Dr Danny Marhaba
Peer Reviewer: Dr David McCreary
Weekly Advanced Group teaching at the Alfred includes a lightning learning presentation from one of our registrars. From time to time, we’ll ask them to record these talks to share their teaching with the FOAMed world.
This week featured a great talk from Dr Danny Marhaba on Altitude Sickness. Albeit not a presentation we will see often in Australia, but an important one nevertheless – particularly if you are expedition-medicine-inclined.
HAH: High Altitude Headache (An isolated headache due to hypoxic cerebral vasodilation).
AMS: Acute Mountain Sickness (HAH + Vomiting / Dizzyness / Insomnia).
HACE: High Altitude Cerebral Edema (Ataxia or AMS).
HAPE: High Altitude Pulmonary Edema.
- Every 500m Ascent, sleep 1 night at that level (can sleep 4 nights at 2000m as an exception).
- Acetazolamide 125mg PO BD started the day before ascent.
- Low flow oxygen 2-4L/min.
- If HAPE, vary oxygen and positive airway pressure aiming sats >90%.
- Start with NSAIDs for headache.
- Use Ondansetron for nausea and vomiting.
- If HACE (ataxia, somnolescence, confusion) use Dexamethasone 8mg IM/PO once, then 4mg q6h.
- If HAPE (dyspnoea, ++ sputum) use Nifedipine 10mg SL once then 60mg daily split in 2 or 3 doses.
- If headache or AMS, stop the ascent.
- If signs of HACE or HAPE. Call for help and Descend >300m if HACE, >1000m if HAPE.
- If descent is challenging can trial a portable hyperbaric chamber or call for retrieval.
Emergency Registrar, Alfred Health
He trained in regional NSW before moving back to Melbourne to complete his training at the Alfred.