Once AMS worsens, low-flow oxygen should be given in conjunction with acetazolamide and/or dexamethasone, and either HBO therapy with a portable compartment or immediate descent should occur Therapy should be more aggressive if HACE ensues, with dexamethasone administered in addition to oxygen, HBO, head elevation to 30 degrees in the supine position, and immediate descent or evacuation The addition of the calcium-channel blocker nifedipine will reduce pulmonary vascular pressures in patients with HAPE Exertion should be limited, oxygen provided, and either HBO or immediate descent arranged Recently, portable hyperbaric chambers that weigh less than kg have been developed and can be lifesaving if descent is not possible Descent is the definitive treatment for all forms of altitude illness but may not always be feasible due to weather or other barriers Prevention Prevention efforts may minimize an individual’s chance of developing altitude illness For example, different formulas exist regarding ideal ascent rates (i.e., above 3,000 m [9,842 ft], sleeping elevations should not exceed the previous day by more than 300 to 500 m and rest should occur every days), following the mantra of “climb high, sleep low.” If physically fit individuals follow such climbing guidelines, prophylaxis with acetazolamide is not typically required However, because of the ease of getting to high elevations via car or airplane, individuals who ascend quickly, and/or have significant underlying diseases (hepatic, renal, or cardiopulmonary dysfunction in particular) may warrant acetazolamide prophylaxis Most sources recommend using 250 mg acetazolamide twice daily, with pediatric dosing extrapolated from acetazolamide dosing for edema at to 10 mg/kg/dose every hours, not to exceed g/day Care should be taken in the individual with a sulfa allergy because acetazolamide contains a sulfa moiety While the incidence of cross-reactivity is low at 7% to 10% in patients with a self-reported sulfa allergy, anaphylaxis has been reported, and thus use of dexamethasone may be more prudent in these cases ELECTRICAL INJURIES Goals of Treatment The goals of emergency therapy are stabilization of cardiopulmonary status, treatment of external injuries, and assessment for potential internal injuries CLINICAL PEARLS AND PITFALLS