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<< Altitude Illness: Strategies In Prevention, Identification, And Treatment
Risk Management
1. “We can keep going.”
2. “We don’t need to take drugs.”
3. “It’s only mild HAPE.”
4. “He’s just tired.”
5. “He’s stumbling because he’s tired.”
6. “I never get altitude sickness.”
7. “We have to go to sea level to get better.”
8. “Dexamethasone will help me to acclimatize.”
9. "Failure to use oxygen."
10. "Failure to ask about medication allergies."
Failure to stop ascending to altitude when symptoms develop will lead to the progression of illness and possible severe illness and morbidity. AMS will typically resolve over 24 to 48 hours if the individual does not ascend further once symptoms occur.
2. “We don’t need to take drugs.”
In cases where one must ascend quickly and the risk of AMS is high, prophylaxis should be utilized as this may prevent progression to the more severe illnesses of altitude.
3. “It’s only mild HAPE.”
One must consider the full differential in evaluating those in the ED who appear to have altitude illness. Altitude illness typically improves quickly with descent or oxygen; failure to improve should strongly suggest an alternate diagnosis.
4. “He’s just tired.”
The earliest sign of HAPE is fatigue and breathlessness out of proportion to the rest of a party at altitude or a sudden decrease in an individuals exercise ability. HAPE can be treated quickly if caught at this early stage.
5. “He’s stumbling because he’s tired.”
An individual with ataxia at altitude should be considered to have HACE until proven otherwise.
6. “I never get altitude sickness.”
While prior experience at altitude is a good guide to likelihood of subsequent illness, it is also true that anyone can become ill if they ascend high enough and fast enough.
7. “We have to go to sea level to get better.”
Descent does not need to be significant to reverse altitude disease, 500 m for AMS and 1000 m for HAPE and HACE are all that may be needed for life saving descent.
8. “Dexamethasone will help me to acclimatize.”
Dexamethasone is effective in reducing AMS in rapid ascents but has no effect on acclimatization, and symptoms may return if the drug is stopped at altitude. Acetazolamide does aid acclimatization.
9. "Failure to use oxygen."
Oxygen is the gold standard treatment for HAPE and HACE and must be utilized if available to keep oxygen saturations greater than 90%. Pharmaceuticals are adjuncts to oxygen use.
10. "Failure to ask about medication allergies."
Acetazolamide is a sulfa based drug and should not begiven to those with significant sulfa allergies.
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