High Altitude Pulmonary Edema

High Altitude Pulmonary Edema


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High altitude pulmonary edema is the abnormal accumulation of extravascular fluid in the lungs as a result of poor acclimatization. It is quite rare for the condition to affect people at an altitude of 8,000 feet above sea level or lower. The primary cause of HAPE is the low levels of oxygen present in the atmosphere. HAPE is the leading cause of death among climbers who ascend mountains at too fast a rate. Lack of oxygen triggers constriction of the small arterioles of the lung, making the blood vessels more prone to fluid leakage. This fluid leakage into the alveoli of the lungs interferes with respiration, and sets off the variety of symptoms listed below.

Symptoms
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Pulmonary edema

  • tight chest
  • ataxia
  • congestion
  • cough, accompanied by phlegm and/or blood
  • extreme fatigue & weakness
  • breathlessness at rest
  • rapid pulse
  • fever
  • crackling noises from chest
  • excessive perspiration
  • cyanosis (blue/purple coloration of the skin)
  • symptoms worsen at night


Why Suarez was affected


It is still unclear as to which people high altitude pulmonary edema affects. Physical conditioning does not seem to play a significant role in one's susceptibility to the condition. Suarez should have stopped scaling the mountain when he first exhibited HAPE-like symptoms at the Plaza de Mulas base camp. Instead, he decided to continue on with Luis and Romero before having to stop 4,000 feet higher up. Some scientists hypothesize that vulnerability to HAPE has genetic roots, although no substantial evidence has been found. HAPE tends to affect people with smaller lungs and higher pulmonary artery pressure. For reasons that are still unclear, HAPE seems to most commonly affect young males.

Treatment


As is the case with most altitude-induced sicknesses, the most effective and efficient method of treatment is to rest, avoid physical activity, and descend as quickly as possible. In the case of HAPE, which drains the patient of all energy and raises pulmonary artery pressure, the patient may need to be carried down the mountain. In any case, descending is vital because patients can deteriorate rapidly and death can occur instantaneously. The patient should use an oxygen tank, if available. While the patient moves to a lower elevation, there are several other forms of medication he or she can take to improve his or her condition.
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A hyperbaric bag


Procardia: This drug works to relieve symptoms by pulmonary vasodilatation, helping to stop the pulmonary hypertension that caused the initial high-pressure leak in the lungs. Oxygen absorption also generally improves after taking procardia.

Diamox: This drug increases breathing rate to metabolize oxygen and alleviate symptoms regarding hypoxic stress.

Hyperbaric bag: A hyperbaric bag is helpful in treating severe forms of altitude sickness because it simulates mountain descent. After the patient is completely enclosed in the bag, the bag is inflated to a significantly higher pressure than the surrounding atmospheric pressure, thereby replicating an atmosphere characteristic of one closer to sea level. Oxygen saturation will improve in this physiological descent, and the patient should experience dramatic improvements.

Diuretics: Among other things, diuretics treat high blood pressure and edema. Diuretics reduce pressure on the walls of arteries by ridding the body of sodium and water. They stimulate the kidneys to saturate urine with sodium and with it taking the water from your blood. This decrease in the amount of liquid flowing through your body reduces blood pressure and swelling.

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