Ch. 3 Altitude Illness

Question 1

What is Altitude Illness?

Answer 1

insufficient oxygen in the blood (hypoxia)

secondary to decreased barometric pressure at altitude

Question 2

What causes Mild/moderate altitude illness (AMS)?

Answer 2

This occurs in unacclimatized people after rapid ascent to altitude

Question 3

Signs and symptoms of AMS (acute mountain sickness)

Answer 3

Headache +

1. nausea / vomiting
2. loss of appetite
3. mild lassitude, fatigue or weakness at rest
4. insomnia

Question 4

treatment principles for AMS (6)

Answer 4

1. Dont go up until signs and symptoms relieve
2. if no improvement over 24-48 hours, descend to last camp without signs and symptoms
3. descend immediately at first signs of severe altitude illness
4. acclimatize
   - maintain adequate hydration and nutrition
   - perform light exercise
   - consider acetazolamide (Diamox) to aid acclimatization
5. pain medication for headache are OK. avoid sedatives.
6. monitor for shortness of breath, ataxia and altered mental status

Question 5

What is High Altitude Cerebral Edema (HACE)?

Answer 5

HACE is AMS with ataxia and changes in mental status/level of responsiveness (fluid in the brain)

Question 6

Signs and symptoms of HACE

Answer 6

1. Ataxia (the best sign that AMS is becoming serious)
2. LOR will become disoriented, irritable and combative
   progressing to unresponsive
3. Headache may or may not be present
4. other neurological signs and symptoms may be present such as vision changes, hallucinations, and seizures.

Question 7

What is High Altitude Pulmonary Edema (HAPE?)

Answer 7

Fluid accumulation in the lungs secondary to high altitude exposure.

Question 8

Signs and symptoms of HAPE

Answer 8

1. decreased ability to exercise
2. persistent dry cough
3. shortness of breath at rest
4. elevated heart rate and respiratory rate at rest
5. SCTM pale or cyanotic
6. Wet lung sounds and productive cough (late sign)

Question 9

Treatment principles for HACE or HAPE

Answer 9

1. descent promptly
2. administer oxygen
3. consider albuterol for HAPE
4. dexamethasone for HACE
5. use a portable hyperbaric chamber
6. consider elevating head 6-8 inches in unresponsive patience with HACE

Question 10

What is the best medication for HAPE?

Answer 10

albuterol

Question 11

what is the best medication for HACE?

Answer 11

Dexamethasone

Question 12

How to prevent altitude illness

Answer 12

1. if you travel above 10,000ft take 2-3 rest days with light exercise
2. utilize staged ascents
3. if experiencing symptoms of AMS, take an extra rest day
4. climb high, sleep low
5. maintain adequate hydration
6. avoid alcohol and sedatives
7. consider acetazolamide Diamox to aid in acclimatization
8. Monitor Sp02

Question 13

what medication is best for aiding acclimatization

Answer 13

acetazolamide (diamox)

Question 14

Evacuation guidelines for Altitude Illness

Answer 14

Evacuate any patient unable to acclimatize

Rapid evac any patient with severe altitude illness