Pediatric emergency medicine trisk 1959 1959
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AMS. AMS is defined as having a headache in the setting of at least one of four
other symptoms: nausea/vomiting, fatigue, difficulty sleeping, and dizziness.
Vasogenic edema is believed to explain the pathophysiology underlying AMS,
with clinical progression to encephalopathy occurring as cerebral edema, or
HACE, worsens. HAPE is the most common cause of death when exposed to
high altitudes; younger individuals may be more susceptible to HAPE because of
immature control of breathing and frequent respiratory illnesses. Pulmonary
vascular leak leads to elevated pulmonary artery pressures. Pediatric patients with
HAPE should undergo evaluation for cardiopulmonary abnormalities such as
structural heart disease and pulmonary hypertension.
Triage and Initial Assessment
The recognition of altitude illness depends mainly on a compatible history of
exposure to high altitude. Children may be at risk for high-altitude illness when
traveling from low altitude to high altitude (sporting events, family vacations,
school activities), returning to high altitude after traveling to low altitude, or
when having a respiratory illness at high altitude without changes in elevation.
Intermediate altitude is defined as 1,520 to 2,440 m (5,000 to 8,000 ft), high
altitude as 2,440 to 4,270 m (8,000 to 14,000 ft), very high altitude as 4,270 to
5,490 m (14,000 to 18,000 ft) and extreme altitude as greater than 5,490 m
(18,000 ft).
Initial Assessment
The diagnosis of altitude illness in children can be challenging, especially in the
preverbal age group. Factors that affect whether an individual gets sick include
the altitude itself, rate of ascent, the altitude where sleeping occurs routinely, and
the individual’s physiology. Information regarding any potential genetic basis of
high-altitude illness is limited. However, from an anatomical perspective, those
who are able to tolerate brain swelling (i.e., the elderly whose brain size
diminishes with age, or infants with their immature sutures and open fontanelles)
are less susceptible to altitude illnesses.
Management and Diagnostic Studies
Treatment for HAH and mild AMS includes stopping the ascent and
acclimatizing at the current altitude; acetazolamide given early will hasten this
process and remains the best choice for prevention of AMS. Analgesics,
hydration, and antiemetics are also given for supportive care. Phosphodiesterase
inhibitors such as sildenafil have shown promise in prevention of HAPE in
patients with AMS.
