In this conversation, Dennis and Ian Wedmore discuss the new high altitude Clinical Practice Guideline (CPG) in the Joint Trauma System. They cover topics such as acute mountain sickness (AMS), high altitude cerebral edema (HACE), and high altitude pulmonary edema (HAPE). They discuss the pathophysiology, symptoms, diagnosis, and treatment options for these conditions. They also touch on pre-treatment strategies and the use of portable hyperbaric chambers. Overall, the conversation provides a comprehensive overview of altitude-related illnesses and their management. In this conversation, Dennis and Ian discuss the treatment options for altitude illness, specifically AMS, HAPE, and HACE. They cover the use of pharmacologic therapy, oxygen, and portable hyperbaric chambers to stabilize and bring down patients with altitude illness. They also discuss the use of dexamethasone as the primary treatment for HACE and the potential use of hypertonic saline for extreme cases. They touch on the side effects of dexamethasone and the importance of protecting the airway. They also mention the use of acetazolamide for prophylaxis and the benefits of intermittent hypoxic exposure. Finally, they discuss the importance of good nutrition and hydration and the new medic encounter form for recording data on altitude illness.
Takeaways
- Acute mountain sickness (AMS) occurs when the body does not have enough time to acclimatize to the physiological stress of altitude.
- High altitude cerebral edema (HACE) is characterized by ataxia and can occur even without AMS symptoms.
- High altitude pulmonary edema (HAPE) is characterized by decreased exercise tolerance and tachypnea.
- Assessment of vital signs, such as heart rate and respiratory rate, can help differentiate between altitude illnesses.
- Portable hyperbaric chambers can be used to stabilize patients with altitude illnesses until they can be brought down to lower altitudes.
- Pharmacologic treatments, such as acetazolamide and dexamethasone, can be used for prophylaxis and treatment of altitude illnesses.
- Improvement in symptoms of HAPE can be rapid with oxygen therapy.
- Pre-treatment strategies, such as using acetazolamide, can help acclimatize the body to altitude before ascent. Pharmacologic therapy, oxygen, and portable hyperbaric chambers can be used to stabilize and bring down patients with altitude illness.
- Dexamethasone is the primary treatment for HACE, and hypertonic saline may be considered for extreme cases.
- Side effects of dexamethasone include increased sugar, gastric erosions, gastric bleeding, and adrenal suppression.
- Acetazolamide can be used for prophylaxis, and intermittent hypoxic exposure may help with acclimatization
- Good nutrition, hydration, and iron status are important for preventing altitude illness.
- The new medic encounter form is a valuable tool for recording data on altitude illness.
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