0071643192.pdf

ENVIRONMENTAL EMERGENCIES

SYMPTOMS/EXAM

■ AMS symptoms (severe headache, nausea/vomiting)
■ HAPE symptoms may also be present.
■ Cerebellar ataxia: Most sensitive sign
■ MS changes: Stupor to coma
■ Seizures
■ Retinal hemorrhages are common, but may occur without HACE.
■ 3rd/6th cranial nerve palsies (rare)

DIAGNOSIS

■ Clinical diagnosis
■ MRI, if diagnosis in question

TREATMENT

■ Supplemental O 2
■ Dexamethasone
■ Immediate descent or evacuation
■ Hyperbaric therapy
■ Furosemide or mannitol may be used with caution (downside = volume
depletion) [see Table 13.11].

Acetazolamide is

contraindicated in sulfa

allergic patients.

Monge disease (chronic

mountain polycythemia) is a

late effect of high altitude

characterized by headache,

trouble sleeping, and mental

sluggishness.

TABLE 13.11. Medications Used For Treatment of High-Altitude Illness

MEDICATION MECHANISM OFACTION INDICATION

Acetazolamide Carbonic anhydrase inhibitor →bicarbonate AMS prophylaxis

diuresis and metabolic acidosis →compensatory AMS treatment

hyperventilation Disturbing periodic breathing

Dexamethasone ↓vasogenic edema Moderate to severe AMS

↓intracranial pressure HACE

Antiemetic

Tylenol Symptomatic treatment AMS

Aspirin

Antiemetics

O 2 (to SaO 2 > 90%) Improves hypoxemia Moderate to severe AMS.

HAPE

HACE

Hyperbaric O 2 Improves hypoxemia Severe AMS

HAPE

HACE

Nifedipine Decreases pulmonary artery pressure HAPE (when O 2 and descent is not

possible)