Emergency Medicine Book

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High Altitude Cerebral Edema

Aka: High Altitude Cerebral Edema, HACE
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  1. Pathophysiology
    1. End-stage High Altitude Sickness
    2. Course from mild ataxia to death can occur within hours
  2. Symptoms
    1. See High Altitude Sickness
    2. Headache
  3. Signs
    1. Ataxia
      1. Screening: Heal-toe walking in a straight line
    2. Altered Mental Status
  4. Diagnosis
    1. Criteria 1
      1. Mental status changes OR ataxia and
      2. Acute Mountain Sickness criteria
    2. Criteria 2
      1. Mental status changes AND ataxia
      2. Without Acute Mountain Sickness criteria
  5. Management
    1. See High Altitude Sickness
    2. Gamow Bag
    3. Descend Immediately
    4. Dexamethasone
      1. Initial: 4-8 mg IM/IV/PO
      2. Later: 4 mg q6h IM/IV/PO
    5. High flow Supplemental Oxygen
    6. Intubation and Hyperventilation if patient comatose
  6. References
    1. Basnyat (2003) Lancet 361(9373): 1967-74
    2. Fiore (2010) Am Fam Physician 82(9): 1103-10
    3. Hackett (2001) N Engl J Med 345(2): 107-14
    4. Wu (2006) High Alt Med Biol 7(4): 275-80

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