2. OBJECTIVES
• Define altitude illnesses, include Acute Mountain
Sickness (AMS), High Altitude Cerebral Edema
(HACE) & High Altitude Pulmonary Edema (HAPE)
• List signs & symptoms of AMS, HACE, HAPE
• Describe emergency care for AMS, HACE, HAPE
• Describe situations that require evacuation
• Describe prevention techniques
3. ALTITUDE ILLNESS OVERVIEW
• Altitude illness occurs when people at high elevation do not get
enough oxygen
• As you gain altitude air grows thinner (less air pressure) &
less oxygen is inhaled
• Most common altitude illness is Acute Mountain Sickness (AMS)
• AMS commonly occurs when person recently has reached heights of
6500 – 8000 feet
4. ALTITUDE ILLNESS OVERVIEW
(CONT’D.)
• Symptoms similar to dehydration & heat illness. (If at lower
altitude < 6500 feet suspect those first)
• High Altitude Cerebral Edema (HACE) is cause by fluid collecting in
the brain tissues. If untreated can lead to death
• High Altitude pulmonary edema (HAPE) is caused when fluid collects
in air spaces in the lungs. HAPE can be life threatening.
5. CHECKING FOR ACUTE MOUNTAIN
SICKNESS (AMS)
• Acute Mountain Sickness Signs & Symptoms:
• Headache
• Loss of normal appetite
• Nausea, with/without vomiting
• Insomnia
• Unusual weariness & exhaustion, called “lassitude”
6. CARING FOR AMS
• Descend or stop ascent & wait for improvement. If
illness progresses, descent is mandatory
• Administer oxygen, if available & trained to do so.
Especially helpful during sleep
• Give aspirin or acetaminophen for headaches, if
patient is able to swallow & has no known
contraindication
• If prescribed & recommended by patient’s health care
provider, help patient self-administer medication for
altitude illness
7. SIGNS & SYMPTOMS FOR HIGH
ALTITUDE CEREBRAL EDEMA
• Loss of coordination or “ataxia” (e.g. can’t walk in a strain
line or stand straight with feet together)
• Severe headache not relieved by rest/medication
• Bizarre changes in personality
• Seizures or coma
8. CARE FOR HACE
• Severely ill patients must descend as soon as
possible
• Provide oxygen, if available & trained to do so
• Keep patient from becoming chilled or
overheated
• If prescribed & recommended, help patient self-
administer medications for altitude illness
• Use portable hyperbaric chamber (caution: do not
use in lieu of descending)
9. SIGNS & SYMPTOMS OF HIGH
ALTITUDE PULMONARY EDEMA
• Dry cough, shortness of breath (at rest)
• Shortness of breath becomes more pronounced
• Possible chest pain
• Cough that becomes productive, first frothy sputum, later reddish
sputum
10. CARE FOR HAPE
• Severely ill patients must descend ASAP
• In addition to descent, provide oxygen, if available &
trained to do so
• Keep patient from becoming chilled or overheated.
Especially important for HAPE, since cold weather
increases pulmonary artery pressures & makes HAPE
worse
• Use portable hyperbaric chamber if available, not a
substitute for descending
11. GUIDELINES FOR EVACUATION
• Patient with AMS should stop ascending until
symptoms resolve themselves
• Patient with AMS does not require evac
unless condition worsens, then descent is
mandatory
• GO FAST for any patient with HACE or HAPE.
Descend at least 1000-1500 feet of elevation.
• Anyone with HACE or HAPE MUST be
evaluated by health care provider ASAP
12. PREVENTING ALTITUDE ILLNESSES
• Most High Altitude Illnesses are preventable
• Make a stage ascent, Allow body to adjust
• Increase altitude of overnight camps gradually
• If possible camp no higher than 8000 ft first
night, no more than 1000’ - 1500’ increase per
night
• If trip starts > 9000’, spend 2 nights acclimating
• Proceed higher during the day, but return to
lower altitude during day during acclimation
period
13. PREVENTING ALTITUDE
ILLNESSES (CONT’D.)
• Eat high carb diet:
• >70% diet of carbs reduces symptoms of AMS
• Start high carb diet 1-2 days before starting trip
• Maintain appropriate exercise level until
acclimated. Avoid excessive shortness of breath
• Stay well hydrated (higher loss of fluids at high
elevations)
• Talk to your health care provider about possible
prescription medication
14. • Near-Drowning vs. Drowning
• Pathophysiology of Drowning and Near-Drowning
• Dry vs. Wet Drowning
• Fresh-Water vs. Saltwater Drowning
• Fresh water causes the alveoli to collapse from a lack of surfactant.
• Salt water causes pulmonary edema and eventual hypoxemia due to its
hypertonic nature.
NEAR-DROWNING
AND DROWNING
16. • Factors Affecting Survival
• Cleanliness of Water
• Length of Time Submerged
• Victim’s Age and General Health
• Water Temperature
• Cold-water drowning.
• Mammalian diving reflex.
• The cold-water drowning patient is not dead until he is warm and dead.
