Altitude Sickness

Altitude Sickness in Mountain – Before hiking in Nepal, it is crucial for you to understand how to prevent altitude sickness also known as Acute Mountain Sickness (AMS), as well as how to cure it if it strikes. Acute Mountain Sickness is a condition brought on by elevation rise. The amount of oxygen is lower at higher altitudes than it is at sea level, and it gets thinner as hikers go further. Please check over the information we’ve provided here about AMS.

 

SYMPTOMS OF Altitude Sickness

There are several possible AMS symptoms. From person to person, they differ. However, the following are general Altitude Sickness symptoms. Do not wait to diagnose the condition and seek prompt treatment if you have any of these symptoms.

• Difficulty sleeping
• Dizziness or light-headache
• Fatigue
• Headache
• Loss of appetite
• Nausea or vomiting
• Rapid pulse (Heart Rate)
• Shortness of breath

High Altitude Pulmonary Edema (HAPE) or HACE may develop in severe cases of AMS (High Altitude Cerebral Edema). The respiratory system is affected by HAPE, whereas the nervous system is affected by HACE.

Symptoms with severe Altitude sickness 

• Blue color to the skin (cyanosis)
• Chest tightness or congestion
• Cough
• Coughing up blood
• Withdrawal from social interaction
• Gray or pale complexion
• Cannot walk in a straight line, or walk at all
• Shortness of breath at rest

Related Oxygen Rate at Different Altitude

Altitude    Oxygen Rate
(In Meters)    (In Feet)
8.850       29.035    33%
8.000      26.247    36%
7.000      22.966    41%
6.000      19.865    47%
5.500      18.045    50%
5.200      17.061    52%
5.000      16.404    53%
4.500      14.764    57%
4.000      13.123    60%
3.500      11.483    64%
3.000      9.843    68%

Sea Level    100%

Facts on HAPE & HACE

• HAPE and HACE may occur alone or together.
• HACE or HAPE occur in approximately 1 to 2% of people going to high altitude.
• HACE usually develops after symptoms of AMS have appeared and often gets rapidly worse during the night.
• HACE may develop in the later stages of HAPE.
• HAPE is roughly twice as common as HACE.
• HAPE causes many more deaths than HACE.
• HAPE may appear without any preceding symptoms of AMS.
• HAPE is more likely in people with colds or chest infections.
• HAPE often comes on after the second night spent at a higher altitude.
• HAPE can develop even after descending from a higher altitude.

HACE (High Altitude Cerebral Edema)

A buildup of fluid in or near the brain is what causes HACE. Typically, AMS symptoms and indications worsen and HACE manifests. HACE could develop in a person with HAPE.

SYMPTOMS & SIGNS

• Severe headache, which often feels worse on lying down and is not relieved by ibuprofen, paracetamol or aspirin.
• Tiredness, severe fatigue.
• Nausea and or vomiting which may be severe and persistent.
• Loss of coordination, clumsiness. The victim needs help with simple tasks such as tying their shoelaces or packing. their bag. They cannot do the finger-nose test.
• Staggering, falling. They cannot do the heel to toe walking test or the standing test.
• Blurred or double vision, seeing halos around objects.
• Loss of mental abilities such as memory. They cannot do a simple mental arithmetic test.
• Confusion, hallucinations.
• Change in behavior (aggression, apathy, etc.).
• Drowsiness, difficult to wake up, coma, death.

TESTS FOR HACE

Walking Test: The subject is instructed to take 10 extremely little steps while stepping from the heel of one foot to the toes of the other. The victim shouldn’t be assisted, and the terrain ought to be quite flat.

Standing test: The subject stands with their feet together, their arms at their sides, and their eyes closed.

Finger – Nose Test: The subject closes their eyes and swiftly alternates between tapping the tip of their nose with the index finger and extending that arm to point in the opposite direction. This is known as the “finger-nose test” (a useful test if the victim is in a sleeping bag).

