Page 90 - PJ MED OPS Handbook 8th Ed

Management:
1. Halt ascent. Immediately descend at least 3,000ft 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 asymptomatic for 24 hours after last dexa-
methasone dose.
3. IF HACE SYMPTOMS PRESENT: ATAXIA OR ALTERED MENTAL STATUS
a. Administer supplemental oxygen to bring SpO2 above 90% (if available)
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 SpO2 above 90% (if available)
b. Nifedipine (Procardia) 30mg SR q24hr. Consider albuterol (Ventolin) 2 inhalations q6hr
as an adjunct treatment.

WARNING Do not use Nifedipine in HACE; the drop in blood pressure may worsen the symptoms
of this condition.
c. Minimize patient exertion during descent for HAPE since this will exacerbate symptoms.
5. Treat per Pain Management Protocol, but avoid the use of narcotics since they may depress
respiratory drive and worsen high altitude illness.
6. Zofran (4mg IV q4hr PRN) for nausea.
7. For signs or symptoms of either HAPE or HACE: If immediate descent is not tactically feasible and
a GAMOW bag is available, use a GAMOW bag in 1-hour treatment sessions with bag inflated to
a pressure of 2psi (approximately 100mmHg) above ambient pressure. Four or five sessions are
typical for effective treatment. GAMOW BAG TREATMENT IS NOT A SUBSTITUTE FOR DESCENT.
8. Treat per Dehydration Protocol.

DISPOSITION:
1. Most cases of AMS are relatively mild, resolve in 2–3 days, and do not require evacuation.
2. Avoid vigorous activity for 3–5 days.
3. Priority evacuation for AMS patients that worsen despite therapy.
4. Urgent evacuation for patients with suspected HACE or HAPE.
5. Individuals who have recovered from HACE or HAPE should not re-ascend without medi-
cal officer clearance.

NOTE: If patient has progressive HAPE despite the above interventions, positive pressure
ventilations (BVM, intubation/ventilator) is definitive treatment.

88 n Pararescue Medical Operations Handbook / 8th Edition