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High-altitude cerebral oedema — DIPIMC MCQ

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HardEnvironmental MedicineHigh-altitude cerebral oedemaDIPIMCDipIMC

A trekker at 4,500 metres becomes confused and ataxic over several hours, with a severe headache and vomiting, having ascended rapidly. What is the single most important management step?

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Correct answer: D — Arrange immediate descent, with oxygen and dexamethasone if available

Ataxia and confusion at altitude indicate high-altitude cerebral oedema, and the single most important intervention is immediate descent, supported by oxygen and dexamethasone where available, with a portable hyperbaric bag if descent is delayed. Continuing to ascend or resting at the same altitude allows the oedema to progress and can be fatal. Sedatives can mask deterioration and depress respiration. Pearl: descent is the definitive treatment for both high-altitude cerebral and pulmonary oedema and should not be delayed.

Reference: JRCALC Clinical Guidelines