Altitude Sickness Webinar – Causes, Prevention, Symptoms and Treatment


Hi everyone. My name is John
Pedraza, and I want to welcome you to the Hartford
Ski Spectacular this year sponsored by
Disabled Sports USA. This is going to be an altitude
sickness webinar that we’re putting on just to
help people show up to the Ski Spec this
year prepared and ready to just have an amazing
week and an awesome time and hopefully nobody
with any sickness issues. Just to introduce myself,
my name is John Pedraza. I’m an intensive care physician
and a commander in the US Navy. I am also a fellow of the
Academy of Wilderness Medicine. And I have a diploma in
International Mountain Medicine. And I’ve done a whole host of
outdoor adventure activities and mountain climbing and lots
of high altitude experience, including climbing
Denali in Alaska and Aconcagua
cargo in Argentina. So I certainly know the
effects of altitude sickness and how lousy it
can make you feel. And so hopefully, we’re going
to prevent that from all of our participants this year. And that’s why we
put this webinar on. So what we’re going to do
in the next few minutes, we’re going to talk a little
bit about the causes of altitude sickness. And we’re going to talk
about some ways that you can hopefully prevent it. And then we’re going
to talk about how to find out if you think
you might have AMS, or Acute Mountain Sickness. That’s the clinical
term for this diagnosis. And then we’ll talk about
some basic treatment strategies for it if you end
up having some issues with it. And just as a
historical note, I’ve been a physician volunteer
for DS USA and Ski Spec for nine years now. And unfortunately,
every year we have people that show up to the
medical tent not really prepared to handle the
altitude that they’re going to be exposed to. And they get sick. And they don’t always show
up for treatment right away. And they didn’t really know
much about altitude sickness. And then we end up with a
pretty significant group of people that end up
not having a great time. And we really, really
want to prevent that, because we want absolutely
everybody 100% of everyone that shows up to just
have a spectacular time. So anyway, let’s talk a
little bit about altitude and where we’re going on
this Ski Spec adventure and what kind of altitudes
we’re going to be exposed to. So most of the
participants– not everybody, but most of the
participants for Ski Spec– they come from sea level. And you’re used to
living at sea level, and you’re used to boiling
water at a certain temperature. It takes a certain
amount of time. And you’re used to breathing
a certain amount of oxygen. And just life is normal
and great for you. Well, for Ski Spec, you’re
going to probably end up on an airplane and you’re
going to fly into Denver. And as soon as
you get to Denver, you’re going to
be at 5,000 feet. The Denver Broncos, they call
the NFL stadium their Mile High Stadium. You’re essentially a
mile high from sea level. And already you’re
going to start to feel some effects from the altitude. You might notice that you’re
breathing a little bit heavier than normal, especially if you
go up and down stairs and stuff like that. But really 5,000 feet is
not that big of a deal. But once we get to
Denver, we’re then going to board a bunch
of buses and we’re going to take a
bus ride and we’re going to go to Breckenridge. When we get to Breckenridge
and we check in at Beaver Run
Resort, you’re going to be assigned some
sleeping quarters there. And you’re going to be
automatically sleeping in an environment
of around 9,700, or for all intents and PURPOSES
we’ll call it 10,000 feet, or almost two miles
high at that point. And you’re definitely going to
notice some effects if you just came that day from sea level. And then you’re going to get out
on the mountain during the week and you’re going to be riding
or boarding or monoskiing, whatever you’re doing to
enjoy the week and have fun, take your lessons and stuff. And some of you may end up going
to some of the highest peaks. And you can take
chairs and lifts on Brec all the way as
high as 13,000 feet. And in the local area, there are
peaks as high as 14,000 feet. And that’s a significant
amount of altitude, especially if you just came
the same day from sea level. So let’s talk a little bit about
what causes altitude sickness. So one of the most important
things for our body to function normally is oxygen.
