Lecture by Joanne Feldman, MD, MS:

At the 2006 Mountain Rescue Conference held in Marin County, Joanne Feldman, MD, MS a Wilderness Medicine Fellow and
Clinical Instructor, Department of Emergency Medicine of Stanford University Medical Center presented a talk on High Altitude Medicine. She prepared a handout which is available here. This is only the handout, and with all lecture materials available on this site, it is for people with the proper medical training, this in and of itself does not constitute medical training, it is merely a refresher, or a way to organize your ideas.

Handout by Mike St. John:

There are three common forms of altitude illness. They are Acute Mountain Sickness (A.M.S.), High Altitude Pulmonary Edema (HAPE), and High Altitude Cerebral Edema (H.A.S.E.). A.M.S. is the most common form of altitude sickness in California and due to our relatively low mountains, documented cases of H.A.P.E. and H.A.S.E. are infrequent.

1. A.M.S.

a. Acute Mountain Sickness generally occurs at elevations over 8,000 feet.  People are not predisposed to A.M.S. because of poor conditioning, overweight or other illnesses. An outstanding athlete could get it at 8,000 feet while their overweight beer drinking, 2 pack a day smoking buddy would not get it at 14,000 feet.

b. Signs and symptoms

    -Headache and Nausea.

    -Fatigue.

    -May feel like a terrible case of the Flu.

c. Treatment

    -Go down in elevation several hundred feet or until they feel better, This is by far the best treatment you can give.

    -Often AMS is complicated by dehydration, make patient drink water even if she/he may not want to.

    -Have him/her eat easy to digest snacks

    -If there will be a delay in going down in elevation, keep patient awake during day.

    -Too much sleep will make patients feel worse.

    -Patient's condition will often decline until patient goes down in elevation.

    -Monitor vital signs.

d. Prevention

    -Acclimate slowly. Your body needs time to adjust to higher altitudes. This often is difficult in SAR responses to the Sierra's. When possible, avoid sleeping at high elevations (over 9,000 ft) the first two nights of an operation to give your body time          to adjust.

    -Stay hydrated and eat well. AMS is linked to poor hydration

    -If you are predisposed to AMS, get a prescription for "DIAMOX". It is the latest and most effective drug to help combat AMS.

2. H.A.P.E.

a. High Altitude Pulmonary Edema is the most common cause of death at very high altitudes (12,000 to 18,000 feet). H.A.P.E. is caused by excess fluid in the lungs.

b. Signs and symptoms

    -Difficulty breathing

    -Patient coughing up pink sputum

    -Audible lung sounds

c. Treatment

    -Get patient down in altitude rapidly. Death may occur within twelve hours after onset.

    -02 6 lpm via cannula.

    -Monitor vital signs.

3. H.A.C.E.

a. High Altitude Cerebral Edema is caused by excess fluid and pressure in the brain. H.A.C.E. also occurs at very high altitudes (12,000 to 18,000 feet).

b. Signs and symptoms

    -Patient will complain of headache and vomiting.

    -Patient may act intoxicated, DUI test works well in diagnosing HASE.

    -Extreme fatigue

c. Treatment

    -Get patient down in altitude rapidly. Like H.A.S.E., death may occur within twelve hours after onset.

    -02 10 lpm via non-re breather mask.

    -Some areas may have GARMAN Bags, a portable hyperbolic chamber developed by Colorado SAR teams.

    -Monitor vital signs.

Prepared by Michael St. John