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HWN Suggests

EM@3AM – Altitude Sickness

AMS: Acetazolamide (250 mg PO q 12h). Dexamethasone (4 mg PO/IV q 6h) is second-line and may lead to rebound AMS when discontinued.

HAPE: Immediate descent; Gamow Bag and supplemental oxygen if present. Nifedipine (10 mg PO x1, then 20 mg ER PO q 8-12h).

HACE: Immediate descent; Gamow Bag and supplemental oxygen if present. Dexamethasone (8 mg IV x1, then 4 mg IV q 6hr) – continue until descent completed and symptoms resolved.

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 Altitude Illness

From the ski clinic, we often send patients home with portable oxygen tanks mainly to use while they are sleeping, since poor sleep often makes symptoms worse. We treat most patients with both acetazolamide and dexamethasone and frequently recommend they come back to clinic the next day for reassessment. We often recommend that patients sleep at lower altitude and just come up for skiing if possible. For patients with evidence of pulmonary edema, they must descend and are sent to the ER for closer monitoring and treatment. The same would be true with any patient with evidence of altered mental status.

Articles of Interest

Learn what is Gamow bag and how to use it correctly in high-altitudes

Gamow Bag is the life-saving first aid device, most needed at these situations. It is very effective in emergency circumstances. The victim is not required to move physically and the person treating the victim also don’t need to give extreme effort, making it very easy and reliable to use.

Managing Altitude Sickness: Advice from an Expert

Altitude sickness and its more serious altitude-related illnesses, High Altitude Cerebral Edema (HACE) and High Altitude Pulmonary Edema (HAPE), are processes we may not see often, but when they appear we need to know what signs to look out for, how to manage treatment, and how to prevent the conditions from worsening.

Mountain Sickness

Most often presents the 1st night or 2nd night at higher elevations. The average duration of symptoms in cases that self resolve is one day (the body successfully acclimates). In mild mountain sickness, the patient can descend to a lower altitude (1000-3000 ft lower) or stop the ascent and acclimate for 12-36 hours. Acetazolamide (125-250 mg BID) can be used to speed up acclimation by increasing respiratory rate from the resultant metabolic acidosis. For patients who have moderate to severe mountain sickness, immediate descent 1000-3000 feet is indicated. Low flow oxygen, especially at night, can be helpful. Hyperbaric oxygen therapy can be considered. Lastly, besides acetazolamide, dexamethasone 4 mg q6 can be considered.

Podcast 623: Acute Mountain Sickness

Mild symptoms can be managed with rest but more severe symptoms will require descent, oxygen, acetazolamide and steroids. Acetazolamide can be used as both a preventative and therapeutic drug.

Resources

Core EM

Descent is the most important treatment for AMS, HACE, and HAPE

WikEM

Most patients are treated symptomatically and managed as outpatients.