Page 186 - ATP-P 11th Ed

ALTITUDE ILLNESS PROTOCOL

SPECIAL CONSIDERATIONS
ACUTE MOUNTAIN SICKNESS (AMS)
1. Usually occurs at altitudes of 8,000 ft. and higher
2. Consider pretreatment when rapid ascent to altitudes above 8,000 ft. may occur:
a.
Acetazolamide (Diamox ) 125mg bid started 24 hours before ascent
SECTION 2 b. cent for patients allergic to sulfa drugs
®
Dexamethasone (Decadron ) 4mg PO bid started 24 hours before as-
®
3. Consider pretreatment if rapid ascent above 11,500 ft. occurs (as with airlifts):
a. Dexamethasone (Decadron ) 4mg PO q6hr within 24 hours of ascent
®
plus acetazolamide (Diamox ) 125mg PO bid (if not allergic to sulfa)
®
4. Symptoms may occur as quickly as 3 hours after ascent.
5. Can avoid onset by limiting initial ascent to no higher than 8,000 ft. then 1,000 ft.
per day thereafter. The key to prevention is slow, gradual ascent.
HIGH ALTITUDE CEREBRAL EDEMA (HACE)
1. Rare below 11,500 ft.
2. Headache is common at altitude. Ataxia and altered mental status at altitude are
HACE until proven otherwise.
HIGH ALTITUDE PULMONARY EDEMA (HAPE)
1. Caused by the hypoxia of altitude, HAPE is the most common cause of death
from altitude illness.
2. Usually occurs above 8,000 ft. Respiratory distress at high altitude is HAPE
until proven otherwise.
3. Nifedipine (Procardia ) is recommended as prophylaxis in personnel who have a
®
history of previous HAPE and are required to operate at altitude. Acetazolamide
(Diamox ), sildenafil (Viagra ), tadalafil (Cialis ), dexamethasone (Decadron ),
®
®
®
®
salmeterol (Serevent ), and albuterol (Proventil ) may be considered if nifedipine
®
®
(Procardia ) is not available.
®
HACE AND HAPE MAY COEXIST IN THE SAME PATIENT!

176 SECTION 2 TACTICAL MEDICAL EMERGENCY PROTOCOLS (TMEPs) ATP-P Handbook 11th Edition 177