High-altitude illness happens when people climb above about 2,500 m (8,000 feet) faster than the body can adapt to lower oxygen. It ranges from acute mountain sickness to life-threatening brain swelling (HACE) or fluid in the lungs (HAPE).
Key symptoms
- Headache after a recent ascent
- Nausea, poor appetite, fatigue and dizziness
- Poor sleep
- Confusion and unsteady walking (HACE)
- Breathlessness at rest, cough and less exercise tolerance (HAPE)
What you find on exam
- Oxygen saturation, unusually low for the altitude in HAPE
- Heel-to-toe walk to detect ataxia
- Level of consciousness and mental status
- Lung sounds: crackles in HAPE
- Heart rate, breathing rate and temperature
Tests
- Diagnosis is clinical, based on ascent history and symptoms
- Lake Louise score for acute mountain sickness
- Glucose to exclude low blood sugar
- Chest X-ray or lung ultrasound in hospital for HAPE
Treatment basics
- Stop ascending; descend if symptoms are severe or worsening
- Oxygen to keep saturation above 90 percent
- Acetazolamide for prevention and mild illness; ibuprofen or acetaminophen for headache
- HACE: dexamethasone and urgent descent
- HAPE: descent and oxygen; nifedipine or a portable hyperbaric bag if descent is delayed
Red flags
- Confusion or unsteady gait
- Breathlessness at rest or pink frothy sputum
- Drowsiness or worsening despite rest
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Sources: NASEMSO National Model EMS Clinical Guidelines; NREMT psychomotor skill sheets (EMT and Paramedic); NCCPA PANCE Content Blueprint. Written by Making Synapses. Making Synapses is not affiliated with these organizations.