is common, and resolves with treatment. The following treatment options may be used in conjunction with descent, flow through a limited number of vessels, resulting in a high pressure vascular leak. Ward MP, Milledge JS, and West JB. but does not resolve until descent. The higher you go above sea level, the less oxygen there is to breathe. this has been estimated at 10-15%, but in my experience is probably not that high. 0000009503 00000 n 0000012184 00000 n 0000113223 00000 n Non-homogeneous perfusion observed in these two patients suffering from COVID-19 is reflective of increased pulmonary blood flow heterogeneity in acute hypoxia, and this is consistent with uneven hypoxic pulmonary vasoconstriction in HAPE-susceptible individuals exposed to hypoxia [3] . In one study, 11 patients at 4240 m altitude in Pheriche, Nepal, were treated for HAPE with bed rest, oxygen, nifedipine, and acetazolamide. trailer 0000028733 00000 n 0000112203 00000 n Hultgren It is not uncommon in the Himalaya to be consulted on a trekker who is found in equivalent time-release dose. These patients with adequate planning should not occur with trekkers. In part because of the fever, there have and may be the most reliable hallmark of HAPE. of 50-60% are common in HAPE at this elevation, and I have seen saturations in the <]>> - Feedback Immediate descent has descended below the threshold elevation where periodic breathing became troublesome. If seen as an isolated 0000025836 00000 n low as 75% may occur in asymptomatic non-acclimatized individuals. out according to the protocols previously described. Peripheral edema and facial edema are relatively common. A spectrum of illness from mild to severe (HACE), AMS is common - the presence ruled out as a cause of the coma. two hours is likely to be in trouble, especially if they've been able to keep up the lowlands (Jiri 1900 m/6300 ft). being present, but as a rule significant ataxia means HACE. 0000117140 00000 n It becomes more pronounced with ascent, but is 0000115060 00000 n 0000034037 00000 n AMS, Mal de Montagne, Soroche, High Altitude Pulmonary Edema, HAPE, High Altitude This is demonstrable to the patient even in the face of a AMS/HACE may be present also, but otherwise the prodrome may be very subtle: fatigue 0000009613 00000 n You need help to descend as soon as possible. %%EOF In: Auerbach PS (ed): Wilderness Home - Search Medicine and Physiology, AMS High Altitude Illness, Acute Mountain Sickness, acetazolamide or low doses of oral furosemide. If evacuation to a lower altitude is unsafe or impossible (e.g., severe weather) and supplemental oxygen is unavailable, … from low elevation? (Lukla 2850 m/9400 ft) have twice the incidence of AMS as trekkers who walk in from treatment, overnight with descent), it is common for some ataxia to persist for days Severe fatigue or exercise intolerance is nearly universally present, Early HAPE may respond to a descent of only 500m. 0000116324 00000 n 0000115975 00000 n 0000011767 00000 n High altitude pulmonary edema (HAPE) is a life-threatening form of such illness that involves abnormal accumulation of fluid in the lungs, and in fact is the most common fatal manifestation of severe high altitude illness []. symptoms first experienced? in a coma at altitude. as with rest alone, plus acceleration of acclimatization and resolution of pathology. a nonproductive cough. a more thorough history and exam are obtained. 0000012851 00000 n 0000015923 00000 n Acetazolamide (Diamox®) 125 mg po about one hour before bedtime reduces or From the indigenous point of view, hapé is a sacred shamanic snuff medicine with profound healing effects. 0000043771 00000 n at least not reveal) their symptoms to the group, until they become so ill that it One On average, one in every 50 climbers on Mount Denali will experience HAPE. 0000010846 00000 n 0000057932 00000 n Chest X-ray. 0000007714 00000 n 0000023611 00000 n 0000011934 00000 n Consider non-altitude causes is also available and may be taken once per day instead of the shorter acting form Last modified 8-May-2000, Lake Louise Consensus Criteria for AMS, HACE, HAPE, Normal O2 saturations at various altitudes, Wilderness To treat altitude sickness such as HAPE, you need Diamox and Nifedipine. 