Pediatric emergency medicine trisk 1960 1960
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Once AMS worsens, low-flow oxygen should be given in conjunction with
acetazolamide and/or dexamethasone, and either HBO therapy with a portable
compartment or immediate descent should occur. Therapy should be more
aggressive if HACE ensues, with dexamethasone administered in addition to
oxygen, HBO, head elevation to 30 degrees in the supine position, and immediate
descent or evacuation. The addition of the calcium-channel blocker nifedipine
will reduce pulmonary vascular pressures in patients with HAPE. Exertion should
be limited, oxygen provided, and either HBO or immediate descent arranged.
Recently, portable hyperbaric chambers that weigh less than 4 kg have been
developed and can be lifesaving if descent is not possible. Descent is the
definitive treatment for all forms of altitude illness but may not always be feasible
due to weather or other barriers.
Prevention
Prevention efforts may minimize an individual’s chance of developing altitude
illness. For example, different formulas exist regarding ideal ascent rates (i.e.,
above 3,000 m [9,842 ft], sleeping elevations should not exceed the previous day
by more than 300 to 500 m and rest should occur every 3 days), following the
mantra of “climb high, sleep low.” If physically fit individuals follow such
climbing guidelines, prophylaxis with acetazolamide is not typically required.
However, because of the ease of getting to high elevations via car or airplane,
individuals who ascend quickly, and/or have significant underlying diseases
(hepatic, renal, or cardiopulmonary dysfunction in particular) may warrant
acetazolamide prophylaxis. Most sources recommend using 250 mg
acetazolamide twice daily, with pediatric dosing extrapolated from acetazolamide
dosing for edema at 5 to 10 mg/kg/dose every 6 hours, not to exceed 1 g/day.
Care should be taken in the individual with a sulfa allergy because acetazolamide
contains a sulfa moiety. While the incidence of cross-reactivity is low at 7% to
10% in patients with a self-reported sulfa allergy, anaphylaxis has been reported,
and thus use of dexamethasone may be more prudent in these cases.
ELECTRICAL INJURIES
Goals of Treatment
The goals of emergency therapy are stabilization of cardiopulmonary status,
treatment of external injuries, and assessment for potential internal injuries.
CLINICAL PEARLS AND PITFALLS
