Environ

High Altitude Cerebral Edema

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High Altitude Cerebral Edema, HACE

  • Pathophysiology
  1. End-stage High Altitude Sickness
  2. Course from mild Ataxia to death can occur within hours
  • Signs
  1. Ataxia
    1. Screening: Heal-toe walking in a straight line
  2. Altered Mental Status
  • 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
  • Management
  1. See High Altitude Sickness
  2. Gamow Bag
  3. Descend Immediately by at least 1000 meters (even 500 meters may be sufficient)
  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