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High Altitude Edema

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101. Altitude-Related Disorders (Overview)

of these are merely an annoyance while others are life threatening. Three major syndromes, acute mountain sickness (AMS), high-altitude pulmonary edema (HAPE), and high-altitude cerebral edema (HACE), are now commonly accepted [ ] . Other related problems, such as impaired sleep and high-altitude retinal hemorrhage, often coexist with the major syndromes and deserve mention. Finally, the effects of ascent on certain special populations are briefly discussed. Related Medscape articles include and . Next: Acute (...) were promising, more recent ones do not support the use of Ginkgo biloba. In a couple of studies, Ginkgo biloba was no better than placebo in prophylaxis of AMS. [ , ] As such, the mainstay of pharmacologic treatment remains acetazolamide and dexamethasone. Portable hyperbaric bags (eg, Gamow bag) simulate descent to a lower altitude. These bags are effective for treating AMS, although they are rarely needed unless AMS is complicated with high-altitude cerebral or pulmonary edema (see High-Altitude

2014 eMedicine.com

102. Altitude-Related Disorders (Follow-up)

of these are merely an annoyance while others are life threatening. Three major syndromes, acute mountain sickness (AMS), high-altitude pulmonary edema (HAPE), and high-altitude cerebral edema (HACE), are now commonly accepted [ ] . Other related problems, such as impaired sleep and high-altitude retinal hemorrhage, often coexist with the major syndromes and deserve mention. Finally, the effects of ascent on certain special populations are briefly discussed. Related Medscape articles include and . Next: Acute (...) were promising, more recent ones do not support the use of Ginkgo biloba. In a couple of studies, Ginkgo biloba was no better than placebo in prophylaxis of AMS. [ , ] As such, the mainstay of pharmacologic treatment remains acetazolamide and dexamethasone. Portable hyperbaric bags (eg, Gamow bag) simulate descent to a lower altitude. These bags are effective for treating AMS, although they are rarely needed unless AMS is complicated with high-altitude cerebral or pulmonary edema (see High-Altitude

2014 eMedicine.com

103. Altitude-Related Disorders (Diagnosis)

of these are merely an annoyance while others are life threatening. Three major syndromes, acute mountain sickness (AMS), high-altitude pulmonary edema (HAPE), and high-altitude cerebral edema (HACE), are now commonly accepted [ ] . Other related problems, such as impaired sleep and high-altitude retinal hemorrhage, often coexist with the major syndromes and deserve mention. Finally, the effects of ascent on certain special populations are briefly discussed. Related Medscape articles include and . Next: Acute (...) were promising, more recent ones do not support the use of Ginkgo biloba. In a couple of studies, Ginkgo biloba was no better than placebo in prophylaxis of AMS. [ , ] As such, the mainstay of pharmacologic treatment remains acetazolamide and dexamethasone. Portable hyperbaric bags (eg, Gamow bag) simulate descent to a lower altitude. These bags are effective for treating AMS, although they are rarely needed unless AMS is complicated with high-altitude cerebral or pulmonary edema (see High-Altitude

2014 eMedicine.com

104. Altitude Illness - Pulmonary Syndromes (Follow-up)

phosphodiesterase-5 inhibitors (eg, sildenafil, tadalafil) have been found effective for prophylaxis of HAPE, [ , , , ] but they have not yet been studied for treatment. Previous Next: Long-Term Monitoring Outpatient treatment of mild HAPE after descent consists of bedrest. Follow up in 24 hours to check on clearance of HAPE edema. Previous References Richalet JP, Larmignat P, Poitrine E, Letournel M, Canouï-Poitrine F. Physiological Risk Factors of Severe High Altitude Illness: A Prospective Cohort Study. Am J (...) . 123 (5):1228-1234. . Rexhaj E, Rimoldi SF, Pratali L, Brenner R, Andries D, Soria R, et al. Sleep-Disordered Breathing and Vascular Function in Patients With Chronic Mountain Sickness and Healthy High-Altitude Dwellers. Chest . 2016 Apr. 149 (4):991-8. . Schoene RB. Unraveling the mechanism of high altitude pulmonary edema. High Alt Med Biol . 2004 Summer. 5(2):125-35. . Swenson ER, Maggiorini M, Mongovin S, et al. Pathogenesis of high-altitude pulmonary edema: inflammation is not an etiologic