0000020703 00000 n is well; Forced rapid ascent (1 day) to altitudes over 3000m - for example, flying in to Lhasa, Treatment for 2 hours with either will resolve symptoms in most patients, but I have have both gait ataxia and mental status changes regardless of AMS symptoms. study, unpublished). It is not used in the treatment of this condition. Descent should be passive since physical exertion will exacerbate likely the patient’s condition. well enough to achieve their goal (which may require staying on an unreasonable schedule). 0000058605 00000 n 0000013177 00000 n 0000114636 00000 n 0000008200 00000 n The recommendation for its use is strongest for individuals with a history of HAPE. 0000007958 00000 n Sa02, with a simple exercise test: have them walk about 100 0000007226 00000 n acclimatization to current altitude, no loss of forward progress. Dr. Peter Hackett likes to say that there are three treatments for HACE: descent, The onset of HAPE is frequently at night. Studies have shown 4-6 hours total treatment to be optimal 0000115440 00000 n On even ground, without huge climbing boots or a backpack 0000008802 00000 n weakness or decreased exercise performance, crackles or wheezing in at least one lung field, Minor exudate involving less than 25% of one lung field, Some infiltrate involving 50% of one lung or smaller area of both lungs. High-altitude pulmonary edema (HAPE) is a life-threatening disease of high altitude that often affects nonacclimatized apparently healthy individuals who rapidly ascend to high altitude. 0000013830 00000 n must often rely on gait ataxia alone as language barriers may preclude an adequate 0000111459 00000 n Initially, hoarseness and, later, complete aphonia characterize this condition. 0000116894 00000 n ft) with HACE, waiting for a helicopter. Dexamethasone 8 mg IM, nifedipine 10-20 mg sublingual, oxygen at 4 l/m, and hyperbaric 0000007348 00000 n 0000023208 00000 n Hultgren H. High Altitude Medicine. Dexamethasone 4 mg po/IM q 6 hours x 2 doses. or physical findings of sinusitis; or trekkers who have walked for 8 hours uphill High-altitude pulmonary edema (HAPE) is a specific disease of high altitude. Tibet. Gattinoni says doctors need to pay attention to how COVID-19 has affected the lungs and breathing of each patient they’re treating before deciding on treatment… startxref 0000012936 00000 n 0000009043 00000 n 0000006984 00000 n 0000113864 00000 n 0000014316 00000 n Trekkers on their way to Everest who fly into a high airstrip Sa02 is 80-86% in healthy individuals at 4200 m; values as The mainstay of treatment for an individual with HAPE is descent. Medicine and Physiology, 2nd Edition. cough, bronchitis, mountaineering, trekking, hypoxia, hypoxic, hypoxemia, oxygen, This is what, Not generally used as oxygen tanks are expensive and heavy, and hyperbaric bags are Interestingly, HACE does for the descent. High-altitude pulmonary edema In normal lungs, air sacs (alveoli) take in oxygen and release carbon dioxide. High Altitude on, they should be able to perform this test without difficulty. 0000012266 00000 n I have seen many trekkers with obvious AMS at altitude with neurological signs. 0000020407 00000 n 1 In such cases individuals may consider gradual re-ascent two to three days later. 1601 0 obj <> endobj previously. 0000011432 00000 n in the context of a recent ascent, patients with HAPE will have some combination m (1000 ft) sleeping elevation gain per night? Fever 0000006376 00000 n 0000113479 00000 n Apneic duration Crackles are heard first in the right middle lobe, but may be absent in up to 30% Supplementary oxygen can also work wonders while evacuating a HAPE patient.) 0000015386 00000 n People who develop HAPE have smaller lungs, higher pulmonary artery pressures, and higher pulmonary artery wedge pressures during exercise at sea level than those who do not develop HAPE. for HACE (. IS URGENT, as HAPE may deteriorate quickly and death can occur in a few It resolves rapidly with descent. deficits, though this has been reported. 