High-altitude medicine

ZONE OF KNOWLEDGE

High Altitude Pulmonary Edema (HAPE) is the second leading cause of death in high mountains after injuries.

HAPE occurs much less frequently than Acute Mountain Sickness, more often in individuals who are bursting with excess energy and prefer to push their bodies to the limit without rest, such as carrying 30kg on their backs during the first days at altitude. When the body is already struggling with a lack of oxygen, adding more strain can be overwhelming.

Symptoms primarily include a significant decrease in exercise tolerance (a sudden, noticeable drop in performance), breathing difficulties, rapid breathing, shortness of breath at rest, a wet cough with the expulsion of blood-tinged frothy sputum, a feeling of bubbling or fluid in the lungs, cyanosis of the lips, tongue, and nails, apathy, meaning a lack of any 'drive' or desire to act, and fear for one’s life.

PATTERNS FOR RECOGNIZING HIGH ALTITUDE PULMONARY EDEMA

Check if your expedition partner:

➤ (1) Cannot calm their breath after physical exertion for a long time

➤ (2) Experiences shortness of breath at rest

➤ (3) Breathes quickly - faster than others

➤ (4) Has audible bubbling sounds in their lungs. Place your ear on their back below the shoulder blades.

If any of the above symptoms occur, suspect high altitude pulmonary edema.

HAPE at altitude can develop over several days, but sometimes it only takes 1-2 hours for a person to start suffocating. A person with HAPE prefers to sit rather than lie down, as this position allows for better breathing. There is no time for speculation or waiting 24 hours; treatment must be initiated as soon as possible, and one must descend as low as possible.Untreated High Altitude Pulmonary Edema can lead to respiratory failure and death.

Descending 300-1000m can improve the condition of the patient. If descent is impossible, we implement available treatments such as administering oxygen, using a portable hyperbaric bag, or administering medications that are part of the high-altitude golden triad – Nifedipine (Cordipin Retard) or Sildenafil.

DETAILS OF TREATMENT:

What to do if you suspect high altitude pulmonary edema?

➤ (1) Stay with the sick friend, do not leave them alone

➤ (2) Organize a descent of 1000m as quickly as possible, no later than tomorrow morning!

➤ (3) Keep your partner in a sitting position

➤ (4) Ensure they are warm

➤ (5) Provide them with oxygen to breathe or use a hyperbaric bag (if available)

➤ (6) Administer Nifedipine 30mg every 12 hours or Sildenafil 50mg every 8 hours if descent and oxygen are not possible

IF DESCENT IS IMPOSSIBLE, CONTINUE THERAPY

A portable hyperbaric bag and oxygen buy time; the hours gained this way are used to organize a rescue operation and survive until descent is possible.

Using a hyperbaric bag is not complicated.

You simply place the injured person in the bag, zip it up, and pump it using a foot or hand pump. You pump throughout the duration of the therapy to exchange the 'used air' inside the bag. Thanks to the properties of the bag, you achieve a higher pressure inside than outside, which means for our injured person a virtual descent of 1500-2000 meters.

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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DO YOU WANT TO LEARNMORE?

If you want to better prepare yourself health-wise for trekking or high-altitude expeditions, you can find an extended version of the guide in the ebook"High Altitude Medicine in Practice – A Guide for Trekking and Expeditions" >>

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You can also gain practical knowledge about emergency procedures in the mountains through the online training"High Altitude First Aid" >> - designed for those planning trips to high altitudes.

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Meanwhile, you can find a detailed contents list for a first aid kit and precise instructions for preparing an expedition first aid kit and personal rescue set in the ebook"Expedition First Aid Kit – A Complete Medical Guide" >>

ARE YOU PLANNING A TREK?MOUNTAINARE YOU PLANNING A HIGH-ALTITUDE EXPEDITION?

If you want to check whether your health condition allows you to safely participate in trekking or a high-altitude expedition, it is worth taking advantage ofa medical consultation >> ora telemedical expedition package >>

This way, you can assess health risks in advance, prepare appropriately for the trip, and increase safety while at high altitudes.

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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