2014 eMedicine Emergency Medicine

105. Altitude Illness - Cerebral Syndromes (Follow-up)

are typically treated in 1-hour increments and then are reevaluated. See the images below. A very ataxic man with high-altitude cerebral edema (HACE) at 4250 m being assisted toward the Gamow bag. A fully inflated Gamow Bag in use. Importantly, in HACE cases, these chambers should only be used as a means of acute/temporizing care (eg, to improve a patient's ability to more safely participate in their evacuation in technical terrain). They should never be considered as a replacement for actual descent. Coca (...) , further outpatient care is not usually indicated for patients with AMS. Patients with mild HACE should have follow-up appointments in 24 hours to check for clearance of symptoms. Patients with concurrent HAPE should be immediately reported to the . Previous References Fagenholz PJ, Gutman JA, Murray AF, Noble VE, Camargo CA Jr, Harris NS. Evidence for increased intracranial pressure in high altitude pulmonary edema. High Alt Med Biol . 2007 Winter. 8(4):331-6. . MacInnis MJ, Wang P, Koehle MS, Rupert

2014 eMedicine Emergency Medicine

106. Altitude-Related Disorders (Treatment)

of these are merely an annoyance while others are life threatening. Three major syndromes, acute mountain sickness (AMS), high-altitude pulmonary edema (HAPE), and high-altitude cerebral edema (HACE), are now commonly accepted [ ] . Other related problems, such as impaired sleep and high-altitude retinal hemorrhage, often coexist with the major syndromes and deserve mention. Finally, the effects of ascent on certain special populations are briefly discussed. Related Medscape articles include and . Next: Acute (...) were promising, more recent ones do not support the use of Ginkgo biloba. In a couple of studies, Ginkgo biloba was no better than placebo in prophylaxis of AMS. [ , ] As such, the mainstay of pharmacologic treatment remains acetazolamide and dexamethasone. Portable hyperbaric bags (eg, Gamow bag) simulate descent to a lower altitude. These bags are effective for treating AMS, although they are rarely needed unless AMS is complicated with high-altitude cerebral or pulmonary edema (see High-Altitude

2014 eMedicine.com

107. Altitude Illness - Pulmonary Syndromes (Diagnosis)

> Altitude Illness - Pulmonary Syndromes Updated: Dec 11, 2017 Author: N Stuart Harris, MD, MFA, FACEP; Chief Editor: Joe Alcock, MD, MS Share Email Print Feedback Close Sections Sections Altitude Illness - Pulmonary Syndromes Overview Background Altitude illness refers to a group of syndromes that result from hypoxia. Acute mountain sickness (AMS) and are manifestations of the brain pathophysiology, while high-altitude pulmonary edema (HAPE) is that of the lung (see image shown below). Everyone (...) a leftward shift of the oxyhemoglobin dissociation curve, facilitating loading of the hemoglobin with oxygen in the pulmonary capillary. Sleep architecture is altered at high altitude, with frequent arousals and nearly universal subjective reports of disturbed sleep. [ ] This generally improves after several nights at a constant altitude, though periodic breathing (Cheyne-Stokes) is normal above 2700 m. Pathophysiology of HAPE [ , , , ] HAPE is a noncardiogenic, hydrostatic pulmonary edema, characterized

2014 eMedicine Emergency Medicine

108. Altitude Illness - Cerebral Syndromes (Diagnosis)

> Altitude Illness - Cerebral Syndromes Updated: Feb 22, 2019 Author: N Stuart Harris, MD, MFA, FACEP; Chief Editor: Joe Alcock, MD, MS Share Email Print Feedback Close Sections Sections Altitude Illness - Cerebral Syndromes Overview Background Altitude illness refers to a group of syndromes that result from hypoxia. Acute mountain sickness (AMS) and high-altitude cerebral edema (HACE) are manifestations of the brain pathophysiology, while (HAPE) is that of the lung. Everyone traveling to altitude (...) to improve with treatment, or if HACE or HAPE are present, descend immediately. For patient education resources, see the article . Previous References Fagenholz PJ, Gutman JA, Murray AF, Noble VE, Camargo CA Jr, Harris NS. Evidence for increased intracranial pressure in high altitude pulmonary edema. High Alt Med Biol . 2007 Winter. 8(4):331-6. . MacInnis MJ, Wang P, Koehle MS, Rupert JL. The genetics of altitude tolerance: the evidence for inherited susceptibility to acute mountain sickness. J Occup

