HIGH-ALTITUDE CEREBRAL EDEMA (HACE)

Post #5 of 6:

The most recent issue of the Wilderness Medicine Newsletter, Nov/Dec 2006, is dedicated to the recognition and management of high altitude illnesses.  To follow is a series of postings regarding high altitude illnesses, recognition and management.

HIGH-ALTITUDE CEREBRAL EDEMA (HACE)
The majority of cases of HACE occur because they continued to ascend while they still had the symptoms of Acute Mountain Sickness.
Signs & Symptoms: Severe AMS plus

Change in mentation or the ability to think and solve simple problems
Loss of coordination – ataxia, can be subtle but cannot tandem-gait walk
Possible hallucinations
Drowsiness
Coma
Cheyne-stokes respirations
Signs of increasing Intracranial Pressure (ICP)

Treatment:

IMMEDIATE RAPID DESCENT at least 500 – 1000 meters
If unable to descend, place in pressure bag, Gamow, Cretec, or PAC bag
Administer O2 if available, 4-6 lpm by nasal cannula or with PEEP
Hydrate if conscious
Monitor SaO2 by pulse oximeter

Drugs:

Dexamethasone (Decadron), 8mg po or IM stat, then 4mg po or IM q6h
Oxygen, 4-6lpm by nasal cannula or with PEEP, titrate as needed

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