On June 25, a 59-year-old male from a guided expedition descended from 17,200-foot camp with high altitude pulmonary edema (HAPE). This climber had spent two nights at that elevation until his shortness of breath and wet lung sounds became overwhelming. After a night of treatment and monitoring at 14,200-foot camp, the patient was able to self-evacuate with his team on June 26. This case highlights the benefits of immediate descent for patients exhibiting signs and symptoms of severe altitude illness—the benefits of descending often outweigh medical treatments.

Conversely, on May 22, a 40-year-old male who began experiencing signs and symptoms of severe altitude illness still continued his ascent to 14,200-foot camp. The patient reported to teammates that he was experiencing shortness of breath at rest, a productive cough, and a severe headache. Once at 14,200-foot camp, the climber continued to deteriorate throughout the night. Starting on May 23, NPS rangers treated him for both HAPE and high altitude cerebral edema (HACE) for the next 24 hours. When his condition failed to improve, he was evacuated via NPS helicopter on May 24.

ANALYSIS

Continuing to ascend while experiencing even mild acute mountain sickness (AMS) almost guarantees a worsening illness. AMS typically resolves by remaining at the current elevation until the climber is feeling better. Immediate descent is the recommended treatment for all patients suffering from any severe altitude illness. When a patient is experiencing severe altitude sickness, it may prove difficult to distinguish between HAPE and HACE, and the two illnesses can be occurring simultaneously. In these cases, it is prudent to treat for both ailments throughout the course of care or until one of the ailments resolves. (See “Essentials: High Altitude Illness” in ANAC 2016.) Above all other treatment options, immediate descent should be the priority for these patients. (Source: Denali Mountaineering Rangers.)