This document discusses two high altitude illnesses: high altitude pulmonary edema (HAPO) and high altitude cerebral edema (HACO). HAPO typically occurs in lowlanders who rapidly ascend to altitudes above 2,500-3,000 meters and is characterized by noncardiogenic pulmonary edema. HACO is a severe form of acute mountain sickness associated with ataxia, fatigue and altered mental status. The main treatment for both illnesses is immediate descent to lower altitudes. Supplemental oxygen and medications like dexamethasone may help reduce symptoms but do not replace the need to descend. Proper nursing care involves monitoring, positioning, administering medications and fluids, and using steroids. Port

1. HAPO & HACO
LT COL BIJAYA SAHA

2. INTRODUCTION
• High altitude pulmonary Oedema (HAPO) is a noncardiogenic
pulmonary edema that typically occurs in lowlanders who ascend
rapidly to altitudes greater than 2500-3000 m.
• at altitudes typically above 2,500 meters (8,200 ft).
• However, cases have also been reported between 1,500–2,500
metres or 4,900–8,200 feet in more vulnerable subjects.

3. Defining altitude
High altitude
1,500 to 3,500 metres (4,900 to
11,500 ft)
Very high altitude
3,500 to 5,500 metres (11,500 to
18,000 ft)
Extreme altitude
5,500 to 8,850 metres (18,000 to
29,000 ft)

4. Signs and symptoms
In the presence of a recent gain in altitude, the presence of the following:
• Symptoms: at least two of:
• Shortness of breath at rest
• Cough
• Weakness or decreased exercise performance
• Chest tightness or congestion
Signs: at least two of:
• Crackles or wheezing in at least one lung field
• Central blue skin color
• Tachypnea
• Tachycardia

5. PATHOPHYSIOLOGY

6. Chest X-ray showing high altitude pulmonary
edema
showing characteristic patchy
alveolar infiltrates with right
middle lobe predominance.

7. Expected SpO2 levels at altitude[
Altitude SpO2
1,500 to 3,500 m
4,900 to 11,500 ft
about 90%
3,500 to 5,500 m
11,500 to 18,000 ft
75–85%
5,500 to 8,850 m
18,000 to 29,000 ft
58–75%

8. Prevention
Above 3,000 meters (9,800 ft), climbers should
• not increase the sleeping elevation by more than 500 meters (1,600
ft) a day, and
• include a rest day every 3–4 days (i.e., no additional ascent)

9. Prevention - medication
• nifedipine,a pulmonary vasodilator that prevents the altitude-
induced pulmonary hypertension.
• Treatment is most effective if given one day prior to ascent and
continued for four to five days, or until descent below 2,500 meters
(8,200 ft).

10. Treatment
• Immediate improvement of oxygenation either by supplemental
oxygen, hyperbaric treatment, or by rapid descent .

11. HAPO chamber
• One man HAPO chamber is a life saving device that provides
emergency treatment to HAPO victim by enhancing the partial
pressure of the breathing air inside the chamber.
• 300 chambers have been inducted into Army and induction of 642 is
under process.

13. HAPO CHAMBER
• It works on the principle of increasing the atmospheric pressure
around the patient
• thereby simulating descent in altitude by about 6,000-8,000 ft in a
controlled manner.

14. Salient features of HAPO Chamber:
• Made from lightweight double texture neoprene coated nylon fabric
• Has provision for controlled escape of carbon dioxide
• Pressure sensor for cut-in and cut off
• Provided with pressure relief safety valve
• Provided with Transparent polycarbonate sheet
• Provided with a wiper mechanism for clarity
• Heavy Duty Air and Waterproof zipper
• Provided with lightweight Carry rods
• Provided with foot pump

15. Nursing mgt of HAPO
Impaired Gas Exchange Interventions
1. Elevate the head of the bed or place the patient on their side.
• For optimal breathing and to avoid obstruction from secretions, turn the
patient on their side or raise the head of the bed.
2. Apply oxygen.
• Supplemental oxygen is often required to maintain oxygen saturation.
3. Regularly check the ABGs.
• ABGs show progress or deterioration in the lung’s ability to exchange
oxygen and CO2.
4. Cautiously use diuretics as prescribed.

16. HACO

17. INTRODUCTION
• High-altitude cerebral Oedema (HACO) is a medical condition in which
the brain swells with fluid because of the physiological effects of
traveling to a high altitude.
• is a severe and potentially fatal condition associated with high
altitude illness that is often thought of as a late or end-stage acute
mountain sickness (AMS). It is often characterized by ataxia, fatigue,
and altered mental status.

18. Signs and symptoms
• It is often characterized by ataxia, fatigue, and altered mental status.
• Ataxia is a term for a group of disorders that affect coordination,
balance, and speech. Any part of the body can be affected, but
people with ataxia often have difficulties with balance and walking.
speaking.

19. PATHOPHYSIOLOGY OF HACO

22. IMMEDIATE MANAGEMENT
• The mainstay of treatment is the immediate descent of at least
1000m or until symptoms improve.
• One should not descend alone and should have assistance to
minimize physical exertion, which may worsen.

23. MANAGEMENT
• portable hyperbaric chamber and/or supplemental oxygen to
temporize illness, but this should never replace or delay
evaluation/descent when possible.

24. MANAGEMENT OF HACO
• Dexamethasone
dexamethasone should be used in conjunction with
evacuation or while waiting for it.
dexamethasone 8mg for one dose, followed by 4mg
every 6 hours should be given to adults via PO, IM, or IV
routes

25. MANAGEMENT OF HACO
• Acetazolamide has proven to be beneficial in only a single clinical
study. The suggested dosing regimen for Acetazolamide is 250 mg PO,
given twice daily.

26. • Though effective in alleviating or temporizing symptoms, none of the
adjunct treatment modalities are definitive or a replacement for an
immediate descent

27. Nursing mgt of HACO
• monitoring of the person's airway ,
• proper positioning,
• medications,
• fluid management,
• steroids.

28. THANK YOU