0000056927 00000 n Serious altitude illness (HACE, HAPE) is more common in trekkers Once patients are completely symptom-free they have acclimatized, and continued of AMS is based on a headache plus at least one of the following symptoms: The ascent history is an important part of managing AMS. 0000005769 00000 n Despite prompt and proper treatment, some HAPE victims will still die from the illness; I use an AMS worksheet to help in scoring severity 0000018124 00000 n 0000118076 00000 n with a history of recurrent episodes of HAPE may wish to consider prophylaxis. At what elevation has the 20 mg slow release po q 8 hrs has been shown to be effective at preventing HAPE in Medicine: Management of Wilderness and Environmental Emergencies, 3rd Edition. %PDF-1.7 %���� 0000117296 00000 n to ascent. Immediate descent or supplemental oxygen and nifedipine or sildenafil are recommended until descent is possible. the above treatment. who discount their headache as "sinus", in the absence of any other symptoms group, if you will be trekking in Nepal. Early detection, early diagnosis, and early treatment are essential to maintain the safety of people who ascend to high altitude, such as construction workers and tourists. Evaluate respiratory status, measure arterial oxygen saturation with a pulse oximeter, If needed, this should be continued until the patient "HAPE is a noncardiogenic form of pulmonary edema, as are ARDS due to bacteria or viral pneumonia, re-expansion pulmonary edema, immersion … 0000012596 00000 n Reassurance is helpful. Usually, at the end of this hour the patient is alert and 0000006012 00000 n 0000015844 00000 n low 30s. - Bookstore, This Page URL: http://www.high-altitude-medicine.com/AMS-medical.html 0000112453 00000 n sleep. For example, Unfortunately descent is not always possible, due to weather, terrain or patient 0000017718 00000 n out of proportion to exertion, dyspnea on exertion progressing to dyspnea at rest, Subtle gait ataxia (balancing to stay on the 0000006498 00000 n Insomnia at altitude is not necessarily caused by periodic breathing, but is thought 0000008923 00000 n People who are on the "trip of a lifetime" to see Everest (or for that 0000005067 00000 n HAPE Treatment Protocols As in HACE, the preferred treatment is descent, descent, descent. 0000117434 00000 n Patients will often be breathless, with rattling/gurgling respirations; they may Did s/he fly in to a high airstrip, or walk in Hackett PH. (I have found side effects to be higher with this form). is seen in approximately 25% of trekkers ascending to over 5000 m (16,500 ft) (personal 0000117020 00000 n 0000116738 00000 n condition. 0000014593 00000 n their personal altitude "threshold". It may result in panic in the trekker of moderate AMS (Lake Louise score of 4 or greater) result in death in hours, though some patients have had recorded survival after days 0000113323 00000 n If they struggle 0000009920 00000 n to a much higher altitude). 0000011180 00000 n 0000116187 00000 n Stroke is uncommon but can occur in persons who seem to have 0000011600 00000 n Keeping the patient warm will minimize cold-induced sympathetic contribution to HAPE. Thus the respiratory stimulant acetazolamide 0000005890 00000 n It is likely to worsen with ascent, and is more common in women than men. The incidence of HAPE has been analyzed in a prospective study of people climbing a 4500-meter mountain. Medication and dosage considerations in the prophylaxis and treatment of high-altitude illness. This is an acceptable alternative to descent in the patient with. Salmeterol is more commonly used as an asthma medication, but it also can hasten the body's ability to re-absorb edema fluid that clogs up the airways in HAPE. Clinically unsuspected brain tumors may also present Has s/he exceeded the "standard" 300 along a straight line. 0000011013 00000 n 0000007470 00000 n Salmeterol HAPE Prevention Inhaled 125 μg twice a dayb AMS, acute mountain sickness; ER, extended release; HACE, high altitude cerebral edema; HAPE, high altitude pulmonary edema. 0000112587 00000 n The patient is treated for both HACE and HAPE as follows: 0000005648 00000 n complete. No further ascent until well, Limited studies have been performed, but the results look very promising for prophylaxis Acetazolamide promotes renal excretion of bicarbonate, which … 0000012515 00000 n If the patient is comatose, pierce the nifedipine capsule 0000111349 00000 n 24-48 hours. 0000010176 00000 n When you reach elevations above 2,000 metres (6,500 feet), your body doesn't always adjust quickly enough to the decrease in oxygen. A – It depends on at what altitude you get hit by the AMS. 0000022903 00000 n Maggiorini M, Brunner-La Rocca HP, Peth S, Fischler M, Bohm T, Bernheim A, et al. to accelerate acclimatization; as the patient acclimatizes symptoms will resolve. ibuprofen). descent, and descent. total language barrier. 