And we all breathe oxygen. Normally it’s necessary for
all the different mechanisms in our body to work normally,
our muscles, our cells, our tissues everything. And what actually allows us
to breathe oxygen normally is air pressure. Air pressure is what
actually drives the oxygen into our lungs when we take
a breath in and then puts that oxygen into
our bloodstream. And when we live
at sea level, we’re breathing 21% oxygen under a
certain amount of pressure, OK. We call the barometric
pressure, and at sea level, it’s 14.7 PSA. Think about that similarly
like the pressure that you might put into
your tire on your car when you’re inflating
the tires on the car. So that’s kind of the
driving pressure that pushes the oxygen into
our lungs and allows us to breathe normally and
feel normal at sea level. When we go into the mountains,
the actual density of air decreases, or for all intents
and purposes, it gets thinner. And when the air gets thinner,
the barometric pressure goes down. Well, that means there’s
less driving force to push that oxygen
into the lungs. And so in a sense this creates
a lower effective oxygen concentration. The actual air, if you measure
the air, it’s still 21% oxygen. But because we’re breathing it
at a lower barometric pressure, we’re essentially in a
relatively hypoxic environment. So you might start,
as I mentioned before, noticing some of these symptoms
when you arrive in Denver around 5,000 feet. But most people
don’t really become susceptible to AMS until
they’re above 8,000 feet. And definitely by the time
you’re in the 10 to 12 range, you’re definitely
susceptible, depending on a number of features. So I made a little
chart here to show you on our trip this year what
you’re going to be exposed to. So again, as I
mentioned, sea level– you’re at 14.7 PSI. Again, think about that like
the pressure in the tires and you’re breathing
21% oxygen. Well, as you arrive in
Denver at 5,000 feet, the pressure is already
down to 12.2 PSI. So effectively, you’re really
only breathing about 17% oxygen. By the time you
arrive at Beaver Run, you’re at a pressure of 10.2. You’re breathing effectively
around 14% oxygen. And if you go up
to the highest peak during the week at
13,000 feet, you’re at a pressure of about 9 PSI. You’re breathing effectively
around 13% oxygen. And how does this all relate? Well, you hear
stories about people that climb Everest every year. Everest has an effective oxygen
concentration of around 7%– so only a third of the
normal amount of oxygen that your body’s used
to seeing all the time. So what are some of the risk
factors for altitude sickness? Well, one is rapid ascent. If you ascend above that
8,000 foot threshold that I talked about rapidly,
like more than 1,000 or 2,000 feet a day, that’s
definitely a significant risk factor for altitude sickness. And then the maximum
elevation achieved also has a significant role. So if you want to guarantee that
you get AMS, go from sea level all the way to the
highest peak at Brec at 13,000 feet right on the
same day and then ski down. And that’s pretty much a
guaranteed way to do AMS. So we don’t want to do that. We want to avoid
that completely. Now out of all the risk factors,
the biggest risk factor for AMS is a previous history of AMS. If you’ve been diagnosed with
AMS before or altitude sickness before, you are statistically
significantly more likely to have AMS again. And every year when I see
patients in the medical tent, they come in, and
I’ve had people that have been at altitude 15,
16 times, never had any issues. And then one year they show up
and they have a little issue and we work our way through it. But patients that come to me
two or three years in a row with AMS– I know– I tell them,
hey, you’re at high risk. We got to take some
necessary steps to prevent this next time. Other risk factors
that I put out here– if you live at a low
altitude, which is most of us, less than less than
3,000 feet or sea level, landlubbers, as they say. You’re definitely at risk
when you go to high altitude and then if you show up and you
get engaged in heavy exertion right away or if you show up and
you have a poor fitness level or you already are a
little bit dehydrated. Obesity does increase risk as
well, in addition to illness. And alcohol through a
variety of mechanisms, by the way it contributes
to dehydration and breathing pattern, can also lead
to altitude sickness. So those are our risk factors. Those are the
things that we want to try to mitigate
as best as possible. So how do we prevent it? Well, first and foremost, show
up to Ski Spec physically fit. Make sure that you’ve
been exercising and you’re capable
and ready to have a vigorous week of exercise
so that you can have fun. The more fit you
are, the more fun you’re going to have and the
more enjoyment for the week. And that’s what we really want. We want everybody to just
have an amazing time. The next way to really
prevent altitude sickness, as I mentioned before, is
take your time getting there. So I know a lot of us,
just because of the way the week’s scheduled and the
travel plans are made in such– a lot of us are going to go
from sea level right to Brec on one day. But if you have the
time in your schedule and you have the flexibility,
consider spending one or two night in Denver
first at 5,000 feet and let your body start
to acclimate a little bit before you head on over to Brec. Another really
important feature– the first day that you arrive,
definitely take it easy that first day. You’re going to feel the
effects of the altitude. You’re going to be
breathing heavy. I remember, every
year when I go, as soon as you climb that first
flight of stairs, you realize, oh, yeah, that’s right. We’re at altitude, because
you’re out of breath a lot faster than normal when
you’re climbing stairs back at sea level. So that first day,
