DEALING WITH ALTITUDE ILLNESS

General Overview:

Severe altitude illness (HAPE or HACE) is rare in the United States (except Alaska) when proper acclimatization practices are followed.  Mild or moderate altitude sickness (Mild or Moderate AMS) is quite common however and organizations should design programs to allow slow acclimatization in an effort to prevent AMS.

Treatment for Altitude Illness:

1. Do not continue ascending until symptoms have resolved.
2. Maintain adequate hydration and nutrition. Light exercise.
3. Pain medication as needed for headache.
4. Acetazolamide, 250mg PO every 6 to 12 hours, for mild/moderate AMS.
5. If symptoms do not improve over 24-48 hours, descend until symptoms abate. Generally 2000 feet (610m) is adequate.
6. If patient has HAPE or HACE, descent is critical. 2000-4000 feet (610m-1219m) can make a remarkable difference.
7. Oxygen will be helpful, if available, especially for HAPE.
8. Nifedipine, 10-20mg PO every 8 hours (for HAPE) and dexamethasone 8mg PO or 10mg IM followed by 4mg every 6 hours PO or IM (for HACE).
9. Gamov Bag, can make a patient ambulatory for self-evacuation.

Evacuation Guidelines for Altitude Illnesses:

Evacuate Rapidly:

• Any patient with severe altitude illness.

Evacuate Rapidly:

• Any patient unable to acclimatize.

References:

Auerbach, Paul S.  “High-Altitude Medicine.” Wilderness Medicine 4th ed.  St. Louis, Missouri: Mosby, 2001. Chapter 1.

Forgey, William.  “High-Altitude Illness.” Wilderness Medical Society Practice Guidelines for Wilderness Emergency Care 2nd ed. Guilford, Connecticut: The Globe Pequot Press, 2001.  Chapter 10.

Hackett, Peter H.  “The Cerebral Etiology of High-altitude Cerebral Edema and Acute Mountain Sickness.” Wilderness and Environmental Medicine 10 1999: 97-109.

Hackett, Peter H. and Robert C. Roach.  “Medical Therapy of Altitude Illness.” Annals of Emergency Medicine 16, 9 September 1987: 89-95.

Schimelpfenig, Tod and Linda Lindsey.  “Altitude Illness.” Wilderness First Aid 3rd ed.  Mechanicsburg, Pennsylvania: Stackpole Books, 2000.  Chapter 14.

Schoene, Robert B.  “High-Altitude Pulmonary Edema: Pathophysiology and Clinical Review.” Annals of Emergency Medicine 16, 9 September 1987: 99-104.

Stewart, Charles E.  “Management of Altitude-Related Emergencies.” Environmental Emergencies.  Baltimore, Maryland: Williams & Wilkins, 1990.  Chapter 6.

Tilton, Buck.  “Altitude Illnesses.” Wilderness First Responder 2nd ed.  Guilford, Connecticut: The Globe Pequot Press, 2004.  Chapter 18.

Wilkerson, James A.  “ Disorders Caused by Altitude.” Medicine for Mountaineering 5th ed.  Seattle, Washington: The Mountaineers Books, 2001. Chapter 21.

Wilkerson, James A.  “ Altitude and Common Medical Conditions.” Medicine for Mountaineering 5th ed.  Seattle, Washington: The Mountaineers Books, 2001. Chapter 22.