Thin Air

The air up here is starting to get crisp.

Right now many a mind is turning to the gnar gnar pow pow that is dusting the high peaks. College fratboys are selling off their furniture for season passes, yuppies are buying new boots and bindings, and everyone is doing gymnastics with their work schedules to have a midweek day off. Besides the ice, rocks, trees, and fratboys, there is another danger lurking the slopes. This threat is so serious that it can kill you without you doing a thing.

Some people may think that the problem with the high altitude on the ski slope is lack of oxygen. While it is true that there is slightly less oxygen in Vail than there is in Denver, the amount of oxygen isn’t the problem. The problem, the silent killer, is air pressure.

Now for some basic medicine and biophysics. Hang on, this won’t hurt, it’s really quite simple. Air goes in and out, blood goes round and round. See, not that hard. In order for the blood to go round and round, the heart has to pump. Like any pump, it exerts pressure to move the blood through the pipes. When your doctor tells you to cut out the salt and take water pills, it’s because there’s too much pressure in the pipes. Overtime this pressure can get so high that it can make the pipes rupture. When the pipes blow you need a priest not a doctor.

This pumping action of the heart drives the blood into and out of the lungs. In the lungs, tiny little blood vessels filled with blood from the body pick up oxygen and get rid of carbon dioxide. This whole process is known as “breathing” and it’s really important. Remember that part about pressure? These little vessels are also under pumping pressure from the heart. As you ascend up a mountain, the ambient pressure becomes lower than the pressure in the blood vessels in your lungs. The blood vessels pop and that whole “breathing” thing quits working.

Ladies and gentlemen meet barotrauma. That’s an awesome word for injuries caused by air pressure (either too much or too little). The thing about the lung blood vessels popping is called HAPE (High Altitude Pulmonary Edema) and it can put a real damper on a fun outdoor adventure. Things to look out for are cough (may be with or without blood), severe exercise intolerance, rapid heartbeat, rapid breathing, chest pressure, or difficulty breathing. If you are experiencing any of these symptoms, stop going up, drink some water and catch your breath. Do the symptoms resolve after 15 minutes? If not, head down and seek medical attention.

HAPE is pretty spooky but his big brother will kill you quick. Can you think of an area in your body that is filled with as much blood as your lungs or your heart and would feel kinda bad if all the vessels started leaking and popping? High altitude cerebral edema is the same process of blood vessel popping but instead of your lungs it’s happening in your brain. Confusion, slurred speech, difficulty walking or using your hands, sudden vomiting, hallucinations, or changes in vision are all warning signs that something is going very bad. If you experience any of these symptoms go down as fast as you can. Got a radio? Call a chopper. HAPE can go from bad to dead in an hour.

Aside from going down quickly the only treatment for HAPE is using IV dexamethasone (a potent steroid) in conjunction with a Gamow bag. That’s an awesome portable hyperbaric chamber you can put a single person in and increase the ambient pressure. At around $25000 for Gamow bag, I’m not getting one unless I climb Denali. If the injury is acute enough it may be necessary to put you in an actual hyperbaric chamber with a provider and a crash cart to dive with you.

The baby sister of HACE and HAPE may not be as scary but it is much more common. Acute mountain sickness (AMS) happens to a lot of people visiting Denver from lower elevations. Headache, fatigue, hangover or flu-like symptoms are common complaints for recent arrivals from below. It may feel like a little cold that you can walk off but don’t get too crazy. AMS is often a precursor to HACE or HAPE and should not be ignored. If you have AMS don’t ascend yet. Wait a day or two in Denver and let your body adjust. The best way to deal with it is to drink water like it’s going out of style. Avoid alcohol, caffeine, and recreational drugs. That’s hard to do around here.

-Richard Hammack