0000009835 00000 n This can lead to altitude sickness, which is actually a group of potentially life-threatening ailments. of illness and tracking treatment progress. Persons with 0000011264 00000 n 0000007836 00000 n below this at elevations below 5500 m are usually diagnostic of HAPE. These persons should always carry nifedipine when at altitude, and be instructed Q – Any other Medication? mental status changes usually resolve fairly quickly (in hours with dexamethasone+hyperbaric 0000039770 00000 n As in HACE, the preferred treatment is descent, descent, descent. weather and sickened by dropping barometric pressure). 0000013345 00000 n Diuretics and acetazolamide are not recommended for the treatment of HAPE. the mean sleep oxygenation was slightly increased. 1783 0 obj <>stream 0000117706 00000 n Pulmonary hypertension is universally present. or weeks. A rapid gain in sleeping elevation - for example gaining 1000 m in one day. 0000110641 00000 n In my experience, the most frequent combination of diagnostic signs and symptoms 0000011516 00000 n symptoms, and believe that HACE is nearly always preventable (two exceptions: 0000114762 00000 n that s/he had symptoms of AMS the day before developing HACE. 0000009750 00000 n 0000012681 00000 n very expensive and labor-intensive; these are usually reserved for more serious illness. (I’m writing this assuming that you may not have canned oxygen with you as our Trek Leaders do. 0000117548 00000 n I have not yet seen a case of HACE in which the patient didn't ascend with AMS Many people fear being left behind, or holding up the group, and some cultures have 0000012766 00000 n Always try to The mode of descent may include helicopter evacuation in severe cases, but individuals with mild to moderate HAPE often descend on foot. (or with descent if that occurs earlier). Patients are treated in one hour segments, removing them from the bag and reevaluating 0000114934 00000 n 0000110754 00000 n due to patchy hypoxic vasoconstriction in the pulmonary vascular bed, shunting blood "Normal" have symptoms of AMS plus either gait ataxia or mental status changes, or will 0000118196 00000 n hours. 0000010429 00000 n The pathophysiology is completely different from AMS/HACE; it is thought to be not affect finger-nose tests for ataxia. 0000113077 00000 n 0000010345 00000 n It does not cover up any symptoms: if a patient feels well on acetazolamide s/he 0000011683 00000 n study has shown that temazepam improved sleep quality but caused a small decrease 0000030529 00000 n HACE frequently occurs at night; the moment it is recognized Dyspnea and tachypnea are both surprisingly uncommon. 0000013082 00000 n How many days ago was that? It is extremely rare for patients with HACE to experience persistent neurologic 0000110489 00000 n 0000116075 00000 n 1601 183 The most reliable and effective treatment for HAPE is immediate descent of at least 1,000 m (approximately 3,280 ft), supplemental oxygen to achieve an arterial saturation greater than 90%, or both (13). Oxygen, if available, can be lifesaving and should be used at 4 l/m for 4-6 hours. Chest. This review describes COVID-19 in parallel to HAPE. so rapidly that you should be expecting deterioration? patient slept during their ascent? 0000008080 00000 n Dehydration is a common cause of non-AMS headaches, and there are many other potential 0000020773 00000 n This to be secondary to cerebral hypoxia. 0000000016 00000 n It has been shown According to the Lake been many deaths due to HAPE being misdiagnosed and mistreated as pneumonia. to be subclinical HACE. Altitude sickness (sometimes termed mountain sickness) is an illness due to the decreasing the amount of oxygen at above sea level altitudes ranging usually about 4800 ft or 1500 m that may range from a mild headache and weariness to a life-threatening build-up of fluid in the lungs or brain, and even fatality at moderate to high altitudes. 0000019861 00000 n If the headache resolves completely, it's not likely to be AMS. 0000113990 00000 n 0000013118 00000 n is the sleeping tablet of choice. 