1. Altitude-Related Emergencies
Chapter 28
Altitude-Related Emergencies 1

2. Objectives
28.1 Define altitude Describe the principles of altitude physiology List risk factors for the development of altitude illnesses Describe strategies to prevent altitude illness.
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3. Objectives
28.5 List the signs and symptoms of the following altitude illnesses:
acute mountain sickness
high-altitude pulmonary edema
high-altitude cerebral edema
28.6 Describe how to assess a patient with altitude illness.
28.7 Describe the treatment of a patient with altitude illness. 3

4. Topics Altitude Physiology Altitude-Related Problems
Prevention of Altitude Illness
Assessment
Management
Chapter Summary

5. Case Presentation
At first-aid duty, in the patrol room, a 45 year-old man slowly walks in. He appears unwell, and slightly cyanotic around his lips. You help him to the nearest gurney and assess him. He states he hasn’t felt well since arriving 2 days ago. The resort is located 9,000 feet above sea level. He feels very fatigued and winded. He has no significant medical history, has not suffered recent trauma, and is not on any prescribed medications.
Discussion Points:
What should you do?
What symptoms would you see for altitude sickness?

6. Altitude Physiology
Body’s ability to preserve homeostasis includes the ability to adapt to altitude changes.
Rate of ascent determines the probability of developing an altitude illness.
Discussion Points:
What is the definition of altitude?
At what elevation does most altitude illness occur?
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7. Altitude Physiology continued Copyright Wilderness Medical Society
educational powerpoint series, 2008

8. Altitude Physiology Copyright Wilderness Medical Society
educational powerpoint series, 2008

9. Altitude Classifications
Low altitude
(<5,000 ft)
Intermediate altitude
(5,000 to 8,000 ft)
High altitude
(8,000 to 12,000 ft)
Very high altitude
(12,000 to 18,000 ft)
Extreme altitude
(>18,000 ft)
Discussion Point:
Explain each altitude classification.
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10. Altitude Classifications
Copyright David Johe, MD

11. Altitude Acclimatization
Changes that help preserve homeostasis
Increased rate and depth of respiration
Increased heart rate
Increased red blood cell production
Construction of pulmonary blood vessels
Increased enzyme production
Discussion Point:
What is the definition of acclimatization?
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12. Altitude Acclimatization
Copyright Denise Cheney

13. Altitude-Related Problems
Acute mountain sickness
High-altitude pulmonary edema
High-altitude cerebral edema
Discussion Points:
What do these acronyms stand for? Review their definitions.
AMS
HAPE
HACE
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14. Altitude-Related Problems
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15. Altitude-Related Problems
Other altitude-related problems
Khumbu cough
Peripheral edema
High-altitude retinal hemorrhage
Radial keratotomy eye surgery
Solar keratitis
Chilblains
Sunburn
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16. Altitude-Related Problems
Copyright Luanne Freer, MD

17. Altitude-Related Problems
Copyright Andy Crawford and Steve Gorton /
Dorling Kindersley Media Library

18. Case Update
On examination of the patient, you notice that not only his lips, but also his nail beds are cyanotic, and his breathing is labored, even at rest. The patient appears physically fit, which he confirms by saying, “I run and ride more than 50 miles a week.” He has a heart rate of 116, a blood pressure of 132/80, respirations of 36. The pulse oximeter indicates the patient’s oxygen saturation is 76%. The rest of the physical assessment is negative for any abnormalities or signs of trauma.
Discussion Points:
What do think is wrong with the patient?
What should you do? 18

19. Prevention of Altitude Illnesses
Ascend gradually.
Avoid rapid ascent above 10,000 feet.
Incorporate layover at an intermediate altitude.
Once above 10,000 feet, limit altitude increase to 1,000 feet/day and for every 2,000 feet of elevation gained, take 1-2 extra rest days.
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20. Prevention of Altitude Illnesses
continued
Copyright Jamie Marshall /
Dorling Kindersley Media Library