just take it easy. Don’t go out on the
mountain that first day. Settle into your rooms. Drink plenty of fluids. Stay hydrated. And just take it
easy that first day, that first night
before you get out on the mountain the second day. Definitely don’t go hitting
the high peaks right away. I would suggest,
unless you’re already living at altitude or
maybe even in Denver or some of the
other higher areas where people are traveling
from, those people probably would be fine going out and
hitting the high peaks right away at the beginning
of the week. But for all the
sea level dwellers, definitely wait a couple
days– two, three days into the week–
before you try to go hitting those really high
peaks because you will notice the altitude effects. And absolutely, stay hydrated. Make sure you’re
drinking plenty of water. At least once a day, your
urine should be clear. And that means you’re
adequately hydrated, and that will definitely help
with the effects of altitude. And then certainly avoid
alcohol as much as possible, because that will
lead to dehydration. It will lead to hangover. It will lead to headache. And it will just exacerbate
all the other effects that altitude has on your body. And then, last but
not least– and I hope this doesn’t
happen to anyone that’s coming to Ski Spec
this year– but if you happen to get sick with a
serious illness, especially the flu right before a
Ski Spec, don’t come. And I hate to say that because
I want everybody to come and I want everybody to
have an amazing trip. But unfortunately, every
year people show up and they’re like, oh, yeah,
two days before I started to get fevers and sweats
and chills and runny nose and blah, blah, blah. And then they show
up at altitude, and it is significantly worse. And then at that point, they
get diagnosed with the flu, and then they end up
having to get sent home because you can’t recover as
easily at altitude when you’re used to living at sea level. So try your best to stay
as healthy as you can and not get sick before the
trip, as easy as that sounds. So those of you that have a
prior history– so maybe you’ve come to Ski Spec in
years past or you’ve done some mountain climbing
or maybe some camping out in the wilderness at altitude
or something like that and you have been
diagnosed with AMS or you recognize that
you probably did have it, you’re at the highest risk. So what do we need
to do for you? We still want you
to come to Ski Spec. We want you to
have a great time. But we want you to take the
necessary steps to make sure that you enjoy yourself
right from day one and you don’t succumb
to AMS and don’t have your entire week ruined. So if you have a higher
previous history, you’re at the highest risk. So it’s very likely
you will get AMS again when you get to Breckenridge. So what do you need to do? You need to acclimatize. You need to go to
Denver a day or two before, hang out in
Denver, sleep in Denver. Get your body readjusted
to the altitude before showing up
at Brec, and that will go a long way towards
helping your body adjust to that altitude. And another thing that you
should definitely consider– and I strongly recommend– is go
talk to your personal physician and consider getting a
prescription for oxygen. There are several vendors in the
local Breckenridge area that provide oxygen concentrators. And they will get you
set up with some oxygen. So you don’t have to necessarily
bring it with you from home. But you can get a
prescription ahead of time, get set up with one
of those vendors so you can get some oxygen.
So at the very least, you can be using oxygen
when you arrive at altitude or be sleeping on
oxygen at night. And that will go a long
way towards helping you with those symptoms of AMS. And then another
consideration– again, talk to your personal
physician about this– but a prophylactic
prescription for Diamox. That’s a medication
that helps prevent AMS. You’d want to start
taking that about 24 hours before coming to altitude. The dose is 125 milligrams. It’s taken by mouth twice a day. It does have some
mild side effects. It can make your
lips feel tingly and your fingertips feel tingly. And it can change the way some
of the foods taste, especially sodas. But it’s otherwise,
generally well tolerated. And it is a very good
way to help prevent AMS. And we use that in the
military all the time when we have soldiers that have
to go to altitude rapidly and they don’t have the way
to acclimatize normally. And it can go a long way
towards making your trip a lot more comfortable. But again, talk to your personal
physician about the risks and the benefits
of that before you decide to go down that route. All right, so let’s move on. So how do you know if
you have AMS or not? Well, first and foremost,
to make the diagnosis you have to have a headache. So it’s a headache plus
a bunch of other stuff. And doctors, we use this thing
called the Lake Louise Score. And it’s a scoring system. Basically, we ask you all
the different symptoms that you’re having. And then we score you on
this little score sheet. If you score above
a certain number, then you’re most
likely to have AMS. So how do we make the diagnosis? It’s you came to altitude. You developed a headache. And then you got a
bunch of other stuff. And those things can be things
like unexplained tiredness. Now if you just
climbed a mountain, you’re going to be tired. But if you just drove
on a bus and an airplane and you didn’t
actually do anything but you’re just
completely exhausted and you have no energy
whatsoever plus that headache, then you probably have AMS– unexplained weakness,
same kind of thing. Certainly any
nausea or vomiting, loss of appetite, loss
of interest, just general apathy– like, you don’t want
to hang out with your friends. You don’t want to
talk to anybody, just want to be left alone. You’ve got this terrible
headache and your nausea. Probably got AMS–
