Red flags
- HAPE (dyspnoea at rest, pink frothy sputum)
- HACE (ataxia, altered mental state)
- Retinal haemorrhage
First steps
- Descend 500-1000 m
- O₂
- Portable hyperbaric bag if descent impossible
Key investigations
- Clinical diagnosis; USS for HAPE (lung comets)
Differentials
- Pneumonia, PE, hypothermia
Initial management
- AMS: acetazolamide 250 mg BD, ibuprofen
- HAPE: nifedipine 30 mg MR BD, PDE5i, descend + O₂
- HACE: dexamethasone 8 mg then 4 mg q6h, descend
Referral
- Retrieval / evacuation team
AI clinical assessment
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