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NOLS: High Altitude Tips – How to Stay Safe and Feel Good

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Alpine climbers descend the famous Arete Valle Blanche from the summit of Aiugille du Midi, above Chamonix, France. In the background is the summit of Grand Jorasses. Photograph by Kamil Tamiola, My Shot

Contributing writer Casey Dean helped with this post.

We have peaks on the brain here at NOLS, as one of our own returns from an expedition to the highest point in the world and our Expedition Denali team prepares for a summer of training on glaciers in Alaska, the Waddington, and the Wind River Range.

But with the exhilaration of our historic endeavor must come education on the risks of altitude, including how to prevent, recognize, and treat altitude illness is imperative when traveling in high-altitude environments. But some tips from wilderness medicine curriculum director Tod Schimelpfenig can help you climb wisely and safely.

Six factors can affect whether you suffer altitude illness and how severe it can be:

1. Rate of ascent. The faster you climb, the greater the risk, so ascend slowly.
2. Altitude gained (especially sleeping altitude). The higher you sleep, the greater the risk, so stick with the mantra, “Climb high, sleep low.”
3. Length of exposure. The longer you stay high, the greater the risk.
4. Level of exertion. Hard exertion, without rest or hydration, increases the risk, so rest and hydrate regularly.
5. Hydration and diet. High-fat and high-protein diets and dehydration may increase the risk. Stick to a high-carbohydrate diet.
6. Inherent physiological susceptibility. Some people are simply more likely to become ill, and we don’t know why.

There are three common types of altitude illness. Acute mountain sickness (AMS) is the most common, and left untreated can progress into high-altitude cerebral edema (HACE), which can be sudden and severe. Finally, high-altitude pulmonary edema (HAPE) is less common but more serious.

Signs and symptoms of AMS
• Headache
• Malaise
• Loss of appetite
• Nausea, vomiting
• Disturbed sleep

Treatment of AMS
• Hydration
• Rest (light exercise is OK)
• Pain medication for headaches
• Descend if symptoms worsen or signs of HAPE or HACE develop
• Avoid sedatives

Signs and symptoms of HAPE
• Signs of AMS
• Shortness of breath on exertion, progressing to shortness of breath at rest
• Fatigue
• Dry cough progressing to wet, productive cough
• Increased heart and respiratory rate
• Rales, sounds of fluid in the lungs
• Treatment of HAPE
• Descend at least 2,000 to 3,000 feet until symptoms abate
• Oxygen may be helpful

Signs and symptoms of HACE
• Signs of AMS
• Lack of muscle coordination
• Severe lassitude
• Headache
• Nausea and vomiting
• Neurological signs such as vision disturbances, paralysis, seizures, hallucinations
• Altered mental status

Treatment of HACE
• Descent
• Oxygen

Remember, the ultimate goal is not the summit; it’s the journey. The mountain will still be there next time, and the memories will always stick with you. Expedition Denali team member Dudley Edmondson put it best last weekend when he said, “It really isn’t about getting to the summit. It’s about what we do when we get back and tell our stories.”