Altitude follies on the ground

[mycrofft]

Tough Mudder last weekend reminded me of the reaction of sea-level flatlanders to sudden climbs coupled with beer (in moderation), and extreme exercise. This was evidenced by choices in clothing (haven't seen so much Spandex* since the circus came to town!), hydration, physical challenges, reactions to pain, healing, diet, risk-taking, etc.

Any reflections of your own about medical emergencies and practice at altitudes (say, 5,000 ft or more)?

*One young female did and end-run on the sports bra and skintight spandex shorts crowd with a tasteful (??) ensemble of yellow three inch construction boundary tape and duct tape.

 

[mycrofft]

Here's a clinical resource

http://www.high-altitude-medicine.com/AMS-medical.html

I was looking for something more anecdotal/behavioral.

The book "Icebound" by Dr. Jerri Nielsen is not a medical reference but includes some medical and behavioral aspects of the South Pole which is at 10,000 feet...and dark for more than half the year...and very COLD.

 

[Jambi]

I did my internship in a mountain community at just under 6,000 feet.

My observations:

People with kidney and pulmonary diseases do not do well - lots of exacerbation

Residents did better than visitors did with such conditions - obviously

Encountered lots of SOB. Was more pronounced in those less fit.

about 80% of the time (anecdotal) it seemed that patients with Dyspnea would resolve after approximately 5 minutes being off the mountain.

Of course incidents occurred most in the Geriatric population followed by the standard adult population, and never in the pediatric population. (all my pedi calls were injury related). This was also highly affected by fitness/health level.

 

[mycrofft]

Expected O2 saturations at altitudes

From the url I listed above:

 

[mycrofft]

Jambi

I noticed slow wound healing, lowered inhibitions and alcohol resistance, and fast/dire sunburns, as well as what you mentioned. Altitude stoopids contributed to many accidents and near-drowings.

 

[Tigger]

One athlete that I work with has thalassemia and exercise induced asthma. We are at just over over 6000 feet. The asthma and occasional bronchospasms are bad enough, but when this is combined with thalassemia we have a more significant problem.

 

[mycrofft]

disregard

...............

 

[Jambi]

I noticed slow wound healing

,
Now that you mention it. I hung out the the NP at the clinic on the hill during down times and she taught me a little about wound care, and there were a few patients that had this issue...

and fast/dire sunburns

There were a lot of Pacific Crest Trail hikers that had this occur.


Also, I had no idea that the south pole was at 10,000 feet. wow. :blink:

 

[mycrofft]

South Pole: half that elevation is ICE, especially since the weight of the ice depresses the actual continent below.

Any participants writing/working from say Telluride, Colorado Springs, Lake Tahoe, etc?

 

[Tigger]

South Pole: half that elevation is ICE, especially since the weight of the ice depresses the actual continent below.

Any participants writing/working from say Telluride, Colorado Springs, Lake Tahoe, etc?

Eight months of the year.

 

[mycrofft]

AND, any altitude affects?

 

[Tigger]

AND, any altitude affects?

The above athlete is a daily concern of mine at work. He has come close passing out multiple times. I have other athletes (mostly freshman from sea level) that will come in and say "my heart is racing" and sure enough it is and it will not calm down along with an elevated BP. At that point it's off to campus health.

Once a year we have a cross country running meet with around 300 total runners. Most of the teams come from sea level and only have one day if any to adjust to altitude. We are usually quite busy at that race, many runners pass out the finish line, finding that they are just more exhausted than usual. Asthma can be exacerbated by the dry air and many state that they have an inhaler but haven't used in years until traveling to altitude. For most of these patients we carry them to shade, get vitals (BP, HR, Pulse Ox, lung sounds), get them water, an inhaler if needed, or if they will not respond to an inhaler, a neb. They are then released to their coaches.

