HAPO & HACO.pptx

hapo and haco

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 SpO 2  levels at altitude [ Altitude SpO 2 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.

12. 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.

13. 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

14. 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 .

15. HACO

16. 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.

17. 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.

18. PATHOPHYSIOLOGY OF HACO

19. 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.

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

21. 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

22. 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.

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

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

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