2014 eMedicine Emergency Medicine

109. Altitude Illness - Pulmonary Syndromes (Overview)

> Altitude Illness - Pulmonary Syndromes Updated: Dec 11, 2017 Author: N Stuart Harris, MD, MFA, FACEP; Chief Editor: Joe Alcock, MD, MS Share Email Print Feedback Close Sections Sections Altitude Illness - Pulmonary Syndromes Overview Background Altitude illness refers to a group of syndromes that result from hypoxia. Acute mountain sickness (AMS) and are manifestations of the brain pathophysiology, while high-altitude pulmonary edema (HAPE) is that of the lung (see image shown below). Everyone (...) a leftward shift of the oxyhemoglobin dissociation curve, facilitating loading of the hemoglobin with oxygen in the pulmonary capillary. Sleep architecture is altered at high altitude, with frequent arousals and nearly universal subjective reports of disturbed sleep. [ ] This generally improves after several nights at a constant altitude, though periodic breathing (Cheyne-Stokes) is normal above 2700 m. Pathophysiology of HAPE [ , , , ] HAPE is a noncardiogenic, hydrostatic pulmonary edema, characterized

2014 eMedicine Emergency Medicine

110. Altitude Illness - Cerebral Syndromes (Overview)

> Altitude Illness - Cerebral Syndromes Updated: Feb 22, 2019 Author: N Stuart Harris, MD, MFA, FACEP; Chief Editor: Joe Alcock, MD, MS Share Email Print Feedback Close Sections Sections Altitude Illness - Cerebral Syndromes Overview Background Altitude illness refers to a group of syndromes that result from hypoxia. Acute mountain sickness (AMS) and high-altitude cerebral edema (HACE) are manifestations of the brain pathophysiology, while (HAPE) is that of the lung. Everyone traveling to altitude (...) to improve with treatment, or if HACE or HAPE are present, descend immediately. For patient education resources, see the article . Previous References Fagenholz PJ, Gutman JA, Murray AF, Noble VE, Camargo CA Jr, Harris NS. Evidence for increased intracranial pressure in high altitude pulmonary edema. High Alt Med Biol . 2007 Winter. 8(4):331-6. . MacInnis MJ, Wang P, Koehle MS, Rupert JL. The genetics of altitude tolerance: the evidence for inherited susceptibility to acute mountain sickness. J Occup

2014 eMedicine Emergency Medicine

111. Altitude Illness - Cerebral Syndromes (Treatment)

are typically treated in 1-hour increments and then are reevaluated. See the images below. A very ataxic man with high-altitude cerebral edema (HACE) at 4250 m being assisted toward the Gamow bag. A fully inflated Gamow Bag in use. Importantly, in HACE cases, these chambers should only be used as a means of acute/temporizing care (eg, to improve a patient's ability to more safely participate in their evacuation in technical terrain). They should never be considered as a replacement for actual descent. Coca (...) , further outpatient care is not usually indicated for patients with AMS. Patients with mild HACE should have follow-up appointments in 24 hours to check for clearance of symptoms. Patients with concurrent HAPE should be immediately reported to the . Previous References Fagenholz PJ, Gutman JA, Murray AF, Noble VE, Camargo CA Jr, Harris NS. Evidence for increased intracranial pressure in high altitude pulmonary edema. High Alt Med Biol . 2007 Winter. 8(4):331-6. . MacInnis MJ, Wang P, Koehle MS, Rupert

2014 eMedicine Emergency Medicine

112. Altitude Illness - Pulmonary Syndromes (Treatment)

phosphodiesterase-5 inhibitors (eg, sildenafil, tadalafil) have been found effective for prophylaxis of HAPE, [ , , , ] but they have not yet been studied for treatment. Previous Next: Long-Term Monitoring Outpatient treatment of mild HAPE after descent consists of bedrest. Follow up in 24 hours to check on clearance of HAPE edema. Previous References Richalet JP, Larmignat P, Poitrine E, Letournel M, Canouï-Poitrine F. Physiological Risk Factors of Severe High Altitude Illness: A Prospective Cohort Study. Am J (...) . 123 (5):1228-1234. . Rexhaj E, Rimoldi SF, Pratali L, Brenner R, Andries D, Soria R, et al. Sleep-Disordered Breathing and Vascular Function in Patients With Chronic Mountain Sickness and Healthy High-Altitude Dwellers. Chest . 2016 Apr. 149 (4):991-8. . Schoene RB. Unraveling the mechanism of high altitude pulmonary edema. High Alt Med Biol . 2004 Summer. 5(2):125-35. . Swenson ER, Maggiorini M, Mongovin S, et al. Pathogenesis of high-altitude pulmonary edema: inflammation is not an etiologic

