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Crag & Route Beta

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Advice for preparation to Everest B.C...


vwills

15-Jan-2010
4:43:44 PM

Here is some information courtesy of the Acute Wildernass Life Support Manual:

Acute Mountain Sickness

The key to the history is the total elevation gain and the rate of this gain.
AMS is a common illness that may occur in 10% – 70% of individuals, depending primarily on the rate of ascent.
Headache is a not a necessary symptom in order to diagnose AMS, but is usually present
In addition to headache, at least one of the following features needs to be present:
Dizziness
Fatigue
Nausea/vomiting/anorexia
Insomnia

High Altitude Cerebral Edema
HACE represents a progression of AMS to the point of life-threatening end-organ damage.
HACE is defined as severe AMS symptoms with additional obvious neurologic dysfunction.
Ataxia
Altered level of consciousness
Severe lassitude
While the boundary between AMS and HACE can be blurry, HACE almost never occurs without antecedent AMS symptoms as a harbinger.
The progression of AMS to coma typically occurs over 1 – 3 days.

High Altitude Pulmonary Edema
HAPE usually evolves over 2 – 4 days after ascent to altitude.
The primary symptoms are dyspnea at rest, cough, and exercise intolerance.
Occasionally, pink frothy sputum is produced, but this is usually later in the illness.
Neurological symptoms may be seen with concomitant HACE.
The physical examination is remarkable for tachycardia, tachypnea, fever, and crackles and central cyanosis.
Hypoxemia and respiratory alkalosis are universally present.
Mild cases may resolve within hours after descent. In contrast, severe cases may progress to death within 24 hours, particularly if descent is delayed.

Treatment

Acute Mountain Sickness
Discontinue ascent and rest.
Acetazolamide 125 mg PO Q 12 hours until symptom free.
Descent is the definitive treatment.

High Altitude Cerebral Edema
IMMEDIATE descent (almost always with assistance) is imperative and should not be delayed unless descent poses a greater danger to the parties involved (i.e. weather, terrain). Even modest elevation losses can be helpful.
In addition to descent, administering dexamethasone 8 mg IM/PO as a loading dose followed by 4 mg IM/PO Q 6 hours should be given immediately.
Acetazolamide 125 mg PO TID should be given if the victim is able to tolerate oral medications.
Oxygen supplementation should be given when available.
If descent is not possible, place victim in a portable hyperbaric chamber for 4 – 6 hours.
Recovery with prolonged sequelae (ataxia) lasting up to weeks is not unusual.
Most who survive eventually fully recover neurologically.

High Altitude Pulmonary Edema
IMMEDIATE descent is imperative (likely with assistance as exertion will worsen symptoms). All that may be required is 500 – 1000 meters of descent before improvement is observed.
Supplemental oxygen.
Rest after descent.
Nifedipine 20 mg PO followed by 10 mg PO Q 4 hours. If the victim is unable to tolerate oral medications, then empty the capsule sublingually.
If descent is not possible, then place the victim in a portable hyperbaric chamber.
Neither supplemental oxygen, hyperbaric therapy, nor any other intervention should delay an opportunity to descend.
Both furosemide and acetazolamide can be modestly helpful in improving oxygenation

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