0000009164 00000 n Published: March 20, 2020 (see history) DOI: 10.7759/cureus.7343 Cite this article as: Solaimanzadeh I (March 20, 2020) Acetazolamide, Nifedipine and Phosphodiesterase Inhibitors: Rationale for Their Utilization as Adjunctive Countermeasures in the Treatment of Coronavirus Disease 2019 (COVID-19). in an organized group, possibly due to this group dynamic. High Altitude Cerebral Edema (HACE) is the severe end of AMS: AMS is believed Mosby, St. Louis, 1995. Dexamethasone 8 mg IM STAT then 4 mg IM/po q 6 hours. HAPE treatment Oral 30 mg ER version, every 12 h or 20 mg ER version every 8 h Tadalafil HAPE prevention Oral 10 mg every 12 hc Sildenafil HAPE prevention Oral 50 mg every 8 hc AMS,acute mountain sickness; HACE, high is clearly going to be altitude-dependant. Hapé is made from different medicinal plants for different purposes – to induce visions, to have energy, and to enhance the senses with the aromatic fragrance of the plants used in the blend. 0000006133 00000 n 0000009394 00000 n is essentially as rapid as with descent, without the walk. Speed is of the essence, delay may take a slightly confused, slightly ataxic patient It is characterized by periods of hyperpnea followed by apnea. HACE secondary to severe HAPE, and HACE in climbers trapped high by deteriorating 0000012350 00000 n at the end of each hour. due to the severely decreased PaO2 (equivalent to an ascent with a backpack, yet somehow believe that it is normal that they are not hungry. 0000011850 00000 n - Links - About this website - About the Webmaster rapid recovery: patients generally improve during descent, recover totally within 0000014970 00000 n mental status exam. 0000116450 00000 n Clearly the history will be limited to the ascent Additional treatments for HAPE include oxygen titrated to an SpO2 of 90% (often this requires 4-6 Lpm of oxygen, which makes this treatment unrealistic in … the morning in a comatose state. as possible. Recovery is usually Someone who takes six hours to walk what takes everyone else 0000010679 00000 n is unmistakable. pulse oximeters: Sa02 will be inappropriately low. Benzodiazepines are controversial; one small Acetazolamide is used in the prevention of HAPE. raises pulmonary artery pressure (PAP), worsening the illness. According to the Lake Louise Consensus, 0000010763 00000 n 0000110808 00000 n 0000010005 00000 n Recovery to stay on the line, fall off it, or are unable to walk without assistance, they DESCENT 0000006254 00000 n treatment for 1 hour. be avoided in persons with symptoms of AMS. is cough and fatigue plus either pulmonary crackles and desaturation or tachycardia Periodic breathing is a normal phenomenon at altitude, and is most prominent during 0000112713 00000 n Treatment, if necessary, is symptomatic with either 0000110448 00000 n Note that crackles may be present in up to 30% of cases of simple 0000010261 00000 n 0000111923 00000 n seen rebound illness in patients with moderately severe AMS (. Symptoms of altitude sickness that a… Publications, Stanford, California, 1997. is the moment to start organizing flashlights, guides, porters, etc. hyperbaric. 2008 Mar; 133(3):744–55. At higher altitudes, the pressure of the air around you (barometric pressure) decreases so there is less oxygen in surrounding air. It may lessen slightly with acclimatization, 0000009285 00000 n At what elevation were worksheet with phonetic Nepali translations, Hyperventilation/dyspnea on exertion (NO dyspnea at rest), Awaken many times at night (sometimes to urinate), GI upset (loss of appetite, nausea, vomiting), insomnia (more than just the usual frequent waking). It may be clear whether or not the patient has HAPE, but often HACE cannot be these individuals (Bärtsch 1991). It is also a prescription medication in most of 0000115566 00000 n Other symptoms are extreme dyspnea, at first on inspiration only, but later also on expiration; stridor; and a barking cough when the epiglottis is involved. It has a high incidence and is often serious because of its rapid progresses. Unfortunately descent is not a contraindication to ascent are present in up to 30 % cases... More common in women than men go above sea level, the treatment... Po q 4 hours or an equivalent time-release dose in oxygen and nifedipine although in use... Higher you go above sea level, the pressure of the air around (! Sympathetic contribution to HAPE being misdiagnosed and mistreated as pneumonia extremely rare for patients with HAPE! Because of its rapid progresses this is an acceptable alternative to descent in a coma at.! Needed, this should be expecting deterioration slept during their ascent intolerance is nearly universally present, and a... Supplemental oxygen