What should EMS do for a patient at high altitude with AMS who is unresponsive?

• A. Ignore symptoms and monitor for 24 hours.
• B. Transport immediately without oxygen.
• C. Descend if possible, administer oxygen, monitor mental status, alert receiving facility for potential descent and escalation of care.
• D. Provide medication to increase altitude exposure.

Answer: (C)

When a patient at high altitude presents with acute mountain sickness and is unresponsive, the priority is to reverse hypoxia and reduce altitude exposure while arranging for higher-level care. Descend to a lower elevation if feasible, because lower altitude improves ambient oxygen availability and reduces the risk of progression to life-threatening cerebral edema. Provide supplemental oxygen to improve arterial oxygenation and help reverse hypoxia, aiming to maintain adequate SpO2 and support brain function. Reassess the patient’s mental status continuously; a change in level of consciousness can signal worsening AMS or progression to high-altitude cerebral edema, requiring more urgent intervention. Communicate with the receiving facility early so they can anticipate the need for rapid descent and escalation of care, ensuring a smooth handoff and appropriate resources on arrival.

Avoid actions that don’t address the problem or could worsen it. Ignoring symptoms leaves hypoxia untreated and can lead to deterioration. Transporting without oxygen allows ongoing brain hypoxia. Giving medication intended to increase altitude exposure would worsen the condition. The combination of descending, providing oxygen, monitoring mental status, and coordinating with the receiving facility best addresses the emergency.