Page 35 - 2026 SMOG

ALTITUDE ILLNESS
Signs and Symptoms
Acute Mountain Sickness High Altitude Cerebral High Altitude Pulmonary
(AMS) Edema (HACE) Edema (HAPE)
• Headache • Presence of AMS • Tachycardia
• Nausea/Vomiting • Ataxia • Tachypnea
• Lethargy • Altered mental status • Crackles/wheezing
• Weakness/Dizziness • Central Cyanosis
• Anorexia • Cough
• Dyspnea at rest
• Pink frothy sputum
Treatment
• For all:
˚ O (100% FiO ), IV/IO Access, Cardiac monitor
2
2
˚ Descend as soon as possible (Consider Gamow bag if unable)
˚ Hypothermia prevention
Note to aircrew—fly at the lowest allowable altitude
˚
• HAPE—Pulmonary Symptoms
˚ Nifedipine (extended release) 30mg PO q12hr
OR
Nifedipine (immediate release) 20mg PO q8hr
˚ Consider assisted ventilation
• HACE—Headache with altered mental status or ataxia
˚ Dexamethasone 8mg IV/IO/PO x1, then 4mg q6hr until asymptomatic
Pediatric: 0.15mg/kg IM/IV/PO q6hr (max dose: 4mg/dose)
■
˚ Acetazolamide 250mg PO q12hr
• AMS—Headache without altered mental status or ataxia
˚ Acetazolamide 250mg PO q12hr (avoid with sulfa allergy/sickle cell)
Pediatric: 2.5mg/kg PO q12hr (max dose: 250mg/dose)
■
˚ Severe AMS: Add Dexamethasone 4mg IV/IO/PO
• For altitude-related headache (in isolation or with AMS/HACE), consider
˚ Acetaminophen 650–100mg PO
˚ Ibuprofen 600–800mg PO
Notes, Warnings, Cautions
• The treatment of choice for all altitude-related illnesses is supplemental O and descent—at
2
least 300–1000m. If unable to descend, use a hyperbaric bag (Gamow bag) if available.
• HAPE and HACE are severe; consider hospitalization for these cases. AMS may be managed
well with outpatient treatment.
• HAPE patients may have crackles/fever/hypoxia. Be prepared to consider asthma, PE,
pneumonia, or other diagnoses as well.
• HACE patients have AMS and may have tremors. HACE may occur along with HAPE.
˚ ANY altered mental status/confusion/abnormal gait should be presumed to have cerebral
edema, and descent should be undertaken immediately.
˚ *Descent should be done with the least amount of patient exertion possible to prevent
worsening of the condition.
Reference: CPG ID #95 (Altitude Emergencies in the Prehospital Environment)
2026 Standard Medical Operating Guidelines (SMOG) • 27