High Altitude Pulmonary Edema
Severe AMS can also take the form of High Altitude Pulmonary Edema (HAPE.) This is where excess fluid develops in the lungs, either in the lung tissue itself or in the space normally used for gas exchange. This means individuals are unable to perform gas exchange properly, and so person cannot get enough oxygen to function normally. It is caused, again, by poor acclimatisation and is often more common in males, although it is not clear whether this is behaviour related or due to genetic susceptibility. HAPE can occur without the traditional signs of AMS. Indications of HAPE include:
- Difficulty walking or inability to keep up
- A tight-feeling chest
- A chesty cough, possibly accompanied first by a clear phlegm and later by blood.
- Extreme fatigue/weakness
- Gurgling sound whilst breathing. If you place an ear to the victim’s chest, you may hear crackling or gurgling noises.
- Poor judgement
- Breathlessness during rest
- Rapid heart rate (90 to 100 bpm at rest)
- Blue/grey lips or fingernails (cyanosis)
- Fever of up to 101.3° F/38.5° C
- Profuse perspiration
- All symptoms are worse at night
Treatment is the same as for HACE. Immediate descent in this case is hindered by the person’s lack of energy, slowed movement, and again, confusion. Unfortunately HAPE, because of its nature can worsen with stress on the body. If oxygen is demanded by the body for strenuous physical activities such as in descent, and due to HAPE and altitude the lungs capability is reduced, the person is likely to worsen their symptoms. However, once at a lower altitude the person may be able to make a full recovery. As with HACE, when the symptoms are completely cleared up cautious ascent can continue.
In addition to descent oxygen should be administered, if it is available, through a mask at anything up to 10 l/m, depending on the severity. It is unlikely that the person will recover until either oxygen is given, or a considerable descent is achieved.
If descent is necessary then the person should always be accompanied by a healthy person. If the person has to be carried then try to keep them in a seated position. Make sure too that they are warm.
Once a person has been diagnosed with HAPE in any stage, they should avoid high altitude until cleared by a doctor, though it
should be noted that this does not include aeroplanes.
HAPE is often confused with other respiratory conditions:
- The Khumbu Cough (High Altitude Hack) and Bronchitis, both of which are characterised by a stubborn hacking cough, and can be with or without phlegm. The difference is that with HAC and HAB a person will have a normal breathing rate at rest, and won’t be excessively tired.
- Pneumonia. Almost all of the signs which indicate pneumonia are exactly the same as HAPE. The only way to tell is by descending.
If the person gets better then it was most likely to be HAPE, whereas if the condition persists then antibiotics may work. HAPE is
more prevalent at altitude, but even so there seems to be reluctance in diagnosing it. Many people with HAPE are wrongly diagnosed
and are treated instead for pneumonia, with fatal results.
- Asthma. Being out of breath teamed with a gurgling cough are all too familiar with asthmatics. Again, only treatment will tell
which it is, and if a descent doesn’t work then treat using asthma medication.