High altitude pulmonary edema: Difference between revisions
Neil.m.young (talk | contribs) (format) |
|||
Line 7: | Line 7: | ||
#Most commonly noticed on the second night at a new altitude | #Most commonly noticed on the second night at a new altitude | ||
#Risk Factors: | #Risk Factors: | ||
# | #*Heavy exertion | ||
# | #*Rapid ascent | ||
# | #*Cold | ||
# | #*Excessive salt ingestion | ||
# | #*Use of a sleeping medication | ||
# | #*Preexisting pulmonary HTN | ||
# | #*Preexisting respiratory infection (children) | ||
# | #*Previous history of HAPE | ||
== Clinical Features == | == Clinical Features == |
Revision as of 02:35, 2 March 2015
Background
- Also known as HAPE
- Noncardiogenic pulm edema d/t increased microvascular pressure in the pulm circulation
- Most lethal of the altitude illnesses
- Occurs in <1/10,000 skiers in Colorado; 2-3% of Mt. McKinley climbers
- Typical pt is strong and fit; may not have symptoms of AMS before onset of HAPE
- Most commonly noticed on the second night at a new altitude
- Risk Factors:
- Heavy exertion
- Rapid ascent
- Cold
- Excessive salt ingestion
- Use of a sleeping medication
- Preexisting pulmonary HTN
- Preexisting respiratory infection (children)
- Previous history of HAPE
Clinical Features
- Early
- Dry cough, decreased exercise performance, dyspnea on exertion, localized rales
- Resting SaO2 is low for the altitude and drops markedly w/ exertion (aids in the dx)
- Late
- Dyspnea at rest, marked weakness, productive cough, cyanosis, generalized rales
- Tachycardia and tachypnea correlate with the severity of illness
- Altered mental status and coma (from severe hypoxemia)
- ECG
- Right strain pattern
- CXR
- Progresses from interstitial to localized-alveolar to generalized-alveolar infiltrates
- ABG
- hypoxemia with respiratory alkalosis
Differential Diagnosis
High Altitude Illnesses
- Acute mountain sickness
- Chronic mountain sickness
- High altitude cerebral edema
- High altitude pulmonary edema
- High altitude peripheral edema
- High altitude retinopathy
- High altitude pharyngitis and bronchitis
- Ultraviolet keratitis
- Asthma
- Bronchitis
- CHF
- COPD
- MI
Treatment
- Immediate descent is treatment of choice
- While pt is descending attempt to limit exertion as much as possible
- If cannot descend use combination of:
- Supplemental O2
- Can completely resolve the pulmonary edema within 36-72hr
- Hyperbaric bag
- Keep pt warm (cold stress elevates pulm artery pressure)
- Use expiratory positive airway pressure mask
- Consider the medications listed below that are usually used for prevention
- Supplemental O2
Disposition
- Admission
- Warranted for severe illness that does not respond immediately to descent
- Discharge
- Progressive clinical and X-ray improvement and a PaO2 of 60mmHg or SaO2>90%
Prevention
- Nifedipine 20mg q8hr while ascending is effective prophylaxis in pts who had HAPE before
- Tadalafil 10mg BID 24hr prior to ascent
- Salmeterol inhaled BID
See Also
Source
Tintinalli