High Altitude Case Studies

Question 1

HAPE

Answer 1

High Altitude Pulmonary Edema

Question 2

diagnostic tests to consider for altitude ddx

Answer 2

EKG

BMP

CXR

CBC

H/H

Wells Criteria

rapid flu

COVID

Question 3

elevation for avg onset of altitude sickness

Answer 3

>6,000 ft

avg: 8,000 ft

Question 4

having HAPE/HACE once is a risk factor for

Answer 4

having it again

Question 5

CCB that is especially useful for tx of HAPE

Answer 5

Nifedepime

better than other CCB

Question 6

phosphodiesterase inhibitors were originally intended for

Answer 6

pulmonary HTN

Question 7

examples of phosphodiesterase inhibitors

Answer 7

Tdalafil (Cialis)

Sildenafil (Viagra)

Question 8

phosphodiesterase inhibitors are what class of med

Answer 8

vasodilators

Question 9

be very cautious using phosphodiesterase inhibitors w.

Answer 9

CCB (Nifedepine) → don’t want to vasodilate too much

Question 10

main tx for backcountry HAPE in backcountry setting

Answer 10

descend!

can bring Nifedepine or Viagra; but still need to descend!

Question 11

prevention of HAPE

Answer 11

Acetazolamide (Diamox) 125 mg po bid

Nifedepine ER 30 mg po q 12 hr

hydration

Question 12

Acetazolamide (Diamox) is what class of drug

Answer 12

anhidrase inhibitor → acts on RBC → affects CO2 loading/offloading

Question 13

s.e of Acetazolamide (Diamox)

Answer 13

dizziness

Question 14

prevention meds for HAPE must be taken

Answer 14

24 hr prior to descending

24 hr after descending

continuously

Question 15

HACE

Answer 15

high altitude cerebral edema

Question 16

HACE is characterized by

Answer 16

swelling or fluid in the brain

Question 17

can someone have both HACE and HAPE

Answer 17

yes!

Question 18

cause of death in HACE is

Answer 18

herniation of the brain stem

Question 19

tx for HACE

Answer 19

descend!

Nifedepine

phosphodiesterase inhibitors

add dexamethasone 8mg loading → then 4 mg after

Question 20

possible ddx for altitude sickness

Answer 20

HAPE

PE

PNA

dehydration

Question 21

altitude sickness symptom

Answer 21

HA

dizziness

n/v

fatigue/loss of energy

SOB

insomnia

LOA

Question 22

factors that contribute to altitude sickness

Answer 22

etoh

dehydration

chronic illness

+/- meds

Question 23

possible complications of altitude illness

Answer 23

HAPE

HACE

Question 24

T/F HAPE can be fatal in hours if untreated

Answer 24

T!

Question 25

symptoms unique to HAPE (not altitude sickness)

Answer 25

SOB at rest

tachycardia

nonproductive cough/cloudy sputum

rales

cyanosis

Question 26

HAPE predisposing factors

Answer 26

cold weather

physical exertion at high altitude

male sex

use of sleep meds

excessive salt ingestion

Question 27

incidence of HAPE in CO

Answer 27

1/1,000 skiers

1/100 climbers

Question 28

previous hx of HAPE = _% chance of recurrence

Answer 28

65%

Question 29

tx for HAPE

Answer 29

descend!

oral Nifedipine ER 30 mg q 12 hr

and/or:

Tadafil 10 mg bid

Sildenafil 50 mg q 8 hr

supplemental O2

Question 30

main enzyme involved in CO2/carbonic acid buffering

Answer 30

carbonic anhydrase

Question 31

carbonic anhydrase is found in

Answer 31

RBC

Question 32

carbonic anhydrase affects

Answer 32

CO2 loading/unloading in tissues

Question 33

differentiating HACE symptoms

Answer 33

swelling/fluid in the brain

disorientation/confusion

Question 34

dexamethasone dosing for HACE

Answer 34

8 mg po loading dose → then 4 mg po q 6 hr