0071643192.pdf

ENVIRONMENTAL EMERGENCIES

SYMPTOMS/EXAM

■ AMS symptoms (common)

■ Cough (dry or productive)

■ Dyspnea at rest

■ Tachypnea and tachycardia

■ Rales

■ Fever

DIAGNOSIS

■ Primarily clinical, but can be confirmed with CXR showing bilateral patchy

infiltrates and normalheart size (see Figure 13.6)

TREATMENT

■ Bed rest

■ Mild to moderate cases may recover with bed rest ±O 2 at altitude.

■ Supplemental O 2

■ Descent(1500–3000 ft)

■ Hyperbaric O 2 therapy

■ If no descent or O 2 available: Nifedepine SL

■ Morphine and furosemide are controversial regarding benefit vs harm.

High-Altitude Cerebral Edema

HACE is the most severe form of high-altitude illness. As with HAPE, onset is

typically 2–4 days after arrival to altitude >12,000 ft.

FIGURE 13.6. CXR of patient with high-altitude pulmonary edema.

(Courtesy of Peter Hackett, MD as reproduced, with permission, from Knoop KJ, Stack LB,

Storrow AB.Atlas of Emergency Medicine, 2nd ed. New York: McGraw-Hill, 2002:515.)

HAPE is the most life

threatening of high-altitude

syndromes.

Dexamethasone can help

treat HACE or AMS but has no

effect for the treatment of

HAPE.