Emergency Department Treatment and Disposition

Mild cases (oxygen saturation in the 90s on low-flow oxygen) at moderate altitudes (below 3500 m, 11,483 ft) may be treated at altitude with bed rest and oxygen. If supplemental oxygen and a reliable person are available, the patient may be discharged with oxygen therapy and bed rest at home or in lodgings. More severe cases should descend immediately and may require admission to a hospital at a lower altitude and, in extreme cases, intubation and mechanical ventilation. Nifedipine is of benefit but is not a substitute for descent. Some experts now use PDE-5 inhibitors such as sildenafil or tadalafil instead of nifedipine. Hyperbaric therapy, especially with a portable hyperbaric chamber (Gamow bag), has an efficacy equal to that of supplemental oxygen and is mainly helpful in prehospital settings where oxygen availability is limited.

SnuncE! Knoop KJr Stack LB. Etorrow AB, Thurman RJi The Adas of Emergency Medicine, 3rd Edition; http;/ywww,a ccesEmedicine.com

Copyright ©The McGrawHHil Companies, Inc. Alt rights reEenieii.

High-Altitude Pulmonary Edema. Chest x-ray in patient with HAPE. Note normal heart size with bilateral "patchy" pulmonary infiltrates. (Photo contributor: Peter Hackett, MD.)

Source: Knoop KJr Stack LB. Storraw AB, Thurman RJ: The Atias of Emergency Medicine, 3rd Edition: -nttp;/j/www,-accessmedici ne.com Copyright ©The McGramHHiK Companies, Inc. All rights reserved,

"Gamow Bag." Portable hyperbaric chamber (Gamow bag). A HAPE patient is being treated at 4300 m at Pheriche, Nepal. Due to orthopnea, the patient was unable to tolerate lying flat, so the bag was propped up immediately after inflation. (Photo contributor: Ken Zafren, MD.)

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