High-altitude pulmonary edema is the leakage of blood into the lungs, which restricts the air sacs (alveoli) in exchanging oxygen and carbon dioxide in the blood. Pulmonary edema rarely occurs in healthy people below 9,000 feet. The average elevation at which it strikes in the United States is 12,000 feet, and the level of onset varies for mountain ranges in other parts of the world.
Early symptoms of pulmonary edema are similar to those of pneumonia, although it is not precipitated by an infection and there is no fever. Within 12 to 36 hours after reaching high altitude, the victim of pulmonary edema experiences extreme weakness, shortness of breath, nausea, vomiting, very rapid pulse (120 to 160), cyanosis (bluish color) of the fingernails, face and lips, noisy breathing which progresses to moist crackling breath sounds, and irritative coughing which produces a frothy white or pink sputum and later blood.
If untreated, the victim rapidly moves into the final phase characterized by unconsciousness and bubbles in the mouth or nose, and death will follow. The early symptoms may be mistaken for mountain sickness or fatigue, or may pass unnoticed during the night, with the moming finding the victim unconscious and in the final phase.
High-altitude cerebral edema is the accumulation of fluid in the brain. Symptoms begin with a severe, relentless headache resulting from pressure due to the swelling of brain tissue. They advance to difficulties with physical coordination, slurred speech, irrational behavior, collapse, and eventually death.
For both pulmonary and cerebral edema, you need to be alert to symptoms in yourself and others. The most effective first aid is rapid evacuation to lower altitude or constant administration of oxygen. Descending is the only way to recover, with a rapid descent of 3,000 feet usually bringing marked improvement. If the victim exhibits only minor symptoms, it may be OK to spend a few days at lower elevations and then go back up. But a climber who demonstrates advanced signs should not return to high altitude, as it takes weeks to recover from edemas.
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