WMS Publishes Guidelines on Acute Altitude Illness

Led by Andrew Luks MD and his colleagues, the Wilderness Medical Society has published Consensus Guidelines for the Prevention and Treatment of Acute Altitude Illness (Wild Environ Med 2010:21;146-155). These guidelines are intended to provide clinicians about best evidence-based practices, and were derived from the deliberations of an expert panel, of which I was a member. The disorders considered were acute mountain sickness (AMS), high altitude cerebral edema (HACE), and high altitude pulmonary edema (HAPE). The guidelines present the main prophylactic and therapeutic modalities for each disorder and provide recommendations for their roles in disorder management. The guidelines also provide suggested approaches to prevention and management of each disorder that incorporate the recommendations.

In outline format, here is what can be found in these Guidelines:

• Acute Mountain Sickness and High Altitude Cerebral Edema (HACE)
  • Prevention 
    • Gradual Ascent
    • Acetazolamide
    • Dexamethasone
    • Gingko biloba
    • Other options (e.g., coca leaves and tea, aspects of hydration)
  • Suggested Approach to AMS/HACE Prevention
  • Treatment
    • Descent
    • Supplemental oxygen
    • Portable hyperbaric chambers
    • Acetazolamide
    • Dexamethasone
  • Suggested Approach to AMS/HACE Treatment
• Acute Mountain Sickness and High Altitude Pulmonary Edema (HAPE)
  • Prevention
    • Gradual Ascent
    • Nifedipine
    • Salmeterol
    • Tadalafil
    • Dexamethasone
    • Acetazolamide
  • Suggested Approach to HAPE Prevention
  • Treatment
    • Descent
    • Supplemental oxygen
    • Portable hyperbaric chambers
    • Nifedipine
    • Beta-agonists
    • Phosphodiesterase inhibitors
    • Continuous positive airway pressure
    • Diuretics
  • Suggested Approach to HAPE Treatment
• Suggested Approach for Patients with Concurrent HAPE and HACE