AMS- Acute Mountain Sickness     

[Surviving Everest]   [Mountain Rescue]

ALTITUDE SICKNESS
Altitude Sickness, often known as Acute Mountain Sickness (AMS) is particularly an important consideration while trekking in Nepal. Altitude Sickness means the effect of altitude on those who ascend too rapidly to elevations 3000m. The initial symptoms of AMS are as follows:

• Nausea, vomiting
• Loss of appetite
• Insomnia / sleeplessness
• Persistent headache
• Dizziness, light headache, confusion
• Disorientation, drunken gait
• Weakness, fatigue, lassitude, heavy legs
• Slight swelling of hands and face
• Breathlessness and breathing irregularly
• Reduced urine output

These symptoms are to be taken very seriously. In case of appearance of any of the above symptoms any further ascend should be reconsidered; otherwise more serious problems may occur which can even cause death sometimes within a few hours. The only cure for the Altitude Sickness is to descend to a lower elevation immediately. Acclimatization by ascending to no more than 300 to 500 meters per day above 3000 meters and the proper amount of rest are the best methods for preventions of AMS.

CAUSE / FACTOR OF ALTITUDE SICKNESS

• Less Oxygen
• Low pressure ie: Barometric Pressure
• Rapid Ascent
• Possible Dehydration
• Hypothermia

TYPES OF ALTITUDE SICKNESS

AMS : Acute Mountain Sickness
HAPE: High Altitude Pulmonary Edema
HACE: High Altitude Cerebral Edema

SYMPTOMS
1. ACUTE MOUNTAIN SICKNESS

• Mild symptoms feels like a hangover / not feeling well:
• Headache
• Fatigue / Tiredness
• Nausea
• Shortness of Breath
• Loss of Appetite
• Disturbance in Sleep
• Dizziness

2. HIGH ALTITUDE PULMONARY EDEMA

• Water in Lungs.
• Increasing shortness of breath even at rest
• Severe cough – Dry / productive
• Very tired unusual fatigue while walking
• High pulse rate, ie: 110
• Blueness of face, lip, fingernails – that means the inability of transporting oxygen into the blood.

3. HIGH ALTITUDE CEREBRAL EDEMA

• Water in the head :
• Severe headache
• Vomiting
• Walking like an intoxicated (ataxia)
• Mental confusion / altered mental status
• Irritable – does not want to be bothered by other people
• Unconsciousness or coma
• Test: tandem walking test, heel to toe step. Fall off from the line.

DECISION MAKING
Find out the main problem at altitude. Assume all problems are altitude sickness unless proven otherwise.

If it is an altitude problem with mild symptoms, stay at the same altitude until the symptoms are completely gone. An example – take an aspirin tablet, try to go up but listen to your body. If symptoms are worsening, descend.

PREVENTION

• Acclimatization – after a 1000m ascent, stay one more night for acclimatization.
• Do not make a rapid ascend, don’t go too fast too high.
• No alcohol, sleeping pills and smoking.
• Drink more fluid 3-4 liters a day – clean water, boiled and filtered, or treated tea/coffee/soup/juice etc.
• Do not carry heavy packs, 10-12 kgs ok.
• Climb higher, always sleep lower.
• Over 3000m, 300m ascent a day.
• Never travel alone.

TREATMENT

Medicines:

• Oxygen

• Diamox- for AMS- 125mg before dinner for sleeping problem if feeling suffocated.

• Nafedipine- for HAPE

• Steroids/Dexamethasone for ACE

• Hyperbolic bag- Gammow bag
  

FOUR GOLDEN RULES

• Awareness of Altitude illness
• If you have mild symptoms, do not proceed higher. Take aspirin tablets.
• If you have worsening symptoms, go down immediately.
• Do not leave your team member behind unattended.

THREE IMPORTANT THINGS TO PERFORM

• Go up slowly.
• Drink plenty of fluids (at least 3 liters per day)
• Before your trip, please refresh your knowledge about altitude sickness so that you can help yourself and others as well.

HIMALAYAN HIGH ALTITUDE SPECIALISTS since 1983