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High-Altitude Illness: Updates in Prevention, Identification, and Treatment
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Publication Date: September 2021 (Volume 23, Number 9)

CME Credits: 4 AMA PRA Category 1 Credits™, 4 ACEP Category I credits, 4 AAFP Prescribed credits, and 4 AOA Category 2-A or 2-B CME credits. CME expires 09/01/2024.

Author

Ninad A. Shroff, MD, FAAEM
Associate Program Director, Emergency Medicine Residency, St. Joseph’s University Medical Center, Paterson, NJ
Jerome Balbin, MD
Medical Director of Simulation/Core Faculty/ Attending Physician, Department of Emergency Medicine, St. Joseph’s University Medical Center, Paterson, NJ
Oluwaseun Shobitan, MD
Attending Physician, East Orange General Hospital, East Orange, NJ

Peer Reviewers

Charlotte Goldfine, MD
Department of Emergency Medicine, Division of Medical Toxicology, Brigham and Women’s Hospital, Boston, MA
Ryan LaFollette, MD
Assistant Program Director, Assistant Professor, University of Cincinnati Emergency Medicine, Cincinnati, OH

Abstract

High-altitude illness is a continuum of syndromes that includes the potential for death. Understanding how to prevent altitude illness and how to treat it if it occurs is fundamental to trip planning and is an important role of medical advisors to travelers. Gradual ascent, along with pharmacotherapy where indicated, are the mainstays of prevention. Travelers with certain chronic medical conditions may require additional pretravel counseling and preparation. Diagnostic recognition of the differing manifestations of high-altitude illness as well as recommendations on appropriate therapeutic options are discussed in detail.

Case Presentations

CASE 1
At 3400 m altitude you meet a woman who says she has a headache and feels “run-down”…

You have flown into Cusco, Peru (3400 m) to join a tour group that plans to hike the Inca Trail to Machu Picchu. During the evening of your arrival, you attend a welcome dinner with your group, where you meet a 29-year-old female fellow traveler from Miami who also flew in earlier in the day. As she gets up to leave the dinner early, she says she has a mild headache and feels generally run-down. You wonder if you should be concerned for her...

CASE 2
At 4730 m altitude, you meet a man who is having difficulty walking and is vomiting…

You are on an expedition to trek Mount Kilimanjaro. You have limited time, so you decided to do the 5-day Marangu route. At the end of day 3, you arrive at Kibo Hut (4730 m). As you are settling in to sleep for the night, you notice a 57-year-old man, also on your trek, who is walking with an unsteady gait and is vomiting. The expedition lead guide is unable to communicate with medical command, and he asks you for advice. You consider the options but know there is only one good one...

CASE 3
At 2860 m altitude, you meet a man who is coughing and says he has “caught a cold”…

While embarking on your own guided trek into the Mount Everest region, you run into a 45-year-old man who had arrived into the Tenzing-Hillary Airport in Lukla, Nepal (2860 m) a few hours prior. He appears to be struggling hauling his backpack. When you ask him if he needs assistance, he mentions that he flew from London into Kathmandu 2 days prior and states that he seems to have “caught a cold” during his travels. He appears short of breath and you notice he is coughing up pinkish-white sputum. You wonder if he has more than just a cold and whether you should intervene...

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