Altitude-Related Emergencies

Altitude-Related Emergencies

Athletic competition in the high-altitude environment continues to increase in popularity for amateur and professional athletes . As a result of this growing popularity, the athletic trainer will have increasing opportunity and responsibility to serve the needs of the athlete performing in the high-altitude environment. Sports activities that are related to high-altitude performance can be individual or team activities. The scope of sports medicine practice by the athletic trainer ranges from pre-event prevention of common medical conditions that are unique to the high-altitude environment to the on-site event coverage and care requiring skills in outdoor medical care. In high-altitude sports participation, the most obvious change is an increase in pulmonary ventilation, which can give the feeling of being out of breath. The response is highly variable among athletes and may not be felt for a few days. Because there is less oxygen in the atmosphere at altitude, the heart rate in an athlete may be elevated to increase cardiac output and maintain an adequate oxygen supply to the body, both at rest and during exercise. The term “high-altitude emergencies” is used to describe illnesses or syndromes that can develop in athletes that are not acclimated to the high altitude. Because many athletes travel to high-altitude locations each year to participate in sports activity, acute mountain sickness is a health problem that must be taken seriously by health professionals. High-altitude pulmonary and cerebral edema, although uncommon in athletics, can be potentially fatal.

Acute Mountain Sickness

Acute mountain sickness is common in athletes who ascend from near sea level to altitudes higher than approximately 3000 m, but it may occur in altitudes as low as 2000 m. General symptoms for acute mountain sickness are characterized by headache, lightheadedness, breathlessness, fatigue,

insomnia, loss of appetite, and nausea.23 Usually, these symptoms will begin 2 to 3 hours after the athlete has reached peak ascent, but the condition is generally self-limiting and most of the symptoms disappear after 2 to 3 days .

The best way to prevent acute mountain sickness is by ascending gradually and allowing for acclimatization. Acclimatization is the process of the body adjusting to the decreasing availability of oxygen. Some authors suggest that with any ascent to an altitude above 3000 m, there should be a 2- to 3-day rest before further heavy athletic activity occurs. Treatment of acute mountain sickness by oxygen or descent is not usually required; aspirin, acetaminophen, or ibuprofen may relieve most headaches. Other medications such as acetazolamide and dexamethazone may be given by a

physician if the symptoms are severe. Severe prolonged acute mountain sickness responds to descent to a more normal altitude for the athlete.

High-Altitude Pulmonary Edema

Another form of altitude illness is high-altitude pulmonary

edema, or fluid in the lungs. Although it often occurs with acute mountain sickness, it is not felt to be related and the The treatment for high-altitude pulmonary edema is immediate descent to a safe altitude level. This must be done with the utmost urgency. Delay may be fatal. A safe altitude is usually described as the last elevation where the athlete felt well on awakening from a restful sleep. Oxygen should be administered if available. Medications such as nifediphine, salmeterol, and sildenafil may be given by a physician to help relieve the symptoms of high-altitude pulmonary edema.

High-Altitude Cerebral Edema

High-altitude cerebral edema is rare but potentially serious, even fatal. The condition often follows acute mountain sickness, and many people think that the two are closely related and that high-altitude cerebral edema is the extreme end of the spectrum. It is defined as a condition in which the brain

swells and ceases to function properly. Like high-altitude pulmonary edema, the cause of high-altitude cerebral edema is poorly understood but is again likely related to changes in cellular permeability. Once high-altitude cerebral edema is present, it can progress rapidly and can be fatal within a few hours. Athletes with this illness are often confused and may not recognize that they are ill. The treatment for high-altitude cerebral edema is descent to a lower altitude as quickly as possible. Oxygen should be administered if available.Medications such as dexamethasone can be given by a physician to decrease the severity of the symptoms. Athletes with high-altitude cerebral edema sometimes recover rapidly after descent to a lower and safer altitude.

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