Altitude Sickness

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Altitude Sickness
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Altitude

• High Altitude
• 5000 ft to 11,500 ft
• Minor decrease in O2 transport (SaO2 90)
• Altitude sickness common with rapid ascent above
  8200 feet

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Altitude

• Very High Altitude
• 11,500 ft to 18,000 ft
• Maximum SaO2
• Most common range for serious altitude sickness

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Altitude

• Extreme Altitude
• 18,000 ft
• Severe hypoxemia, hypocapnia
• Deterioration outstrips acclimatization

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Altitude

• Mount Everest
• 29,028 ft
• Unacclimatized person
• Unconscious in 45 seconds
• Dead in 4 to 6 minutes

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Altitude Pathophysiology
Hyperventilation to compensate for decreased FiO2
Alkalosis
Episodic respiratory arrests during sleep
Suppression of breathing during sleep
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Altitude Pathophysiology
Cerebral edema
Increased cerebral blood flow
Vasodilation
Hypoxia
Increased Capillary Permeability
Pulmonary edema
Peripheral edema
Increased cold injury risk
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Altitude Sickness Symptoms

• Mild Acute Mountain Sickness
• Headache
• Malaise
• Anorexia
• Nausea, vomiting

• Dizziness
• Dyspnea on exertion
• Dry cough
• Decreased urine output

Any AMS symptoms are due to altitude until proven
otherwise
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High Altitude Cerebral Edema

• Lassitude
• Headache
• Mental dullness
• Ataxia
• Focal defects
• Paralysis
• Paresthesias

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High Altitude Pulmonary Edema

• Dyspnea at rest
• Fatigue, weakness
• Orthopnea
• Hemoptysis, blood-tinged sputum
• Cyanosis
• Rales

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HAPE/HACE Treatment

• Stop ascent!!
• Descend immediately if
• No improvement with treatment
• Ataxia, decreased LOC, pulmonary edema
• Minimize exertion
• Bed rest

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HAPE/HACE Treatment

• Oxygen
• Pulmonary edema
• CPAP or PEEP
• Possible hyperbaric chamber
• No lasix or morphine (non-cardiogenic)
• Cerebral edema
• Steriods (Dexamethasone)