1. Dysbarism By
Jyme Dickson

2. What is Dysbarism?
“Medical Definition of dysbarism. : the complex of symptoms (as the bends, headache, or mental disturbance) that accompanies exposure to excessively low or rapidly changing environmental air pressure.”

3. Why do I give a F***?
Dysbarisms are Anatomical disruptions from changes to environmental pressure which lead to pathological changes that greatly affect:
a diver: The bends, decompression sickness, arterial gas emboli
Climber: acute altitude sickness, Hape, Hace
Soldier: blast injuries, TBI

4. High altitude pulmonary edema
My dysbarism report will focus on high altitude pulmonary edema. Be advised that this topic includes any condition related to changes atmospheric environment.

5. High Altitude Pulmonary Edema
Incidence
Less than 1 to 2 % of world athletes are affected by this.
0.01% of skiers in Colorado are affected each year
1 in 50 climbers of Mt. Mckinley
Symptoms and severity vary with the rate of ascent

6. High altitude pulmonary edema
Pathophysiology
Non-cardiogenic pulmonary edema
Precise pathophysiology is unknown, but it is widely thought to be related to a combination of alveolar leakage coupled with over perfusion.
Possible impaired endothelial or epithelial barrier
Intense pulmonary artery vasoconstriction

7. High Altitude Pulmonary Edema
Very little is known about hape in depth, a recent study done on deceased patients that have died as a result of hape had these findings:
“Bronchoalveolar lavages performed on patients with HAPE have also shown the fluid to have a high protein content, higher than in patients with adult respiratory distress syndrome (ARDS). The fluid was also highly cellular. Unlike ARDS, which primarily has neutrophils in the lavage fluid, HAPE fluid contains a higher percentage of alveolar macrophages. Additionally, chemotactic (leukotriene B4) and vasoactive (thromboxane B2) mediators were present in the lavage.”

9. High altitude pulmonary edema
Clinical presentation
Usually signs and symptoms occur 2-4 days after ascent.
Fatigue, weakness, and extreme lethargy
Cough, dyspnea at rest and tachypnea
Rales, cyanosis
If left untreated, this is fatal within a few hours. If timely treatment is rendered, patients usually recover fully without deficits.

10. High altitude pulmonary edema
Possible differential diagnosis
Pneumonia
High altitude bronchitis or pharyngitis
Pulmonary embolis.

11. High altitude pulmonary edema
Chest Xray findings
Patchy infiltrates with areas that are clear between the patches.
The patches may occur in one lung or in both.
Cardiomegaly may be seen with a bat wing distribution of infiltrates and kerley-b lines are absent.

12. Hape cxr

14. High altitude pulmonary edema
Treatment
Abc’s
Supplemental oxygen
Descent
Bed rest
Nifedipine (Procardia): Calcium chanel blocker for the purpose of decreasing hr and bP.
Lasix: diuresis.
Morphine: pain management.
Acetazolamide: an inhibitor of the enzyme carbonic anhydrase, secondary treatment of edema.

15. Scenario
42 year old (82kg) male extreme sports enthusiast presents to your local emergency department complaining of sob. Upon arrival he is unable to speak more than a simple yes or no, and his wife is frantic because he just got back from an aggressive climb up mount mckinley.
Wife tells you he is healthy as a horse, we’ve never had any issues in all the other things he does, but he just started to get into climbing. She states he has NKDA, takes a multivitamin, he is vegan and has never been to a hospital.

16. Scenario Initial vital signs: A&O x4, gcs 15. P:148 Bp: 88/62 RR:30
Spo2: 85%, ra
Interventions:
Iv fluids:
ABG: 7.2/48/60/19/85/-3
Cpap is applied:
F: 20/Vt: 500/Fio2:1.0/Peep:6
Abg after 30 min:
7.28/46/70/20/90/-2.6

17. Final scenario
Without intervention our patient would continue to rapidly deteriorate and be at great risk for death.
Giving the appropriate oxygen therapy is key. Our patient was nearing a respiratory failure but wasn’t quite there and I decided to be more conservative with a cpap regiment versus direct intubation as that can have potentially deleterious risks as well and I need to get his blood pressure up.
Quick o2 intervention benefitted the patient with continued life.

18. References https://www.merriam-webster.com/medical/dysbarism