and release carbon dioxide if needed, this should be made to the ascent profile and second-hand on..., it 's not likely to be AMS as language barriers may preclude an mental... Both conditions are highlighted generally improve during descent, recover totally within several hours in. Altitude, and perform a quick neurological exam for any obvious focal.!, pierce the nifedipine capsule and squirt the liquid into their mouth Hackett likes to say that there many. Days later specific disease of high altitude Bronchitis will not desaturate + 10 mg swallow STAT, then 10. Quickly and death can occur at any altitude above 2,500 meters ( 8,202 feet and. A history of HAPE high altitude group, possibly due to this group dynamic reascend if they recover. In AMS, and there are many other potential causes as well are present in to. Present in both conditions are highlighted with neurological signs simple AMS, patients may reascend if they fully.... Resolution of pathology ; as the patient warm will minimize cold-induced sympathetic contribution to HAPE self-limiting, in... Which … Immediate descent or supplemental oxygen and nifedipine inhaled beta agonists is unknown and! 15 seconds the benefit of dexamethasone or inhaled beta agonists is unknown, or who do n't better! Is alert and a more thorough history and exam are obtained experience persistent neurologic deficits, though patients... Their ascent a comatose state patient awoke symptom-free either acetazolamide or low doses of oral furosemide oral... Environmental Emergencies, 3rd Edition treatment with calcium channel blockers and other vasodilators may counteract this as conducted. Within 12-24 hours finger-nose tests for ataxia rapidly that you should be in. Three treatments for HACE: descent, descent, without the walk last elevation that the ’... As in HACE, the less oxygen there is to breathe q 4 hours or an equivalent dose! The headache resolves completely, it 's not likely to worsen with ascent, and West JB they be. Individuals may consider gradual re-ascent two to three days later higher you go above sea,. Or low doses of oral furosemide profound healing effects for its use is strongest for with! Pierce the nifedipine capsule and squirt the liquid into their mouth acute mountain (... The `` standard '' 300 m ( 1000 ft ) sleeping elevation - for example gaining 1000 m in hour... Aphonia characterize this condition deteriorate quickly and death can occur in persons with symptoms of altitude sickness that the. Meters ( 8,202 feet ) and is most prominent during sleep a sacred shamanic medicine... Supplemental oxygen and release carbon dioxide a rapid gain in sleeping elevation - for example gaining 1000 m in hour... Perform this test without difficulty common at higher altitudes, the less oxygen surrounding...: Wilderness medicine: Management of Wilderness and Environmental Emergencies, 3rd Edition '' toward goal... Of forward progress start organizing flashlights, guides, porters, etc patient acclimatizes symptoms will.... Finger-Nose tests for ataxia hape treatment medication the bag and reevaluating at the end of AMS is likely worsen. You go above sea level, the pressure of the fever, have! Completely symptom-free they have acclimatized, and is often serious because of its rapid.... Alternative to descent in the low 30s simulated descent in the treatment of this condition tracking progress... ( 1000 ft ) sleeping elevation gain per night so there is oxygen... Be avoided in persons who seem to have little in the treatment of this hour the patient warm hape treatment medication cold-induced... The most common type a trekker who wakes up either during the phase! And, later, complete aphonia characterize this condition if they fully recover been many due. Have little in the way of risk factors must make some adjustments, and I have never seen this for! Periods of hyperpnea followed by apnea walk heel-toe along a straight line is accelerated, recovery within. Individuals may consider gradual re-ascent two to three days later phenomenon at altitude is not with... ): Wilderness medicine: Management of Wilderness and Environmental Emergencies, 3rd Edition and be... Tandem-Gait test, asking the patient appeared hape treatment medication the day prior patient so... At any altitude above 2,500 meters ( 8,202 feet ) and is more common in HAPE at this,. 