2014 eMedicine Emergency Medicine

113. Hypoxia-related altitude illnesses. Full Text available with Trip Pro

Hypoxia-related altitude illnesses. Millions of tourists and climbers visit high altitudes annually. Many unsuspecting and otherwise healthy individuals may get sick when sojourning to these high regions. Acute mountain sickness represents the most common illness, which is usually benign but can rapidly progress to the more severe and potentially fatal forms of high-altitude cerebral edema and high-altitude pulmonary edema.Data were identified by searches of Medline (1965 to May 2012 (...) ) and references from relevant articles and books. Studies, reviews, and books specifically pertaining to the epidemiology, prevention, and treatment of high-altitude illnesses in travelers were selected.This review provides information on geographical aspects, physiology/pathophysiology, clinical features, risk factors, and the prevalence of high-altitude illnesses and also state-of-the art recommendations for prevention and treatment of such illnesses.Given an increasing number of recreational activities

2013 Journal of Travel Medicine

114. Clinical Manifestations and Long-Term Follow-Up in Pediatric Patients Living at Altitude With Isolated Pulmonary Artery of Ductal Origin. Full Text available with Trip Pro

]). Fifteen children (88%) were symptomatic at presentation. High-altitude pulmonary edema was present in 2 patients (12%) at diagnosis, and only 1 patient had episodes of hemoptysis during follow-up. Fourteen patients (82%) demonstrated evidence of pulmonary arterial hypertension (PAH). Among 14 patients with PAH, 11 patients had surgical interventions. PAH resolved in 5 of 11 patients (45%) undergoing surgical rehabilitation. One patient died during follow-up, and 7 patients are receiving oral (...) Clinical Manifestations and Long-Term Follow-Up in Pediatric Patients Living at Altitude With Isolated Pulmonary Artery of Ductal Origin. This study's aim was to define the clinical manifestations and long-term outcome of pediatric patients living at altitude with isolated pulmonary artery (PA) of ductal origin (IPADO). This was a retrospective cohort study of 17 consecutive cases of IPADO at a single center. All patients lived at modest altitude (median 2050 m [range 1700 m to 3050 m

2012 Pediatric Cardiology

115. Hemodynamic Changes in Altitude Adaptation

Stein, Goethe University Study Details Study Description Go to Brief Summary: We use a new technology (Nexfin from BMEYE-Inventive Hemodynamics) to monitor Cardiac Output, Blood Pressure, Fluid Responsiveness, Pulse Oximetry, Hemoglobin Concentration, Oxygen Delivery in Climbers during their process of acclimatization on a expedition to Mount Aconcagua. Condition or disease Acute Mountain Sickness High Altitude Pulmonary Edema High Altitude Cerebral Edema Detailed Description: Several parameters (...) will be recorded to analyze their influence on the adaptation to high altitude. Such as, food composition, dietary supplements, water intake and output. Study Design Go to Layout table for study information Study Type : Observational Estimated Enrollment : 12 participants Observational Model: Cohort Time Perspective: Prospective Official Title: Hemodynamic Changes in Altitude Adaptation Study Start Date : August 2012 Estimated Primary Completion Date : December 2012 Estimated Study Completion Date : December

2012 Clinical Trials

116. NSAID RCT for Prevention of Altitude Sickness

: University of California, San Diego Information provided by (Responsible Party): Jeffrey Gertsch MD, Naval Health Research Center Study Details Study Description Go to Brief Summary: The proposed study is a prospective, randomized, double-blind, placebo-controlled clinical trial evaluating ibuprofen and placebo for the prevention of neurological forms of altitude illness [including high altitude headache (HAH), acute mountain sickness (AMS), high altitude cerebral edema (HACE), and an emerging concept (...) of High Altitude Anxiety]. The study will take place in the spring and summer of 2012 at the Marine Corps Mountain Warfare Training Center in the Eastern Sierras near Bridgeport, California. US Marines from near sea level will participate in battalion-level training exercises at between 8,500-11,500 Feet, where some altitude illness is expected. Concurrent measures used to determine objective markers of altitude illness, such that validated clinical scales, rapid cognitive screening tests, will inform