NEAR-DROWNING
AND DROWNING
17. • Treatment for Near-Drowning
• Remove the patient from the water.
• Attempt rescue only if properly trained and equipped.
• Initiate ventilation while the patient is still in the water.
• Suspect head and neck injury if the patient experienced a fall
or was diving. Place the victim on a long spine board and use
c-spine precautions throughout care.
• Protect the patient from heat loss.
• Evaluate ABCs. Begin CPR and defibrillation if indicated.
NEAR-DROWNING
AND DROWNING
18. • Manage the airway using proper suctioning and airway
adjuncts.
• Administer oxygen at 100% concentration.
• Use respiratory rewarming, if available.
• Establish IV of lactated Ringer’s or normal saline at
75 mL/hr.
• Follow ACLS protocols if the patient is normothermic. Treat
hypothermic patients according to hypothermia guidelines.
• Adult Respiratory Distress Syndrome
NEAR-DROWNING
AND DROWNING
19. DIVING EMERGENCIES
• Scuba
• The Effects of Air Pressure on Gases
• Boyle’s Law
• The volume of a gas is inversely proportional to its pressure if
the temperature is kept constant.
• Dalton’s Law
• The total pressure of a mixture of gases is equal to the sum of
the partial pressures of the individual gases.
• Henry’s Law
• The amount of gas dissolved in a given volume of liquid is
proportional to the pressure of the gas above it.
20. DIVING EMERGENCIES
• Pathophysiology of Diving Emergencies
• Increased dissolution of gases during descent due to Henry’s
law.
• Boyle’s law dictates that these gases have a smaller volume.
• In a controlled ascent, the process is reversed and the gases
escape through respiration.
• A rapid ascent causes gases to come out of solution quickly,
forming gas bubbles in the blood, brain, spinal cord, skin,
inner ear, muscles, and joints.
21. DIVING EMERGENCIES
• Classification of Diving Emergencies
• Injuries on the Surface
• Injuries During Descent
• Barotrauma
• Injuries on the Bottom
• Nitrogen narcosis
• Injuries During Ascent
• Decompression illness
• Pulmonary overpressure and subsequent arterial gas embolism,
pneumomediastinum, or pneumothorax
22. DIVING EMERGENCIES
• General Assessment of Diving Emergencies
• Time at Which Signs and Symptoms Appeared
• Type of Breathing Apparatus Used
• Type of Hypothermia-Protective Garment Worn
• Parameters of the Dive
• Number of dives, depth, and duration
• Aircraft Travel following a Dive
23. DIVING EMERGENCIES
• Factors to Assess
• Rate of Ascent
• Associated with panic forcing a rapid ascent
• Inexperience of the Diver
• Improper Functioning of Depth Gauge
• Previous Medical Diseases
• Old Injuries
• Previous Episodes of Decompression Illness
• Use of Alcohol or Medications
24. PRESSURE DISORDERS
• Decompression Illness
• May occur with dives of 33’ or more.
• Signs & Symptoms
• Occur within
36 hours.
• Joint/abdominal
pain.
• Fatigue,
paresthesias,
and CNS
disturbances.
• Treatment
• Recompression.
25. PRESSURE DISORDERS
• Treatment
• Assess ABCs and begin CPR if required.
• Administer high-flow oxygen and intubate if indicated.
• Maintain supine position.
• Protect the patient from heat, cold, wetness, or noxious fumes.
• Transport and establish IV access.
• Consult with medical direction regarding administration of
dexamethasone, heparin, or diazepam if CNS is involved.
• If aeromedical evacuation is used, maintain cabin pressure at
sea level or fly at the lowest possible altitude.
• Send diving equipment with the patient for analysis if possible.
26. PRESSURE DISORDERS
• Pulmonary Overpressure Accidents
• Can occur in depths as shallow as 6’.
• Signs & Symptoms
• Substernal chest pain with associated respiratory distress and
diminished breath sounds
• Treatment
• Treat as a pneumothorax.
• Provide rest and supplemental oxygen.
27. PRESSURE DISORDERS
• Arterial Gas Embolism
• Signs & Symptoms
• Onset is within 2–10 minutes of ascent .
• There is dramatic onset of sharp, tearing pain.
• Common presentation mimics a stroke; suspect AGE in any
patient with neurological deficits immediately after ascent.
• Treatment
• Assess ABCs, provide high-flow oxygen.
• Maintain a supine position; monitor vital signs frequently.
• Establish IV access and consider administering corticosteroids.
• Rapidly transport to a recompression chamber.
28. PRESSURE DISORDERS
• Pneumomediastinum
• Signs & Symptoms
• Substernal chest pain, irregular pulse, abnormal heart sounds,
hypotension with a narrow pulse pressure, and a change in voice
• Treatment
• Provide high-flow oxygen.
• Establish IV access.
• Transport for further evaluation.
29. PRESSURE DISORDERS
• Nitrogen Narcosis
• Occurs during a dive.
• Can contribute to accidents during the dive.
• Signs & Symptoms
• Altered levels of consciousness and impaired judgment.
• Treatment
• Return to shallow depth.
• Use oxygen/helium mix during dive.
