High-Altitude Medical

HANDBOOK

High-Altitude Cerebral Edema (HACE) is a life-threatening condition. If left untreated, it can lead to loss of consciousness and death, in severe cases within as little as one hour from the onset of symptoms.

A lack of sufficient oxygen may cause the brain to swell, while the rigid skull leaves no room for expansion. This results in dangerous compression of brain structures. There is no time to lose.

SYMPTOMS OF HACE

Common symptoms include:

➤ Severe headache

➤ Loss of balance and coordination

➤ Behavioral changes (confusion, aggression, apathy)

➤ Persistent, severe vomiting

➤ Visual, hearing, or sensory disturbances

➤ Disorientation in time and space

➤ Decreased level of consciousness, drowsiness

➤ Coma

A person with HACE usually presents several of these symptoms at the same time.

A simple way to assess coordination problems is the finger-to-nose test or the heel-to-toe walking test.

SIMPLE FIELD TESTS TO SUSPECT HACE

Ask your climbing partner to:

➤ Close their eyes and rapidly touch the tip of their nose alternately with the index finger of the right and left hand (first with eyes open, then closed)

➤ Walk in a straight line using the heel-to-toe method

➤ Stand still with eyes closed and arms extended forward without swaying

➤ Count backwards from 100 to 0

Difficulty performing any of these tasks should raise strong suspicion of HACE.

WHAT TO DO IF YOU SUSPECT HACE

➤ Stay with the affected person at all times—never leave them alone.Organize an immediate descent of 500–1,000 m.Not later, not tomorrow morning—do not wait for improvement. Symptoms will worsen.

➤ Administer supplemental oxygen or use a portable hyperbaric chamber, if available.

➤ Administer Dexamethasone

- 4 mg every 6 hours

- First dose doubled (8 mg)

- Add gastric protection: Omeprazole 20 mg once daily, on an empty stomach

➤ Administer Acetazolamide

- 1 tablet every 12 hours

➤ If descent is impossible, continue treatment and initiate an emergency rescue immediately.

LITERATURE

• Wilderness Medical Society Clinical Practice Guidelines for the Prevention, Diagnosis, and Treatment of Acute Altitude Illness: 2024 Update.

• Johnson C., Anderson S.R., Dallimore J. et al. Oxford Handbook of Expedition and Wilderness Medicine. Oxford University Press, 2008

• Forgey W.W. Wilderness Medical Society: Practice Guidelines for Wilderness Emergency Care. Falcon, 2006

• West J.B., Schoene R.B., Milledge J.S. High Altitude Medicine and Physiology. Hodder, London, 2007

• Travelling in High Mountains.www.medex.org.uk

• Hackett P.H., Roach R.C. High-altitude cerebral edema. High Alt. Med. Biol., 2004; 5: 136–146

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WANT TO LEARN MORE?

If you want to better prepare your health for trekking or a high-altitude expeditions, check out the expanded guide in the ebook "High-Altitude Medicine for Trekkers and Climbers" >>

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Gain practical skills for handling emergencies in the mountains through our online training "High-Altitude First Aid" >> - prepared for those planning trips to high altitudes.

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 For a detailed list of what to include in your expedition medical kit and step-by-step instructions for assembling your personal first aid set, see the ebook "High-Altitude Expedition Medical Kit Guide" >>

PLANNING A TREK OR A HIGH-ALTITUDE EXPEDITION?

If you would like to check whether your health condition allows you to safely participate in a trek or high-altitude expedition, consider booking a medical consultation >> or using a telemedical expedition package >>

This allows you to assess potential health risks in advance, prepare properly fot altitude, and increase your safety during the expedition.

The company was established in 2004. The goal of MedEverest is education in the field of mountain medicine and the dangers of high altitudes. I deal with all medical aspects of staying at high altitude. I organize medical support for trekking and high-altitude expeditions.

Specialist Medical Practice Medeverest Robert Szymczak based in Gdańsk (80-360), at ul. Bolesława Krzywoustego 19F, NIP: 5841943576, REGON: 220148318.

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