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Chapter 28
Altitude-Related
Emergencies
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Objectives
28.1 Define altitude.
28.2 Describe the principles of altitude
physiology.
28.3 List risk factors for the development of
altitude illnesses.
28.4 Describe strategies to prevent altitude
illness.
continued
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Objectives
28.5 List the signs and symptoms of the
following altitude illnesses:
a. acute mountain sickness
b. high-altitude pulmonary edema
c. high-altitude cerebral edema
28.6 Describe how to assess a patient with
altitude illness.
28.7 Describe the treatment of a patient with
altitude illness.
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Topics
 Altitude
Physiology
 Altitude-Related Problems
 Prevention of Altitude Illness
 Assessment
 Management
 Chapter Summary
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Case Presentation
At first-aid duty, in the patrol room, a 45 year-old man
slowly walks in. He appears unwell, and slightly
cyanotic around his lips. You help him to the nearest
gurney and assess him. He states he hasn’t felt well
since arriving 2 days ago. The resort is located 9,000
feet above sea level. He feels very fatigued and
winded. He has no significant medical history, has
not suffered recent trauma, and is not on any
prescribed medications.
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Altitude Physiology
 Body’s
ability to preserve
homeostasis includes the ability to
adapt to altitude changes.
 Rate of ascent determines the
probability of developing an altitude
illness.
continued
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Altitude Physiology
continued
Copyright Wilderness Medical Society
educational powerpoint series, 2008
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Altitude Physiology
Copyright Wilderness Medical Society
educational powerpoint series, 2008
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Altitude Classifications

Low altitude
◦ (<5,000 ft)

Intermediate altitude
◦ (5,000 to 8,000 ft)

High altitude
◦ (8,000 to 12,000 ft)

Very high altitude
◦ (12,000 to 18,000 ft)

Extreme altitude
continued
◦ (>18,000 ft)
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Altitude Classifications
Copyright David Johe, MD
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Altitude Acclimatization
 Changes
that help preserve
homeostasis
◦
◦
◦
◦
◦
Increased rate and depth of respiration
Increased heart rate
Increased red blood cell production
Construction of pulmonary blood vessels
Increased enzyme production
continued
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Altitude Acclimatization
Copyright Denise Cheney
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Altitude-Related Problems
 Acute
mountain sickness
 High-altitude pulmonary edema
 High-altitude cerebral edema
continued
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Altitude-Related Problems
continued
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Altitude-Related Problems
 Other
◦
◦
◦
◦
◦
◦
◦
BRADY
altitude-related problems
Khumbu cough
Peripheral edema
High-altitude retinal hemorrhage
Radial keratotomy eye surgery
Solar keratitis
Chilblains
Sunburn
continued
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Altitude-Related Problems
Copyright Luanne Freer, MD
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Altitude-Related Problems
BRADY
Copyright Andy Crawford and Steve Gorton /
Dorling Kindersley Media Library
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Case Update
On examination of the patient, you notice that not
only his lips, but also his nail beds are cyanotic, and
his breathing is labored, even at rest. The patient
appears physically fit, which he confirms by saying, “I
run and ride more than 50 miles a week.” He has a
heart rate of 116, a blood pressure of 132/80,
respirations of 36. The pulse oximeter indicates the
patient’s oxygen saturation is 76%. The rest of the
physical assessment is negative for any
abnormalities or signs of trauma.
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Prevention of
Altitude Illnesses
 Prevention
◦ Ascend gradually.
◦ Avoid rapid ascent above 10,000 feet.
◦ Incorporate layover at an intermediate
altitude.
◦ Once above 10,000 feet, limit altitude
increase to 1,000 feet/day and for every
2,000 feet of elevation gained, take 1-2
continued
extra rest days.
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Prevention of
Altitude Illnesses
continued
Copyright Jamie Marshall /
Dorling Kindersley Media Library
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Prevention of
Altitude Illnesses
 As
you increase altitude, more rest
and less altitude gain per day may be
necessary.
 Avoid heavy physical exertion for the
first 24-48 hours at altitude.
continued
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Prevention of
Altitude Illnesses
 Stay
hydrated. Altitude acclimatization
is often accompanied by fluid loss,
drink often (3-4 quarts/day). As
breathing increases, fluid is lost due
to increased exhalation. Urine output
should be copious and straw colored.
continued
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Prevention of
Altitude Illnesses
continued
Copyright Dorling Kindersley Media Library
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Prevention of
Altitude Illnesses
 Avoid
alcohol and other depressant
drugs.
 Eat a high carbohydrate diet.
 If symptoms of altitude illness occur,
do not ascend until they resolve.
continued
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Prevention of
Altitude Illnesses
 Acclimatization
occurs at different
rates. If traveling in a group, make
sure everyone is properly
acclimatized before going higher.
 “Climb high and sleep low.”
continued
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Prevention of
Altitude Illnesses
 Medications
◦ Acetazolamide
◦ Dexamethasone
◦ Gingko biloba
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Prevention of
Altitude Illnesses
Copyright Dorling Kindersley Media Library
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Assessment
 Initiate
life saving equipment
 ABCDs
 SAMPLE
 OPQRST
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Assessment
Copyright Studio 404
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Assessment
Copyright Candace Horgan
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Management
 Descend
to lower elevation
 General management
◦
◦
◦
◦
BRADY
AMS treatment
HAPE treatment
HACE treatment
Khumbu cough treatment
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Management
Copyright Dorling Kindersley Media Library
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Prevention of
Altitude Illnesses
continued
Copyright Nigel Hicks /
Dorling Kindersley Media Library
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Case Disposition
The patient may have early signs of HAPE, so you
place him on high-flow oxygen, keep him
comfortable, and mobilize resources to transport him
to a hospital approximately 1,500 feet lower. Two
days later, the patient’s wife thanks you “for taking
such great care of my husband.” She reports he
recovered from is symptoms within a day after
descent and supplementary oxygen. She further
states that her husband was advised to avoid high
altitude or to ascend slowly next time.
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Chapter Summary
Altitude sickness is a common disorder that
affects outdoor enthusiasts. It is caused by
a decrease in available oxygen
concentration and can afflict even those
who are extremely healthy.
 Compensatory mechanisms increase
cardiopulmonary function to speed oxygen
delivery to the cells. The body must work
harder to keep up.

continued
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Chapter Summary

As an OEC technician, you have a good
chance of encountering an altitude-related
illness if you live and work in a high-altitude
setting, and compounded by guests who
arrive from a low altitude and without
gradual ascent. Symptoms can manifest
quickly in these individuals.
continued
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Chapter Summary
Preventive measures, such as slow ascent
and the use of prophylactic (prescribed)
medications may provide some protection
but are no guarantee of immunity.
 Thus, it is essential that you recognize the
signs and symptoms of acute mountain
sickness, HAPE, and HACE as well as
other altitude-induced conditions.

continued
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Chapter Summary
Additionally, be prepared to act quickly to
treat an altitude-related illness to halt the
progression of symptoms and to reduce the
chance of a potentially lethal outcome.
 Altitude illness can become lifethreatening.
 Once symptoms of AMS develop, do not
ascend until symptoms completely resolve.

continued
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Chapter Summary
Suspect HACE in the presence of
headache and ataxia when at altitude.
 Descent with supplemental oxygen will
almost always improve symptoms of
altitude illness.

BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