NOLS: National Outdoor Leadership School Home
The Leader

Wild Side of Medicine:
What Happens When You Go Higher

By Buck Tilton
Reprinted from The Leader, Fall 2001, Vol. 17, No. 1

Camped at the base of Gannett Peak, tomorrow's ascent into the clouds taking up most of your thoughts, you're brought back to earth by a student with a complaint. No, it's not your cooking that's bothering him, it's his head and his stomach. His head hurts, his stomach doesn't want to hold down food, and, on questioning, he reveals he hasn't been sleeping well and, in fact, he really thinks this whole NOLS thing sucks. Obviously he is unwell but nothing about his physical appearance alarms you. His heart rate and respiratory rate are elevated, but not to the point where the numbers are a big surprise. You are, after all, sitting well above sea level.

Well above sea level! Aha! You test the student for ataxia and he fails the test. Time for descent of at least one thousand feet. On full recovery, you may consider a return to the heights. Without a full recovery, you'll want to keep descending.

When you go higher in altitude, the amount of oxygen available in each breath grows lower. If you go too high too fast, unhealthy physiological responses may occur. Right out of the starting blocks, altitude illness should be on the list of possible explanations for your student's problems. For simplicity, these problems can be divided into two categories: mild and severe.

Anyone coming from lower altitudes to 8,000 ft. or more may complain of headache, unusual fatigue, nausea, loss of appetite, difficulty sleeping, unusual shortness of breath when exercising, and lassitude - all symptoms of mild altitude illness. The best treatment is: Do not go up until the symptoms go down. Exercise lightly and drink plenty of water.

Maintain a diet high in carbohydrates. Acetazolamide may be used for treatment after symptoms appear. Do not use acetazolamide if the patient is allergic to sulfa drugs. If the symptoms do not go down within two days, the patient should.

Untreated, mild illness may progress to severe. The most important early sign of this progression is ataxia (loss of coordination). An ataxic patient cannot walk a straight line or stand straight up with feet together, hands pressed into the thighs, and eyes closed. Severe altitude illness may show up as High Altitude Pulmonary Edema (HAPE): constant shortness of breath, chest pain, productive cough, and very fast heart rate. Or it may show up as High Altitude Cerebral Edema (HACE): severe headache unrelieved by rest and medication, bizarre changes in personality, perhaps coma. Or it may show up as some of both. The patient needs to go down as soon as possible. In addition to descent, the best treatment is supplemental oxygen. Treatment may also include 1) the drug nifedipine (sold often as Procardia®) for HAPE. 2) The drug dexamethasone (sold often as Decadron®) for HACE. If descent is delayed, use of the Gamow Bag®, a portable hyperbaric chamber that simulates descent, may save the patient's life. Do not use a Gamow Bag® instead of descent. If your assessment is HAPE or HACE, the patient needs evacuation from the field for a physician's assessment.

For more information on wilderness medical training, check out



NOLS Top of Page
NOLS Home About Us Courses Wilderness Medicine Institute NOLS Professional Training Alumni Store Donate Account NOLS Home Parents Press Room School Resources Photos NOLS.TV Events WRMC The NOLS Blog Introduction About Leadership History Mission & Values Profiles Partnerships Frequent Questions Find a Course Skills School Locations School Locations Leave No Trace Financial Aid Academic Credit Find a Course Skills School Locations Course Types Leave No Trace Financial Aid Academic Credit NOLS Pro Home 1-3 Day Courses 7-30 Day Courses Risk Management Staff Clients Design Your Course Contact NOLS Pro NOLS Pro 1-3 Days 7-30 Days Risk Management Clients Contact Us NOLS Pro Design Your Course NOLS Pro Staff Overview Outcome-based Curriculum Faculty Overview Outcome-based Curriculum Faculty Case Studies Overview Administrative Training Staff Training Consulting Conference: WRMC How to Apply Apply Online Download an Application Admission Policies WMI Home About WMI Courses Schedule FAQ Photos & Movies Curriculum Updates Employment Sponsors WMI Home About WMI Admissions Courses Schedule Host a Course Resources Gallery Alumni Home Trips and Events The Leader Alumni Chapters Employment Staying in Touch Volunteer Photos & Videos Home NOLS Photos NOLS.TV The NOLS Podcast NOLS on Flickr Leave No Trace Overview Leave No Trace Principles Leave No Trace Master Educator Courses Host a Course Contact Map of Events Dream Expedition Leadership Week Press Room Images for the Press Archives