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HAPE is often accompanied by HACE, so seek medical attention if have severe headache, difficulty keeping
your balance or have hallucinations.
Follow-up Actions
Return evaluation: If evacuated promptly, patient may recover rapidly (hours to days) and completely.
Individuals who have had one episode of HAPE are at increased risk of recurrence.
Evacuation/Consultation Criteria: Evacuate all patients with more than mild HAPE to a hospital facility.
They should be evaluated for possible medical profile to restrict exposure to altitudes above 8000 ft.
*NOTES: Portable hyperbaric chambers (e.g., Gamow bag, CERTEC bag, Hyperlite chamber, Portable
Altitude Chamber [PAC]) are not normally available in the military medical supply inventory. They are available
in the civilian sector in the USA and many European countries. These light weight, highly portable cloth
chambers are extremely useful in treating altitude illnesses (including AMS). When deploying rapidly to high
altitude terrain, consider procuring such a chamber. Given that the incidence of altitude illness diminishes
greatly after acclimatization to altitude (7-10 days), portable chamber could be stored (or discarded) after
that time.
Chapter 23: Cold Illnesses and Injuries
Cold Illnesses and Injuries: Freezing Injury (Frostbite)
Murray Hamlet, DVMIntroduction: Frostbite occurs at temperatures below freezing (32°F), most often in exhausted, wet,
discouraged soldiers who are poorly dressed and inattentive to prevention. Although there are four basic
degree categories of frostbite, it is important to differentiate merely superficial from deep or severe frostbite
since they are managed differently (see below). Superficial involves just the surface of the skin but no blisters
form. Deep or severe frostbite involves partial or full-thickness skin injury, causes blisters and demarcates
over a period of days or weeks. Extremities and exposed skin are at an increased risk of injury.
Subjective: Symptoms
Progression from cool, to cold and uncomfortable, to numb and painless tissue; injury is often concealed by
mittens, gloves or boots; slow, stiff movements. Injured tissue becomes extremely painful upon rewarming.
Deep injury can produce acidosis, rhabdomyolysis, fever and coagulopathies.
Objective: Signs
Using Basic Tools: Frozen tissue is blanched white or pale yellow, completely ischemic and hard to the
touch. The skin is immobile over joints. Upon rewarming the skin becomes red, swollen and may turn gray or
deeply red to purple-blue. Large blisters containing either clear or hemorrhagic fluid form in severe frostbite.
Assessment:
Differential Diagnosis - gangrene from other sources (ischemia, burns, and severe infections) may present
similarly but the history of cold exposure should clarify the diagnosis.
Plan:
Treatment
Primary:
- Do not thaw tissue if there is any threat of re-freezing during evacuation.
- Warm superficial frostbite gradually in the axilla, groin or in warm water.
- Deep frostbite is best managed with:
a. Moving water immersion (whirlpool) at 104°F or 40°C for thirty minutes. This produces significant
pain but affords the best tissue salvage.
b. Apply a loose, dry dressing for transport.