Altitude-Related Illness

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Scott gives us an awesome review of altitude-related illness from the mountains! From the CorePendium chapter "Altitude-Related Illness."

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Timothy P. -

I typically enjoy the Daily Dose. As a practitioner at 9,300 feet for 33 years who has been a trip physician on multiple Himalayan expeditions, I must push back.
Your presenter is a smart guy who read a lot. However...

* The Lake Louise Criteria are in all the papers and are neither practical nor workable. The Mild, Moderate, Severe categories DO work in clinical practice. You do NOT need headache PLUS ____, as the presenter said.
Acute Mountain Sickness is not linear. Like many medical entities, the patients do not always read the book.
* It's fine to talk about "ascent" when mountaineering. In the Inter-mountain West, they ARRIVE. More important is where they sleep. In Breckenridge and Taos Ski Valley, folks sleep over 9,000 feet as opposed to Vail, etc.
If they can't sleep and have no appetite, and this is worse after night #2, they need acetazolamide, headache or not..
* HAPE Rales are a LATE finding. Early RML X Ray findings precede decreased 02 sat, followed later by rales. I have treated this entity over 100 times without having the patients descend. We have a protocol.
* HAPE does NOT present like other pulmonary edema.
* Nifedipine selectively reduces right pulmonary artery pressure in this non cardiogenic pulmonary edema.
* We prefer regular nifedipine for the first dose because it works in ninety minutes. Either is fine thereafter.

* HACE. Very rare under 11,000 feet. We have not seen a single case in those 33 years at our 9,300 foot elevation clinic.

My comments, respectfully submitted.
Tim Quigley Peterson
Taos Ski Valley, NM

@skobner -

Hey Tim,

Thanks for the great comment and sharing your expertise! Your perspective is invaluable as one of the clinical experts in high altitude medicine. Not many doctors serve as the physician on Himalayan expeditions, let alone for multiple trips.

You are totally right--patients don't always follow the classic presentation of a disease, and medicine is a practice filled with many gray areas. The recognition of disease processes, specific treatment plans, and appropriate clinical application of medical science to the patient in front of us is not just determined by the textbook, but a multifactorial process that involves our own experience as clinicians, the standards of care in our community of practice, and each patient's characteristics dutifully considered.

That being said, this video is meant to be a review of the textbook information on this disease to serve as a framework for approaching this topic, using the definitions and recommendations of research consensus and society guidelines.

We'd love you to help us make this textbook better! Please reach out to us on our CorePendium chapter ( so that we can add your expertise to the fund of EM knowledge we hope to bring to the world!

Thanks again for the comment,
Scott Kobner

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