High altitude pulmonary edema: Difference between revisions
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#Typical pt is strong and fit; may not have symptoms of AMS before onset of HAPE | #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 | #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 == | == Clinical Features == | ||
| Line 32: | Line 33: | ||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
*[[Asthma]] | |||
*[[Bronchitis]] | |||
*[[CHF]] | |||
*[[COPD]] | |||
*[[MI]] | |||
{{High altitude DDX}} | {{High altitude DDX}} | ||
== Treatment == | == Treatment == | ||
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== Disposition == | == 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 == | == 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== | ==See Also== | ||
[[High Altitude Medicine]] | *[[High Altitude Medicine]] | ||
==Source== | ==Source== | ||
[[Category:Environ]] | [[Category:Environ]] | ||
Revision as of 03:49, 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
Treatment
- Immediate descent is treatment of choice - minimize exertion
- 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
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