitude pulmonary edema (HAPE)
List signs and symptoms of AMS, HACE, HAPE
Describe emergency care for AMS, HACE, HAPE
Describe situations that require evacuation
Describe prevention techniques

3. Altitude Illness Overview
Altitude illness occurs when people at high elevation do not get enough O2
As you gain altitude air grows thinner (less pressure) and less oxygen is inhaled
Most common altitude illness is Acute Mountain Sickness (AMS)
AMS commonly occurs when person recently has reached heights of 6500 – 8000 feet

4. Altitude Illness Overview
Symptoms similar to dehydration and heat illness. If at lower altitude < 6500 feet) suspect those first
High Altitude Cerebral Edema(HACE) is cause by fluid collecting in the brain tissues. If untreated can lead to death
High Altitude pulmonary edema (HAPE) is caused by fluid collects in air spaces in the lungs. If enough collects death can result

5. Checking for Acute Mountain Sickness
Acute Mountain Sickness Signs and Symptoms
Headache
Loss of normal appetite
Nausea, with/without vomiting
Insomnia
Unusual weariness and exhaustion, called lassitude

6. Caring for Acute Mountain Sickness
Descend or stop ascent and wait for improvement. If illness progresses, descent is mandatory
Administer oxygen, if available and trained to do so. Especially helpful during sleep
Give aspirin or acetaminophen for headaches if patient is able to swallow and has no known contraindication
If prescribed and recommended by patient’s health care provider, help patient self-administer medication for altitude illness

7. Signs and Symptoms for High Altitude Cerebral Edema
Loss of coordination or ataxia (can’t walk in a strain line or stand straight with feet together)
Severe headache unrelieved by rest/medication
Bizarre changes in personality
Seizures or coma

8. Care for HACE Severely ill patients must descend as soon as possible
Provide oxygen if available and trained to do so
Keep patient from becoming chilled or overheated
If prescribed and recommended, help patient self-administer medications for altitude illness
Use portable hyperbaric chamber (not in place of descending)

9. Signs and Symptoms of High Altitude Pulmonary Edema
Dry cough, shortness of breath (at rest)
Shortness of breath becomes more pronounced
Possible chest pain
Cough that becomes productive, first frothy sputum, later reddish sputum

10. Care for HAPE Severely ill patients must descend ASAP
In addition to descent, provide oxygen if available and trained to do so
Keep patient from becoming chilled or overheated. Especially important for HAPE since cold weather increases pulmonary artery pressures and makes HAPE worse
Use portable hyperbaric chamber if available, not a substitute for descending

11. Guidelines for Evacuation
Patient with AMS should stop ascending until symptoms resolve
Patient with AMS does not require evac unless condition worsens, then descent is mandatory
GO FAST for any patient with HACE or HAPE. Descend at least feet of elevation.
Anyone with HACE or HAPE MUST be evaluated by health care provider ASAP

12. Preventing Altitude Illnesses
Most High Altitude Illnesses are preventable
Make a stage ascent, Allow body to adjust
Increase altitude of overnight camps gradually
If possible camp no higher than 8000 ft first night, no more than 1000 – 1500 increase per night
If trip starts > 9000, spend 2 nights acclimating
Proceed higher during the day, but return to lower altitude during day during acclimation period

13. Preventing Altitude Illnesses
Eat high carb diet
>70% carbs reduces symptoms of AMS
Start high carb diet 1 – 2 days before starting trip
Maintain appropriate exercise level until acclimated. Avoid excessive shortness of breath
Stay well hydrated (higher loss of fluids at high elevation
Talk to your health care provider about possible prescription medication