Mental Arithmetic Test: Give the sufferer a mental calculation test, for instance. 7 should be subtracted from 100, 7 from 93 (but remember some people may be poor at arithmetic even at sea level).

Assume the victim has HACE if they are unable to complete any of the aforementioned tests without assistance (or if they refuse to cooperate), exhibit excessive wobbling, or trip over during the first two tests (be ready to catch the victim if they fall over!). Compare the victim’s performance to that of a healthy person if you are unsure. Be ready to take these tests repeatedly.

TREATMENT

Drop instantly (prompt descent will begin to reverse the symptoms). Get as low as you can, at least 1000 meters (3280 feet). If necessary, descend at night or during terrible weather.

Oxygen or the use of a PAC together with the required drugs will keep the individual alive until descent can be started if descent is not immediately possible (due to hazardous terrain or weather, a lack of rescuers, or while waiting for a helicopter, for example).

GIVE OXYGEN

1. (2 to 4 L/min) from a bottle while wearing a mask.
2. With the aid of a pressure bag (approximately 2 to 4 L of oxygen per minute).

Note: If a pressure bag and oxygen are both available, use the oxygen first while the victim is being readied for the bag and then again once they are removed. If the bag is not intended for this use and you have not received training to do so, do not administer oxygen within the bag.

GIVE MEDICATIONS

1. Dexamethasone 8 mg all at once (by mouth, IV, or IM), then 4 mg every six hours. Dexamethasone takes a while to start working. Stop it by gradually reducing the dosage once you are below 2500m/8200ft AND after at least 3 days of treatment (give the last 3 doses 12-hourly).
2. Diamox 250 mg 8–12 hours per day.
3. Utilize antiemetics to treat persistent vomiting.

The person should be supported in a semi-reclining position because lying flat could worsen their condition.

If at all possible, refrain from making even the smallest effort. Even a brief walk could exacerbate or bring back their symptoms. Don’t let the victim be left alone.

Give someone rescue breathing if they are going blue or are about to lose consciousness before they cease breathing.

HAPE (HIGH ALTITUDE PULMONARY EDEMA)

The buildup of fluid in or around the lungs is what causes HAPE. It may develop concurrently with AMS or it may manifest on its own without any prior AMS symptoms (this occurs in roughly 50% of cases). If in doubt, treat for both asthma and a chest infection since HAPE is easily confused with either condition.

SYMPTOMS & SIGNS

Dry coughing and a decline in physical function are sometimes the first indications that HAPE is beginning to experience dyspnea.

This may just include taking a little longer to breathe while returning to rest after little exertion in the early stages of HAPE. Later, even light exertion causes noticeable dyspnea. Finally, being at rest causes dyspnea. Take note of your breathing rate.

Later on, the dry cough could turn wet and produce frothy, bloody sputum (pink or rust colored). This is a grave indication.

Deep breathing produces wet sounds in the lungs (place your ear on the bare skin of the victim back below the shoulder blades; compare with a healthy person).

Be aware that even in very severe cases of HAPE, there may be NO wet noises; this is known as dry HAPE.

Mild temperature up to 38.5oC, a feeling of inner chill, and chest aches are possible.

due to a shortage of oxygen in the blood, you may have blue or dark skin, lips, tongue, or nails (cyanosis).

TREATMENT

Use oxygen or the PAC and the needed drugs to keep the person alive until descent can be attempted. Otherwise, use the same general course of action as for HACE.

GIVE MEDICATIONS

Nifedipine. If bottled oxygen or a pressure chamber are unavailable and the victim is warm and well-hydrated, this should only be employed. Give the pills in modified release (MR) form (20 mg 12-hourly for 2 or 3 days). Treat as shock if nifedipine causes a drop in blood pressure (pallor, weak quick pulse, dizziness upon standing).

Diamox 250 mg 8–12 hours per day.

An asthma spray (2 puffs every four hours) might be helpful.