DISORDERS CAUSED BY ALTITUDE - Medicine for Mountaineering and Other Wilderness Activities - page 352

sessions,untiltheindividual isnolongershortofbreathandcanmaintain anoxygensatur-
ation that is appropriate for the altitude.
THE GOLDEN RULES OF ALTITUDE ILLNESS
Mountaineers who climb to high altitude experience AMS if their ascent rate exceeds
the ability of their body to acclimatize. Since AMS is usually self-limited, waiting
at altitude is a reasonable option, unless symptoms are severe. It is a mistake to
ascend higher with symptoms of AMS. The Himalayan Rescue Association has en-
couraged following the “Golden Rules of Altitude Illness.” Nobody who heeds these
rules should ever die from altitude illness.
Golden Rule 1: If you have symptoms at altitude, they are due to altitude illness
unless proven otherwise.
◆ The symptoms include headache plus any additional symptoms of AMS.
Golden Rule 2: If you have symptoms at altitude, do not ascend farther.
◆ Treating symptoms at altitude with medications such as acetaminophen, anti-
nausea formulations, and acetazolamide is certainly acceptable. If symptoms
resolve with these, ascending farther at a slower rate is reasonable.
Golden Rule 3: If the symptoms are severe or getting worse, descend.
◆ Anyone who has a decreased level of consciousness or cannot walk a straight
line, must descend immediately.
◆ Anyone with HACE or HAPE has a life-threatening condition, for which the
treatment is descent. Descent should be continued until symptoms are improv-
ing and the level of consciousness is normal. Difficulty walking does not usu-
ally improve right away with descent and often persists for several days.
Golden Rule 4: No one with altitude illness should descend alone.
◆ Individuals with AMS may still be worsening even with descent.
◆ PersonswithHACEneed,attheveryleast,supervisionandhelpwalking;most
need to be carried.
◆ Individuals with HAPE should avoid exertion, although if descent is easy
enough, persons with mild HAPE can sometimes walk down with assistance.
They should not carry a pack. If their condition worsens, they need to be car-
ried.
Studies have shown that nifedipine, which relaxes the pulmonary arterioles and reduces
pulmonary artery pressure, is an effective adjunct to descent and supplemental oxygen
for treating HAPE. Nifedipine should not be used alone to treat HAPE. It may lower the
systemic as well as the pulmonary artery blood pressure and cause faintness—even col-