Illnesses, First Aid Management and Sickness Prevention
High altitude pertains to anything greater than 8,000 feet above sea level and because of the decreased oxygen molecules per breath, can lead to illnesses.
High altitude refers to great heights above sea level. Altitude can be defined as High (8,000 – 12,000 feet [2,438 – 3,658 meters]), Very High (12,000 – 18,000 [3,658 – 5,487 meters]), and Extremely High (18,000+ feet [5,500+ meters]). High altitude illnesses can develop in some people, but not all. There are no specific risk factors that predispose an individual to such illnesses. However, it is known that as an individual increases in altitude, chances of developing illnesses also increase.
The main cause of altitude sickness is the decreased oxygen concentration. Most people are accustomed to 21% oxygen concentration at sea level. As the altitude increases, although the concentration remains the same, the number of oxygen molecules per breath is reduced. The body will then have to adjust to having less oxygen. Moreover, fluid is leaked from the capillaries, which may lead to fluid build-up in the lungs and the brain.
It is highly recommended to take first aid courses before going to high altitudes. Emergencies may arise due to high altitude and registering for first aid courses may help prepare in cases medical emergencies occur.
High Altitude Illnesses
There are three main altitude related illnesses. Their symptoms will discussed for easier identification of the possible high altitude illness.
Acute Mountain Sickness (AMS)
- Common at high altitudes, especially at elevations over 10,000 feet
- Dependent upon elevation, rate of ascent, and individual susceptibility
- Symptoms usually begin 12-24 hours after arrival at particular altitude
- Mild AMS symptoms: headaches, dizziness, fatigue, shortness of breath, loss of appetite, nausea, disturbed sleep, and malaise
- Moderate AMS symptoms: cannot be alleviated by medication, nausea and vomiting, increasing weakness and fatigue, shortness of breath, and ataxia
- Severe AMS symptoms: worsening symptoms of previously mentioned symptoms, shortness of breath at rest, inability to walk, decreasing mental status, and fluid build-up in the lungs
High Altitude Pulmonary Oedema (HAPE)
- Caused by fluid build-up in the lungs preventing effective oxygen exchange
- Symptoms: cyanosis, shortness of breath at rest, “tightness in the chest,” weakness, fatigue, feeling of suffocation at night, coughing white, watery, or frothy fluids, confusion, and irrational behaviour
- May be fatal
High Altitude Cerebral Oedema (HACE)
- Swelling of brain tissue from fluid leakage
- Symptoms: headache, ataxia, weakness, and decreasing levels of consciousness, including, disorientation, loss of memory, hallucinations, psychotic behaviour, and coma
High Altitude First Aid Management
Severe cases of high altitude illnesses will require immediate first aid. Recommended actions for the different high altitude illnesses include:
Acute Mountain Sickness
- Discontinued ascent and rest may be done to help acclimatize an individual. Do not continue ascent until after 18 hours after the last dose and symptoms free.
- Take pain medications for headache and Acetazolamide 125mg by mouth every 12 hours and Dexamethasone 4mg every 4-6 hours two doses.
- If oxygen supplementation is available, give so.
- Another option is descent from altitude is symptoms persist for more than 24-48 hours or if symptoms worsen.
High Altitude Pulmonary Oedema
- Descent immediately to avoid complications.
- Dexamethasone and Acetazolamide should be given as prescribed by medical help.
- If oxygen supplementation is available, give so.
- If descent is not possible, place the patient in a portable hyperbaric chamber (Gamow bag) for 4-6 hours.
High Altitude Cerebral Oedema
- Descent immediately to avoid complications. In some cases, descent of 500-1000 meters may already show symptoms of improvement.
- If oxygen supplementation is available, give so.
- Rest after descent.
- Nifedipine should be given as prescribed.
- If descent is not possible, place the patient in a portable hyperbaric chamber (Gamow bag) for 4-6 hours.
High Altitude Sickness Prevention
There are several ways to help prevent high altitude illnesses. Although these tips do not guarantee complete prevention of the high altitude illnesses, they are known to help reduce risks:
- Ensure that one is properly acclimatized before going to higher altitudes. If possible, increase altitude by 1,000 feet (305m) per day for every 3,000 feet.
- Take Dexamethasone and Acetazolamide as preventive medications.
- Stay properly hydrated at all times.
- If symptoms begin to show, do not go to higher altitudes.
- Avoid tobacco, alcohol and other depressant drugs.
- Eat a high carbohydrate diet while at high altitude.