injuries and poisoning
Altitude Illness
Treatment of Altitude Illness
Descent to lower elevation is the best treatment for all forms of acute altitude illness. For mild symptoms, stopping the ascent and treating symptoms with medications For severe or slow-to-resolve acute mountain sickness, descent to a lower altitude and treating with medications For high-altitude cerebral edema (HACE) and high-altitude pulmonary edema (HAPE), immediate descent to a low altitude and medications (if descent is not feasible, medications and supplemental oxygen or a portable hyperbaric chamber) People who have swelling of the hands, feet, and face do not need treatment. The swelling goes away on its own after a few days or following descent. Poor sleep is a common problem at high altitude, even among healthy people, and, by itself, is not a reason to descend to lower elevation. People with mild acute mountain sickness (AMS) must stop their ascent and rest. They should not ascend to higher altitudes until symptoms disappear. Other treatment includes fluids andacetaminophenor nonsteroidal anti-inflammatory drugs (NSAIDs) to help relieve headache. Fluids do not treat AMS, but do eliminate dehydration, the symptoms of which can imitate those of AMS. Most people with AMS improve within a day or two. Sometimes,acetazolamideordexamethasoneis given to help relieve symptoms. If AMS symptoms are more severe, or if symptoms persist or worsen despite treatment, the person should descend to a lower altitude, preferably 1,650 to 3,200 feet (500 to 1,000 meters) lower. The descent often provides rapid relief. The person is also given fluids,acetaminophenor NSAIDs, andacetazolamideordexamethasone. People with HAPE should immediately descend to a low altitude. Oxygen should be given if it is available. The drugnifedipinemay temporarily help by decreasing blood pressure in the arteries to the lungs. Heavy exertion should be avoided during descent as this can worsen pulmonary edema. People who promptly descend usually recover from HAPE within 24 to 48 hours. Most people who develop HAPE are admitted to a hospital, but some (for example, those in areas with adequate medical resources such as a ski resort community) can be discharged with supplemental oxygen if they have family or friends who can monitor them. If HACE develops, the person should immediately descend as far down as possible. Oxygen anddexamethasoneshould be taken.Acetazolamidemay be added. When prompt descent to a lower altitude is not possible and people are seriously ill, a hyperbaric bag can be used to buy time. This device consists of a lightweight, portable fabric bag large enough to completely contain a person and a manually operated pump. The person is sealed tightly in the bag, and the bag's internal pressure is then increased using the pump. The increased air pressure simulates a decrease in altitude. The person remains in the bag until symptoms resolve. The hyperbaric bag is as beneficial as Oxygen Therapy , which often is not available when mountain climbing, but is not a substitute for descent. 