High Altitude Pulmonary Edema (HAPE)files.meetup.com/1783201/Part 2 - Mountaineers 2012.pdf•HAPE...
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High Altitude Pulmonary Edema (HAPE)
Transcript of High Altitude Pulmonary Edema (HAPE)files.meetup.com/1783201/Part 2 - Mountaineers 2012.pdf•HAPE...
High Altitude Pulmonary
Edema(HAPE)
• HAPE is a fluid build-up in the lungs.
• Cases seen at altitudes as low as 8,000 ft. (e.g., Colorado ski resorts)
• Can occur in people with no other symptoms of altitude illness (AMS or HACE)
• Can occur up to 4-5 days after arrival at altitude
• HAPE is potentially fatal if not recognized and treated appropriately.
HAPE: Some Basics
• Decreased exercise performance
• Long time needed to recover with breaks.
• Dry cough (becomes wet in severe cases)
• Profound fatigue
• Out of breath with simple activities
• Blue lips and finger tips
HAPE: How To Recognize The Problem
Preventing High Altitude Illness
Preventive Steps That Don’t Require Taking Medicine
Undertake a gradual ascent!!!Above 10,000 ft: limit increases in sleeping elevation to 1,000 to 1,500 ft per night; Rest days every 3-4 days or
with large gains in elevation
Minimize alcohol use
Avoid narcotic pain medications
Avoid over-exertion
An Ascent Profile: Everest Base Camp
8,000
10,000
12,000
14,000
16,000
18,000
20,000
Day 1 Day 2 Day 3 Day 4 Day 5 Day 6
9,315
11,283 11,283
12,660
14,464 14,464
Elevation (ft)
Sleeping or Maximum Elevation for First 6 Days of Trip
Everest Base Camp (First 6 Days of Trek to 17,593 ft)
A Faster Ascent Profile: Kilimanjaro Machame Route
8,000
10,000
12,000
14,000
16,000
18,000
20,000
Day 1 Day 2 Day 3 Day 4 Day 5 Day 69,315
11,283 11,283
12,660
14,464 14,464
9,840
12,595
15,088
16,334
18,49919,335
Elevation (ft)
Sleeping or Maximum Elevation for First 6 Days of Trip
KilimanjaroEverest Base Camp (First 6 Days of Trek to 17,593 ft)
A Key Point on Trip Planning
Be Flexible!!!
• People with a prior history of altitude illness
• People who must travel to over 10,000 feet on their first day (e.g., flying into Lhasa, Cuzco or La Paz)
• People who need to push a fast rate of ascent after the first day (e.g., S&R)
Prophylactic Medications: Who Should Take Them
Prophylactic Medications:Two Accepted Options
Acetazolamide
Dose: 125 mg every 12 hrs
Caution in people with sulfa allergy
Side effects: increased urination; tingling in
extremities
Dexamethasone
Dose: 4 mg every 12 hrs or 2 mg every 6 hours
Does not affect acclimatization
Usually reserved for those who do not tolerate
acetazolamide
• Nifedipine: 30 mg of the long-acting version twice a day
• Alternatives: Tadalafil (Cialis) or Sildenafil (Viagra)
Extra Prevention for People With a History of HAPE
These are not used for prevention unless the person has had HAPE before
• Start taking the night before or the day you begin your ascent
• May start at any point along the ascent
• Stop taking them when you start to descend or after many days at same/peak altitude
Prophylactic Medications:How to Take Them
Treating High Altitude Illness
The Key Principle of Treatment
Descent Makes Things Better
Who Actually Needs To Descend?
Severe Acute Mountain Sickness
High Altitude Pulmonary Edema
(HAPE)
High Altitude Cerebral Edema
(HACE)
If Descent is Not Possible: Supplemental Oxygen
Oxygen Concentrator
Oxygen Tanks Gamow Bag
How The Gamow Bag Works
Outside the Bag14,330 ft
Inside the Bag10,720 ft
Altimeter Watch
• Stop ascending
• Aspirin, tylenol, ibuprofen for headache (no narcotics)
• Drink plenty of fluids
• Consider acetazolamide: (250 mg twice a day)
• Okay to go higher if symptoms resolve; descend if no improvement
Most People With AMS Do Not Require Descent
Pharmacologic Treatment Of Severe Altitude Illness *
Severe AMSDexamethasone4 mg every 6 hrs
or
Acetazolamide250 mg every 12 hrs
HAPENifedipine
(sustained release)every 12 hours
HACEDexamethasone
8 mg once then 4 mg every 6 hrs
* For treatment in the field. The approach may differ at a health facility
Some Other Treatment Principles
Never go higher in the face of symptoms of altitude illness!!!
Avoid This Disease!!!
Summit Fever
Some Common Questions
“Where can I get the high altitude medications?”
A Question
• These medications require a prescription that can be obtained from:
- Your regular physicians
- Travel clinic
• Watch for one of two problems in your efforts to obtain the medicines:
- Reluctance to prescribe them
- Ignorance about the correct doses, how to use them
Obtaining The High Altitude Medications
“If I’ve been sick at altitude before, will I get sick again on
a future trip”
A Question
Prior responses at altitude are a good, but not perfect predictor
of future responses
“If I make some trips to high altitude prior to my planned
trip will this help prevent altitude illness?”
A Question
It All Depends...
How high you go How long you stay up high
How many trips you make
How close to your planned trip
“I’m in great physical shape... Doesn’t this protect against
getting altitude illness?”
A Question
Being In Good Shape Is NOT Protective Against AMS
=
“I can’t sleep at altitude... What medicines are safe for
me to take at night?”
A Question
• Shown to be safe and effective
- Acetazolamide (Diamox)
- Temazepam (Restoril)
- Zolpidem (Ambien) and Zaleplon (Sonata)
• Not studied but probably safe and effective:
- Diphenhydramine (Benadryl)
- Eszopiclone (Lunesta)
• Do NOT use:
- Narcotics
- Diazepam (Valium)
Sleep Aids At High Altitude
The Take-Home Messages
Know how to recognize the symptoms of altitude illness when traveling up high
Slow ascents are the best way to prevent altitude illness
The altitude wins... you have to listen to your body when you don’t feel good