lightheaded, dizzy. And then certainly can’t sleep. And that’s very
common, unability to sleep with a headache. So any of those symptoms
plus that headache, you probably have AMS. And at that point, you should
come to the medical tent and get evaluated. The sooner you get
treatment, the sooner you get feeling
better, the more time you have to enjoy the rest
of the week as Ski Spec. Keep in mind that
these symptoms, they can go on for like
three or more days. So if you wait to go talk to
anybody about what’s going on until day two or day three– you’ve already been feeling
miserable for two or three days and then we start
treatment– it’s going to take another day or
two for you to start feeling better. By then, the week’s over
and you just lost out on a great opportunity. So don’t wait. Get on it right away. And just know that, the
symptoms of AMS at Brec, when we’re only around
roughly 10,000 feet, they’re not that bad. But AMS can become very serious,
and it can lead to very life threatening conditions. There’s high altitude
cerebral edema, high altitude pulmonary edema. We usually don’t
see those things at the elevation of Brec. But they can develop,
especially if you have some pre-existing conditions. So definitely be aware of
that and definitely seek out treatment early if you think
that you’re starting to have some signs of those things. How do we treat it? How do we make you feel better? Well, first and foremost, rest. So if you’ve got a
headache and you’re nauseous, the very
first thing we’re going to tell you is, hey,
you need to stop take it easy. And every year this happens
where somebody– they’re really excited to come to Ski Spec. So they get hooked up
with an instructor. They go out on the hill
for the first afternoon. And then by that
first afternoon, they have a headache. Usually the symptoms
of AMS, they can start as early
as three hours at arrival of the altitude. But the average person usually
starts anywhere between six and 12 hours after arrival. So if you don’t show up
till the evening before– and you’re just
resting and you’re sleeping– you may
not really start to get the symptoms
until you’ve started some physical exertion, which
is after that first lesson in the morning. So we’re going to tell you right
away, hey, you need to rest. You need to knock off. Don’t do an afternoon lesson. Go back to your room. Chill out, relax. Drink some water,
that kind of stuff. Don’t go back out on the
hill, because that’s is going to make it even worse. And unfortunately, every
year we have a couple of people that try to
sneak out there and do that despite medical advice. And then we really
can’t help you because you’re not really
following the recommendations for treatment to get better. Motrin– Motrin’s a huge benefit
with this disease process because, again, everybody
presents with headache. So I recommend,
actually, everybody that comes to Ski Spec,
regardless of your risk factors or history, you bring an
adequate supply of Tylenol or Motrin just for your
general aches and pains and if you end up
having a headache, because you can self
treat with that. And that’s great. But if you end up with
AMS, one of the treatments is going to be Motrin. We’ll usually use 600
or 800 milligrams. You’re going to take
it three times a day around the clock initially
for the first 24 hours, along with some rest
and some hydration. And then we’ll re-evaluate
how things are going. For those of you that are
more seriously affected, you may end up requiring
oxygen. And we usually have oxygen
concentrators available. And we’ll get you started on
some oxygen therapy initially. Usually, everyone
ends up with it– those of you that require
oxygen, like your symptoms are severe enough to require
that, you’re probably going to be on it for the
rest of that day and the night before you get re-evaluated to
see if you need to come off. So that’s one consideration. And then, again, as I
mentioned, Diamox also called Acetazolamide– we use that for
prevention of AMS. But it’s also used in the
treatment at a higher dose. So that’s another consideration. And then lastly– and we
hope to never do this– but every year we
do end up having to do this for those
with severe symptoms, is we end up having
to send you back to a lower altitude, sometimes
just to Denver and other times all the way back
home at sea level to get the symptoms to go away. So we really want
to prevent that. We really don’t want to
see that happen to anybody. We want everyone that
shows up, has a great time. But that’s a little bit of
information about AMS, about the treatment, and whatnot. So to conclude,
DSUSA staff, they put a tremendous amount of
work into this event every year and they want everybody
to show up and just have an amazing time. And the reason why we’re
putting on this well webinar is just an awareness. Really, we want everyone
to know, hey, altitude, it can make you sick and it
can really ruin your trip. And you need to be aware of
it in order to prevent it. So we talk about some
prevention strategies. And if you start planning now,
you’ve got a couple weeks to go and you can really, really head
things off and show up and just have an amazing week. Unfortunately, if you
do show up and you start having altitude
sickness, it’s a bummer. But come seek
treatment right away. Come see me or one of the
other docs or medical providers at the medical tent. And we will get
you squared away. We’ll get you on a
good treatment plan. We’ll get you feeling
better so that at least we can try to salvage some time and
you can still enjoy yourself. So, I’m Dr. John Pedraza just
finishing up altitude sickness webinar for the Hartford Ski
Spectacular and Disabled Sports USA. And thank you all
for listening in. And I can’t wait to meet
you at Ski Spec this year. And I’m hoping everyone
has an awesome time. Bye for now.