HAPE Treatment Guidelines

Transcription

1 HAPE Treatment Guidelines Approved by Version Number 0 16 December 2006 Active Divisions/Departments (McMurdo, South Pole) Raytheon Polar Services Company Medical Department Hard Copy Not Controlled Controlled Copy Available On-line

2 Table of Contents Table of Contents i Purpose 1 Scope/Applicability 1 Terms and Definitions 1 Discussion 1 Treatment With Initial Diagnosis 1 Treatment Upon Arrival at McMurdo 2 Upon Return to Altitude 2 Records Management 3 Medical Department i

3 Purpose Provide alternate treatment options for High Altitude Pulmonary Edema (HAPE). Scope/Applicability Treatment guidelines for High Altitude Pulmonary Edema (HAPE) for McMurdo and South Pole Stations. Terms and Definitions High Altitude Pulmonary Edema (HAPE) A serious medical condition resulting from the accumulation of fluid in the lungs, caused by the lower barometric pressure and decreased oxygen levels that exist at high altitude. Discussion Treatment With Initial Diagnosis: Oxygen titrate to get saturation to high 90s Bed rest, keep warm Consider Diamox 250mg BID as respiratory stimulant and means to reverse edema/leaky tissue effect of respiratory alkalosis Consider Nifedipine,10mg PO x1, followed by Nifedipine mg sustained release q12-24 hours Consider Sildenafil 50mg QD, may precipitate or exacerbate headache Consider dexamethasone 4-8mg Q 6 hours, as clinically indicated Consider Albuterol neb, then 2 puffs via MDI every 4-6 hours Medical Department Page 1 of 3

4 Descent (via Gamow transiently or via plane) as clinically indicated Consider Low sodium diet Don't forget to consider cardiogenic pulmonary edema in persons in risk-factor-range O2 during flight to McMurdo **Do NOT use sildenafil if patient has chest pain that could be cardiac (unclear safety in cardiac patients; unable to use concurrently with nitroglycerine) Treatment Upon Arrival at McMurdo: Evaluate. o o Admit to ward as clinically indicated. Supplemental oxygen to maintain pulse oxygen saturation in high 90s. Discharge to dorm with close follow-up when clinically stable Bed rest first day Continue Diamox mg BID for 2-3 days for reversal of respiratory alkalosis (persists for 2-3 days after descent) Consider Albuterol 2 puffs every 4-6 hours as clinically indicated Consider nifedepine SR 20-30mg as clinically indicated Consider dexamethasone 4mg Q 6 hours, as clinically indicated Consider Low sodium diet Prior to Return to Altitude May initiate return once oximetry stablizes at rest and with exertion, and lungs are clear. X ray as clinically necessary. o Maintain SaO2 >95% on treadmill: VS at rest; treadmill 3.2 mph with 10% incline for 3 min; vs immediately and again after 3 minutes rest. 2 days prior to departure from McMurdo, consider Diamox 500mg BID (may decrease to 250mg BID if unable to tolerate higher dose, but benefit is questionable for dose <750mg/d) Consider nifedipine SR 20-30mg BID or sildenafil 50mg QD; remain on this for first 3-4 days at altitude. Medical Department Page 2 of 3

5 Consider Dexamethasone 4-8mg q 6 hours Consider albuterol 2 puffs q6h on arrival at altitude Consider low salt diet May consider sleep with oxygen first 2 nights at altitude No exertion first 2 days at Pole, then light exertion with close monitoring. Activity level should be gradual enough that the patient can carry on normal conversation with un-labored breathing during activity. Records Management All medical information generated in the treatment of a USAP participant are maintained in printed/hand-written form in the RPSC Health Record (either the NSF Medical Record or Administrative Record, or both). RPSC Health Records are filed alphabetically in the secure area of the RPSC-HQ Medical Office, while active. The NSF Medical Records are sent to the clinic that will be supporting the participant during their deployment. When the participant re-deploys, the NSF Medical Record is returned to RPSC-HQ Medical Office and filed with the other portion of the RPSC Health Record. After an RPSC Health Record has been inactive for 5 years, it is boxed up by year last active, with alphabetic listing, and moved to secure off-site storage, managed by the Supervisor, Medical Processing. After 8 years inactivity, records are destroyed by a certified shredding company or other method approved by NSF. Listing of destroyed records, by candidate name, is sent to NSF documenting the destruction. Medical Department Page 3 of 3