High Altitude Medicine

This isn’t about altitude sickness, but that’d be much fancier i’m sure…

So, this is something I have very limited experience about, but I felt the need to post a very very short post on this concept as it was something I had never had to take into consideration until I did Locum Tenens. For a majority of my training, I was at or below sea level (eg: New Orleans). I’ve traveled across several states in the US but generally not experienced much altitude changes until I was recently in Santa Fe, NM. We would have the usual presentations of kids that got sick, but noted on almost EVERY single one of them that they would have significant Oxygen Desaturations to the mid-80s. Although having transient dips in oxygen movement around the body especially in the setting of pulmonary (lung) issues like asthma or infections isn’t uncommon, i was surprised to see it in almost every kid. On top of it, many of our newborns would have lower oxygen levels during their newborn course and I saw multiple cases of PPHN (Persistent Pulmonary Hypertension) where there’s a delay in the normal transition of the pulmonary vasculature to adapt to breathing oxygen instead of fluid. It was an entity I had only briefly interacted with in small situations in my training, but saw multiple cases over a small amount of time. I even spoke to a cardiologist when i saw a big discrepancy between oxygen saturations in arms and legs and her exact words, “Everyone. Every, single, one, gets PPHN. It’s fine. Put them on some oxygen and send them home.

It was fascinating for me! Of course throughout my training i’d always conceptually known that there is a difference in the amount of oxygen in the air at 7000 ft of elevation vs -1000 ft – i’m sure most people know about this. It’s not a secret that climbers need oxygen and that I feel like i’m going into cardiac arrest climbing stairs when i’m in the mountains… But, to see in practice such an actual difference was amazing to me.

It went on! It was super common for everyone to refer to supplemental oxygen in “ccs.” Fractions of liters, a concept that was a total language change for me. Often times we will put patients on oxygen that flows at a certain unit of liters per minute (LPM). If we’re less than 1 LPM, the common vernacular is to say 1/2 or 1/4… Never, “500 ccs” or “120ccs.” I think the smallest fraction of oxygen i sent any kiddo home on was 20 ccs of oxygen – basically, that’s about as much oxygen as you get from me blowing at your face from across the room. But miraculously we would put them on such a tiny amount and they would pop back up into the 90% range and would be stable enough to go home.

I discussed this with a Stanford (CA) trained Hospitalist that had been working in the area and the evidence we perused from other high altitude centers such as regions of India and Colorado, and it seemed fitting that the amount of Art involved in medicine at this juncture was baffling. While we wouldn’t often send kids home with oxygen readings of 88%, we suspected that it’s not uncommon for healthy people to have just lower numbers in this altitude and manifest more of a change when sick. It seemed so common sense, but was still so odd!

I’m not at all a pro in high altitude medicine; i spent about 2 weeks getting to know it, but it taught me a little more about physiology and opened my eyes a little bit more to how variations persist in geographic places all over the country. Definitely a neat learning experience as a Locum Tenens Provider.

Image Credit: https://uphillathlete.com/hypoxico-normobaric-altitude-tents-climbing-everest-altitude-8000/

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