High altitude pulmonary oedema (HAPE) is a well-known potential hazard of activities at high altitudes but not a common disease presentation that most emergency physicians have experience treating. The mainstay of treatment is intuitive—early recognition with immediate descent, rest and oxygen—but what does the emergency physician do when a patient is in severe distress from HAPE even after descent to sea level? A case of severe HAPE is presented in a young man; the successful treatment strategy is outlined including non-invasive positive pressure ventilation. The role of calcium antagonists, corticosteroids and phosphodiesterase inhibitors are also discussed in the acute management of this potentially life-threatening condition.
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