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Morning Report

Nate Ostheimer, MD June 17, 2011

High Altitude Pulmonary Edema

Risk factors
Usu above 8000 feet At 14, 800 ft: 0.2-6% of population* Males Cold temperatures Pre-existing respiratory illness Vigorous exertion L>R cardiac shunts Primary Pulmonary Hypertension History of previous altitude illness
*Depends upon rate of ascent

Poor ventilatory response to hypoxia Increased sympathetic tone Exaggerated or uneven pulmonary vasoconstriction Decreased NO Increased Endothelin


Subtle non-productive cough, mild dyspnea, decreased activity tolerance, fever. URI or bronchitis can precipitate Usually within 2-4 days of being at altitude

Increased activity intolerance and dyspnea at rest Pink, frothy sputum AMS (50%)
HA, GI sx, insomnia, dizziness, lassitude/fatigue

*Can develop more precipitously in children

Hypoxia, tachycardia, crackles Elevated white count CXR: patchy infiltrates, nl heart, full pulmonary arteries

Pneumonia Acute heart failure Bronchitis Asthma PE MI

Oxygen Rest and warmth Descent Hyperbaric chambers Positive pressure Nifedipine (Rx and ppx) Sildenafil (ppx)