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Emergency Maneuver in High-Altitude Pulmonary Edema

Jerry Bock; Herbert N. Hultgren, MD
JAMA. 1986;255(23):3245-3246. doi:10.1001/jama.1986.03370230051014.
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To the Editor.—  Patients with high-altitude pulmonary edema (HAPE) may occasionally experience alveolar flooding and fluid-filled airways caused by copious amounts of pulmonary edema fluid. The mechanism of death in such cases is usually asphyxiation within a few hours unless prompt descent can be achieved or high-flow oxygen therapy is administered.1 For this reason, a personal observation of what was probably a life-saving maneuver to increase fluid removal from the airways in a patient with a severe episode of HAPE is described herein.

Report of a Case.—  A 33-year-old experienced mountaineer had a history of episodes of HAPE experienced while camping and climbing in the Sierra Nevadas above 3,050 m (10,000 ft). While on a trek in Nepal, HAPE developed at an altitude of 5,100 m (16,700 ft). The only evacuation route involved crossing a 5,800-m (19,000-ft) pass where the group was forced to camp. During the evening, the


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