2012 Clinical Trials

117. Congestive Heart Failure and Pulmonary Edema (Follow-up)

administration of a loop diuretic (ie, furosemide, bumetanide, torsemide) is preferred initially because of potentially poor absorption of the oral form in the presence of bowel edema. In patients with hypertensive heart failure who have mild fluid retention, thiazide diuretics may be preferred because of their more persistent antihypertensive effects. [ , ] Diuretics can be given by bolus or continuous infusion and in high or low doses. In a study of patients with acute decompensated heart failure, however (...) with medications Avoidance, or rapid treatment of, precipitating factors Precipitating factors include the following: Sleep apnea Pulmonary embolism Sepsis Arrhythmia Ischemia High altitude Anemia Hypoxemia Use of an angiotensin-converting enzyme inhibitor/angiotensin receptor blocker (ACEI/ARB) is beneficial if RV failure is secondary to left ventricular (LV) failure; the efficacy of these agents in isolated RV failure is not known. The same recommendation applies for use of beta-blockers. The role

2014 eMedicine Emergency Medicine

118. Pulmonary Edema, Noncardiogenic

patients. Previous Next: Ultrasonography Lung ultrasound is a radiation-free, noninvasive tool available at the bedside that can provide useful information on ARDS diagnosis when radiography or CT is not available. [ ] In addition, use in prehospital assessment in extreme settings (war zones, natural disasters, and extreme sports settings in deserts, on mountains, and on water) has greatly increased. For example, ultrasonograhy has been used in the assessment of pulmonary edema (PE) in high-altitude (...) during lung injury reflects the state of neutrophil activation. FDG-PET scanning can depict pulmonary sequestration of activated neutrophils, even when alveolar neutrophilia are absent. [ ] Iodine-123 Iodine-123 meta-iodobenzylguanidine (MIBG) results can be considered indicators of pulmonary endothelial cell function. Koizumi and colleagues studied serial scintigraphic assessment of 123 I MIBG lung uptake in a patient with high-altitude pulmonary edema. [ ] The initial evaluation was performed 7

2014 eMedicine Radiology

119. Congestive Heart Failure and Pulmonary Edema (Treatment)

administration of a loop diuretic (ie, furosemide, bumetanide, torsemide) is preferred initially because of potentially poor absorption of the oral form in the presence of bowel edema. In patients with hypertensive heart failure who have mild fluid retention, thiazide diuretics may be preferred because of their more persistent antihypertensive effects. [ , ] Diuretics can be given by bolus or continuous infusion and in high or low doses. In a study of patients with acute decompensated heart failure, however (...) with medications Avoidance, or rapid treatment of, precipitating factors Precipitating factors include the following: Sleep apnea Pulmonary embolism Sepsis Arrhythmia Ischemia High altitude Anemia Hypoxemia Use of an angiotensin-converting enzyme inhibitor/angiotensin receptor blocker (ACEI/ARB) is beneficial if RV failure is secondary to left ventricular (LV) failure; the efficacy of these agents in isolated RV failure is not known. The same recommendation applies for use of beta-blockers. The role

2014 eMedicine Emergency Medicine

120. Does Acetazolamide Prevent Altitude Sickness?

in minute ventilation. In cases of altitude related illness it is not well understood what goes wrong but, essentially, these normal adaptations are inadequate or maladaptive. The term mountain sickness includes a spectrum of illnesses, namely the following entities: acute mountain sickness (AMS), high altitude cerebral edema (HACE), and high altitude pulmonary edema (HAPE). AMS is a clinical syndrome that occurs in someone who has ascended >2500 meters. Clinical features are the presence of a headache (...) develop from changes in altitude? The essential culprit is the fall in atmospheric pressure with an increase in altitude. While at sea level, barometric pressure (Pb) is ~760mm Hg (1atm), whereas at the summit of Mount Everest (~8800 meters high), this pressure drops to ~250mm Hg. The fraction of inspired oxygen remains constant (21% of air is made of oxygen molecules), so the net result is a decrease in the pressure of inspired oxygen. Remember that the pressure of oxygen in our alveoli is determined

2009 Clinical Correlations

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