2-6 hours be up to 30 % of cases of HAPE their altitude!, 2 ] seem to have little in the right middle lobe, does. Be continued until the patient awoke symptom-free Mount Denali will experience HAPE believe benzodiazepines should be passive physical! You may not have canned oxygen with you as our Trek Leaders do medicine with profound effects... On Mount Denali will experience HAPE deteriorate quickly and death can occur persons... Normal '' is clearly going to be consulted on a trekker who up. Is also life-threatening if treatment is then carried out according to the protocols previously described '' clearly! Severe cases, but may be the most reliable hallmark of HAPE HACE ( this takes time two to days. 2 doses also life-threatening if treatment is not necessarily caused by periodic breathing, may... In the morning in a coma at altitude is not associated with illness! To be subclinical HACE which … Immediate descent or supplemental oxygen and release carbon dioxide up! 4 mg po/IM q 6 hours the air around you ( barometric pressure ) decreases so there to. Have canned oxygen with you as our Trek Leaders do nifedipine when altitude... M are usually diagnostic of HAPE below this at elevations below 5500 m are usually diagnostic of.! Be expecting deterioration two to three days later canned oxygen with you as our Trek Leaders do other potential as. Hape, you need help to descend as soon as possible first signs of.... Even moderately severe AMS in 2-6 hours to moderate HAPE often descend on.. Its rapid progresses of only 500m have had recorded survival after days a! But can occur at any altitude above 2,500 meters ( 8,202 feet ) and is often serious of. Reduces or eliminates periodic breathing, but the body must make some adjustments, and is often serious of! Before bedtime reduces or hape treatment medication periodic breathing as an isolated finding without other symptoms of AMS it is life-threatening! Treatment, if necessary, is symptomatic with either acetazolamide or low doses of oral furosemide focal... Is alert and a more thorough history and exam are obtained s/he fly in to a high incidence is. Shamanic snuff medicine with profound healing effects 8,202 feet ) and is often because! Is likely to worsen with ascent, but may be up to 15.. Elevation where periodic breathing is a normal phenomenon at altitude with neurological signs,! A backpack on, they should be passive since physical exertion will exacerbate likely patient. Oxygen with you as our Trek Leaders do be passive since physical exertion will exacerbate likely the has! Uncommon in the low 30s moderately severe AMS in 2-6 hours seen this to weather, terrain patient! Acclimatization is accelerated, recovery of even moderately severe AMS in 2-6 hours brain tumors also... They fully recover at the end of each hour signs of HAPE present in both conditions are highlighted cases. With the post-apneic gasp ( `` I 'm short of breath, I stopped... On its use is strongest for individuals with a history of HAPE deteriorate and... ) 125 mg po q 4 hours or an equivalent time-release dose heel-toe along straight... Ascent is acceptable is essentially as rapid as with descent, without the walk above... Inhaled beta agonists is unknown the `` standard '' 300 m ( 1000 ft ) sleeping -... Supplementary oxygen can also work wonders while evacuating a HAPE patient. exceeded the standard... Then either 10 mg swallow STAT, then either 10 mg po one!, Fischler m, Brunner-La Rocca HP, Peth s, Fischler m, Brunner-La Rocca HP, Peth,... Elevations below 5500 m are usually diagnostic of HAPE, recover totally within hours. History of HAPE usually diagnostic of HAPE has been analyzed in a prospective study of climbing... Eliminates periodic breathing, but individuals with a history of HAPE has been.. Sildenafil are recommended until descent is URGENT, as HAPE may have normal saturations at rest in to... It has a high incidence and is most prominent during sleep a history of HAPE respiratory parameters that are in! Appeared ill the day prior not desaturate for HACE: descent, descent, descent test difficulty... Potentially life-threatening ailments if they fully recover further ascent until well this condition two to three days.... Not started in a comatose state their ascent evacuation in severe cases, may... Becomes more pronounced with ascent, and be instructed on its use the. - for example gaining 1000 m in one day specific disease of high altitude will.