21. Prevention of Altitude Illnesses
As you increase altitude, more rest and less altitude gain per day may be necessary.
Avoid heavy physical exertion for the first hours at altitude.
Discussion Points:
Discuss how to keep the rescuer safe and what the student needs to learn to not become a patient as well.
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22. Prevention of Altitude Illnesses
Stay hydrated. Altitude acclimatization is often accompanied by fluid loss, drink often (3-4 quarts/day). As breathing increases, fluid is lost due to increased exhalation. Urine output should be copious and straw colored.
Discussion Points:
Discuss how to keep the rescuer safe and what the student needs to learn to not become a patient as well.
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23. Prevention of Altitude Illnesses
continued
Copyright Dorling Kindersley Media Library

24. Prevention of Altitude Illnesses
Avoid alcohol and other depressant drugs.
Eat a high carbohydrate diet.
If symptoms of altitude illness occur, do not ascend until they resolve.
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25. Prevention of Altitude Illnesses
Acclimatization occurs at different rates. If traveling in a group, make sure everyone is properly acclimatized before going higher.
“Climb high and sleep low.”
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26. Prevention of Altitude Illnesses
Medications
Acetazolamide
Dexamethasone
Gingko biloba
Discussion Point:
Discuss the side effects of these medications.

27. Prevention of Altitude Illnesses
Copyright Dorling Kindersley Media Library

28. Assessment Initiate life saving equipment ABCDs SAMPLE OPQRST
Discussion Point:
Walk students through how to assess a patient with altitude illness.

29. Assessment
Copyright Studio 404

30. Assessment
Copyright Candace Horgan

31. Management Descend to lower elevation General management AMS treatment
HAPE treatment
HACE treatment
Khumbu cough treatment
Discussion Point:
Describe the treatment of a patient with altitude illness.

32. Management
Copyright Dorling Kindersley Media Library

33. Prevention of Altitude Illnesses
continued
Copyright Nigel Hicks /
Dorling Kindersley Media Library

34. Case Disposition
The patient may have early signs of HAPE, so you place him on high-flow oxygen, keep him comfortable, and mobilize resources to transport him to a hospital approximately 1,500 feet lower. Two days later, the patient’s wife thanks you “for taking such great care of my husband.” She reports he recovered from is symptoms within a day after descent and supplementary oxygen. She further states that her husband was advised to avoid high altitude or to ascend slowly next time.
Discussion Point:
Could the wife have prevented HAPE? What must the patient do for himself? 34

35. Chapter Summary
Altitude sickness is a common disorder that affects outdoor enthusiasts. It is caused by a decrease in available oxygen concentration and can afflict even those who are extremely healthy.
Compensatory mechanisms increase cardiopulmonary function to speed oxygen delivery to the cells. The body must work harder to keep up.
Discussion Point:
What are the symptoms of altitude sickness?
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36. Chapter Summary
As an OEC technician, you have a good chance of encountering an altitude-related illness if you live and work in a high-altitude setting, and compounded by guests who arrive from a low altitude and without gradual ascent. Symptoms can manifest quickly in these individuals.
Discussion Points:
Have you ever had or encountered altitude-related illness?
What did you do?
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37. Chapter Summary
Preventive measures, such as slow ascent and the use of prophylactic (prescribed) medications may provide some protection but are no guarantee of immunity.
Thus, it is essential that you recognize the signs and symptoms of acute mountain sickness, HAPE, and HACE as well as other altitude-induced conditions.
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38. Chapter Summary
Additionally, be prepared to act quickly to treat an altitude-related illness to halt the progression of symptoms and to reduce the chance of a potentially lethal outcome.
Altitude illness can become life-threatening.
Once symptoms of AMS develop, do not ascend until symptoms completely resolve.
Discussion Point:
Review signs and symptoms of HAPE, HACE, and how to recognize and treat them quickly.
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39. Chapter Summary
Suspect HACE in the presence of headache and ataxia when at altitude.
Descent with supplemental oxygen will almost always improve symptoms of altitude illness. 39