Two years we had an athlete pass out after finishing who was found unresponsive. We roused him but he was quite out of it and vomiting so an ALS unit was called for. A verbal altercation (away from the patient) then with myself and a paramedic who was insistent that the patient was refusing transport. He was from Kenya, spoke little English, was vomiting and unable to sit upright, and could only answer "yes" to any and all questions. One coach also thought that he was diagnosed with sickle cell anemia though that could not be confirmed. After convincing the medic crew to take him my coworker and I are were forced to carry the patient to the ambulance since they wouldn't drive the truck down. We had to lift him into the truck too since they wouldn't pull the stretcher. That last bit is unrelated to altitude, but that race was two weeks ago and brings back sour memories. It was fairly uneventful this year, though the temperature was far cooler.

 

[mycrofft]

Dang. Good on you for not accepting "yes" at face value.
Remembered exchange:
"Hey, you all right?"
"Yes."
"Okay, where do you live?"
"Yes"

Turned out to be CVA on the sidewalk. h34r:

 

[mycrofft]

I wonder if the higher number of circulating RBC's causes any particular issues, besides obvious blood cell count results?

 

[Tigger]

We have one athlete with sickle cell on campus, and procedure for such (02 must always be present). I attended a great conference on athletes with sickle cell last year, I wonder if I still have the notes. It was put on by the Air Force Academy's Sports Medicine director and a local doc.

The athlete with thalassemia had a sit down with our staff and a doc last year (it was his first year). The issue with that disorder is that the RBCs are always much smaller than average person's. So he already struggles to deliver oxygenated blood throughout his body, obviously being at 6000 feet this becomes more of an issue since anyone not acclimated is already experiencing this issue.

Combine this with asthma and we have big problem. He cannot deliver enough oxygen to the alveoli because of the bronchospasm, so now this lower carrying capacity is magnified and we start to have issues. His asthma attacks come on much much quicker than the others I've treated. Procedure is to have 02 and a neb setup present at all times.

 

[mycrofft]

That person needs a geographic altitude cure.

An issue I used to see in the San Bernardino mts (So Calif, altitudes from 5 to 7k ft) was retirees having to move back down the hill, usually associated with COPD or cardiac trouble, but also skin cancers.

That first couple days back at see level are like breathing a milkshake after the altitude and aridity/dust.

 

[Jambi]

That person needs a geographic altitude cure.

An issue I used to see in the San Bernardino mts (So Calif, altitudes from 5 to 7k ft) was retirees having to move back down the hill, usually associated with COPD or cardiac trouble, but also skin cancers.

That first couple days back at see level are like breathing a milkshake after the altitude and aridity/dust.

I had move conversation with a resident on the "hill" and her argument was that she used to live in Taos, NM which was higher. She had lived there years prior but didn't understand that such changes weren't permanent.

 

[Tigger]

I had move conversation with a resident on the "hill" and her argument was that she used to live in Taos, NM which was higher. She had lived there years prior but didn't understand that such changes weren't permanent.

Not permanent for sure thought I must say as a season resident of higher altitude, every year I return after a three month break I find the re-acclimatization time to be much quicker.

Other altitude follies include being a student at elevation with a student body with the overwhelming majority of the student body being from sea level. When the freshman first come and start drinking and going to parties bad things happen. Your tolerance level can be decreased by as many as five or six drinks, which leads to many EMS responses to campus and a lot of fighting in the first few weeks.

 

[mycrofft]

I saw people blitzed on one beer, plus exercise and too much sun.

 

[Tigger]

I saw people blitzed on one beer, plus exercise and too much sun.

We have a wet campus and the college does what I consider to be a great job of promoting safe habits of alcohol but man do I wish that freshman were given a warning about the altitude's effects. The first week was quite an eye opener (read: closer) and it wasn't till I met someone from Colorado that I figured out what was going on. Now we're all a bit more careful in the early days of being home.

It's the same with athletes coming up from sea level, they are never told how the altitude will affect them beyond "you'll be out of breath quicker" so those with respiratory ailments are completely shocked and unprepared for what happens.