9.18. MOUNTAIN SICKNESS

Related titles

Altitude sickness, cerebral edema at altitude, pulmonary edema at altitude, acute mountain sickness.

Definition

1. Altitude sickness – the presence of a headache plus one or more symptoms: anorexia, nausea or vomiting, weakness or fatigue, dizziness, sleep problems. These symptoms appear after climbing to a certain height (usually higher than 1.5-2 km).
2. Altitude pulmonary edema – progressive dyspnea, cough, hypoxia, weakness in conditions of a certain altitude (above 2.5 km). Symptoms may or may not occur depending on whether the symptoms of acute altitude sickness precede pulmonary edema.
3. Altitude cerebral edema is manifested by altered consciousness in patients with symptoms of acute altitude sickness, including altered consciousness, ataxia, stupor that progresses to coma. It usually manifests itself in conditions of considerable altitude (above 2.5 km).
4. Help for converting feet to meters

 

Purpose of providing EMD

1. Improve oxygenation by combining ascent from a height with oxygen therapy.
2. Safe, but fast transport from a height down.

Description of the patient

Inclusion criteria

Patients suffering from altitude sickness, including:

a) acute mountain sickness;
b) high-altitude cerebral edema;
c) high-altitude pulmonary edema.

Exclusion criteria

Patients who did not climb to significant heights.

Providing assistance to the patient

Status assessment

The review should focus on the signs and symptoms of altitude sickness, however, other possible contributors to these symptoms should also be considered.

Treatment and intervention

1. Ensure the safety of the EMD team at the scene.

2. Stop the climb:

a) patients with acute mountain sickness can remain at this altitude and receive symptomatic therapy;
b) patients with pulmonary or cerebral edema should descend.

3. Perform an examination (ABS) and control the airway, if necessary.

4. Administer oxygen therapy, if necessary, aiming for a saturation above 90%.

5. Descend to a lower altitude. Descent is the basis of therapy and is the main means of treatment in the presence of mountain sickness. Descent should begin if the patient’s condition allows:

a) in severe respiratory failure and pulmonary edema, rescuers should start ventilation with positive pressure;
b) provide IV access, administer infusion solutions by bolus, the goal is support systolic blood pressure above 90 mmHg

6. Descent should always be the main therapeutic measure for mountain sickness, especially if the patient suffers from high-altitude pulmonary or cerebral edema. If the descent is impossible or there is no permission from the medical management, the rescuers should use the following therapeutic measures – portable hyperbaric chambers, which are an effective means of treating mountain sickness. However, they are not a substitute for descent, but only as an alternative if descent is impossible.

6.1. Acute mountain sickness:

a) use ibuprofen or paracetamol for pain;
b) ondasetron 4 mg IV, IV or sublingually every 6 hours for vomiting;
c) acetazolamide – up to 250 mg orally twice a day:

• • • • children – dose 2.5 mg/kg, maximum dose 250 mg twice a day;
      • this drug accelerates acclimatization, therefore helps to treat mountain sickness;

d) dexamethasone – 4 mg IV, IV or sublingually every 6 hours until relief of symptoms:

• • • • children – 0.15 mg/kg intravenously, intravenously or orally every 6 hours;
      • dexamethasone helps to treat the symptoms of acute mountain sickness and can be used as adjunctive therapy for worsening mountain sickness, provided that the above drugs do not relieve the symptoms. In this case, the patient should start the descent, as dexamethasone does not contribute to acclimatization.

6.2. High-altitude brain edema – All the following therapeutic measures should be positioned as additional to spusku Descent should always remain the main therapeutic measure:

a) dexamethasone – 8 mg i/v, i/m or orally with additional administration of 4 mg every 6 hours:

• • • • children – 0.15 mg/kg intravenously, intravenously or orally every 6 hours;
      • dexamethasone helps to treat the symptoms of cerebral edema and should be used in high-altitude cerebral edema – in such cases, the patient should also start the descent;

b) It is possible to use acetozolamide in the doses given above.

6.3. Altitude pulmonary edema – All the following therapeutic measures should be positioned as additional to the descent. Descent should always remain the main therapeutic measure:

a) nifedipine – 30 mg orally twice a day, if the drug is not available:

• • • • tadalafil – 20-40 mg orally once a day

OR

• • • • sildenafil – 20 mg orally three times a day;

b) Avoid simultaneous use of several pulmonary vasodilators.

Patient safety

1. Locations at height are a dangerous environment. Rescuers must weigh the needs of the patient against the safety of the EMD team and the patient.
2. A rapid descent of at least 100-300 meters is a priority, but the speed of descent should be balanced with regard to weather conditions and other safety measures.

Useful information for training

Key points

1. Patients suffering from altitude sickness are in a dangerous environment. Accordingly, this environment is dangerous for the EMD team, so pay attention to colleagues for signs of altitude sickness.
2. A descent of 100-300 meters is usually sufficient to relieve symptoms.
3. Patients with high-altitude pulmonary edema suffer from edema of non-cardiogenic origin, so their condition can be improved with the help of positive pressure ventilation using an AMBU bag, ventilator with PPTD setting or other means of positive pressure ventilation.
4. Patients with altitude sickness are often dehydrated and require IV infusion – after resuscitation, patients no longer require a fluid bolus, maintain the volume of administration at 125 ml/h.
5. Altitude pulmonary edema is the most lethal of all altitude sicknesses.
6. Suspect other causes of altered state of consciousness – symptoms may indicate other etiologies, such as: carbon monoxide poisoning (if the patient cooks indoors), dehydration, exhaustion, hypoglycemia, hyponatremia.

Corresponding evaluation results

1. Control the airway in the presence of severe changes in the state of consciousness.
2. High-altitude pulmonary edema will manifest itself in the form of progressive respiratory failure, characterized by wheezing on exhalation.
3. Altitude cerebral edema will manifest as altered consciousness, ataxia, and coma.

Key elements of documentation

1. Patient route including starting altitude, highest altitude reached and rate of descent.
2. Presence (or lack) of preventive drugs against altitude sickness (including such drugs as acetazolamide or sildefanil).
3. Total length of descent.

Criteria for the effectiveness of aid provision

1. The mechanism of treatment of acute mountain sickness, high-altitude edema of the lungs and brain.
2. Factors for choosing a certain medical therapy (weather, impossibility of descent).