Page 187 - ATP-P 11th Ed

Signs and Symptoms
1. AMS is generally benign and self-limiting, but symptoms may become debilitating.
Worsening condition should prompt consideration of a more life-threatening condition
(HAPE or HACE).
a. AMS: Diagnosis is made in presence of headache AND one or more of the follow-
ing: anorexia, nausea, vomiting, insomnia, dizziness, lassitude, or fatigue
b. No correlation with fitness level (likely genetic predisposition)
2. HACE: Unsteady, wide, and unbalanced (ataxic) gait and altered mental status are hall-
mark signs.
3. HAPE: Dyspnea at rest is the hallmark signs. Other symptoms may include cough, SECTION 2
crackles upon auscultation, tachypnea, tachycardia, fever, central cyanosis, or low oxy-
gen saturation disproportionate to the elevation level.
Management
1. Halt ascent. Immediately descend at least 3,000 ft. for HACE, HAPE, or refractory
AMS if tactically feasible.
2. IF AMS SYMPTOMS PRESENT
a. Acetazolamide (Diamox ) 250mg PO bid UNLESS PATIENT IS ALLERGIC
®
TO SULFA
®
b. Dexamethasone (Decadron ) 4mg PO q6hr if patient is allergic to sulfa
®
If Dexamethasone (Decadron ) is administered, no further ascent until asymp-
tomatic for 24 hours after last Dexamethasone (Decadron ) dose.
®
3. IF HACE SYMPTOMS PRESENT: ATAXIA OR ALTERED MENTAL STATUS
a. Administer supplemental oxygen to bring SaO above 90% (if available).
2
b. Dexamethasone (Decadron ) 8mg IV/IM STAT, then 4mg IV/IM q6hr
®
c. Individuals with HACE should not be left alone and especially not be allowed
to descend alone.
4. IF HAPE SYMPTOMS PRESENT: SHORTNESS OF BREATH AT REST
a. Administer supplemental oxygen to bring SaO above 90% (if available)
2
b. Nifedipine (Procardia ) 30mg SR q12hr or 20mg SR q8hr if blood pressure is
®
stable
i. IF NIFEDIPINE IS NOT AVAILABLE: sildenafil (Viagra ) 50mg q8hr, or
®
tadalifil (Cialis ) 10mg q12hr
®
ii. Do not use nifedipine (Procardia ) in HACE; the drop in blood pressure
®
may worsen the symptoms of this condition.

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