- Emergency Medicine
- Wilderness Medicine
Clinical Assistant Professor, Emergency Medicine
Fellowship: Stanford University Wilderness Medicine Fellowship (2018) CA
Residency: University of Chicago Emergency Medicine Residency IL
Medical Education: Loyola University Stritch School of Medicine (2014) IL
- Interstitial Pulmonary Edema Assessed by Lung Ultrasound on Ascent to High Altitude and Slight Association with Acute Mountain Sickness: A Prospective Observational Study HIGH ALTITUDE MEDICINE & BIOLOGY 2019
Interstitial Pulmonary Edema Assessed by Lung Ultrasound on Ascent to High Altitude and Slight Association with Acute Mountain Sickness: A Prospective Observational Study.
High altitude medicine & biology
Alsup, Carl, Grant S. Lipman, David Pomeranz, Rwo-Wen Huang, Patrick Burns, Nicholas Juul, Caleb Phillips, Carrie Jurkiewicz, Mary Cheffers, Christina Evans, Anirudh Saraswathula, Peter Baumeister, Lucinda Lai, Jessica Rainey, and Viveta Lobo. Interstitial pulmonary edema assessed by lung ultrasound on ascent to high altitude and slight association with acute mountain sickness: A prospective observational study. High Alt Med Biol. 00:000-000, 2019. Background: Acute mountain sickness (AMS) is a common disease that may have a pulmonary component, as suggested by interstitial pulmonary edema quantified by the B-line score (BLS) on ultrasound (US). This subclinical pulmonary edema has been shown to increase with ascent to high altitude and AMS severity, but has not been prospectively associated with AMS incidence in a large prospective study. Materials and Methods: This prospective observational study was part of a randomized controlled trial enrolling healthy adults over four weekends ascending White Mountain, California. Subjects were assessed by lung US and the Lake Louise Questionnaire at 4110 ft (1240 m), upon ascent to 12,500 ft (3810 m), and the next morning at 12,500 ft (3810 m). Results: Three hundred five USs in total were completed on 103 participants, with 73% total incidence of AMS. The mean (±standard deviation) BLS increased from baseline (1.15 ± 1.80) to high altitude (2.56 ± 2.86), a difference of 1.37 (±2.48) (p = 0.04). Overall BLS was found, on average, to be higher among those diagnosed with AMS than without (2.97 vs. 2.0, p = 0.04, 95% confidence interval [CI] -∞ to -0.04). The change in BLS (ΔBLS) from low altitude baseline was significantly associated with AMS (0.88 vs. 1.72, r2 = 0.023, 95% CI -∞ to -0.01, p = 0.048). Conclusions: Interstitial subclinical pulmonary edema by lung US was found to have a small but significant association with AMS.
View details for PubMedID 31045443
Altitude Sickness Prevention with Ibuprofen Relative to Acetazolamide.
The American journal of medicine
BACKGROUND: Acute mountain sickness is a common occurrence with travel to high altitude. Although previous studies of ibuprofen have shown efficacy for acute mountain sickness prevention, recommendations have been limited, as it has not been compared directly with acetazolamide, until this study.METHODS: Adult volunteers were randomized to ibuprofen 600 mg, three times daily, 4 hours before ascent or acetazolamide 125 mg, twice daily, started the night before ascent to 3810m in the White Mountains of California. The main outcome measure was acute mountain sickness incidence, using the Lake Louise Questionnaire (LLQ), with a score of >3 with headache. Sleep quality and headache severity were measured with the Groningen Sleep Quality Survey (GSQS) and a modified visual analogue scale (mVAS).RESULTS: Ninety-two participants completed the study: 45 (49%) ibuprofen and 47 (51%) acetazolamide. The incidence of acute mountain sickness was 56.5%, with ibuprofen 11% greater than acetazolamide, surpassing the predetermined 26% noninferiority margin (62.2% vs. 51.1%, 95% CI: - 11.1% to 33.5%). No difference was found in the total LLQ scores or subgroup symptoms between drugs (p=0.8). The GSQS correlated with LLQ sleep (r=0.77, 95% CI: 0.67 to 0.84) as was the mVAS with total LLQ severity (r = 0.57, 95% CI: 0.42 to 0.7). The acetazolamide group had higher SpO2 than ibuprofen (88.5% vs. 85.6%, p=0.001).CONCLUSION: Ibuprofen was slightly inferior to acetazolamide for acute mountain sickness prevention and should not be recommended over acetazolamide for rapid ascent. Average symptoms and severity were similar between drugs, suggesting prevention of disease.
View details for PubMedID 30419226
Budesonide Versus Acetazolamide for Prevention of Acute Mountain Sickness.
The American journal of medicine
2018; 131 (2)
BACKGROUND: Inhaled budesonide has been suggested as a novel prevention for acute mountain sickness. However, efficacy has not been compared with the standard acute mountain sickness prevention medication acetazolamide.METHODS: This double-blind, randomized, placebo-controlled trial compared inhaled budesonide versus oral acetazolamide versus placebo, starting the morning of ascent from 1240m (4100 ft) to 3810m (12,570 ft) over 4 hours. The primary outcome was acute mountain sickness incidence (headache and Lake Louise Questionnaire≥3 and another symptom).RESULTS: A total of 103 participants were enrolled and completed the study; 33 (32%) received budesonide, 35 (34%) acetazolamide, and 35 (34%) placebo. Demographics were not different between the groups (P>.09). Acute mountain sickness prevalence was 73%, with severe acute mountain sickness of 47%. Fewer participants in the acetazolamide group (n=15, 43%) developed acute mountain sickness compared with both budesonide (n=24, 73%) (odds ratio [OR]3.5, 95% confidence interval [CI] 1.3-10.1) and placebo (n=22, 63%) (OR0.5, 95% CI 0.2-1.2). Severe acute mountain sickness was reduced with acetazolamide (n=11, 31%) compared with both budesonide (n=18, 55%) (OR2.6, 95% CI 1-7.2) and placebo (n=19, 54%) (OR0.4, 95% CI 0.1-1), with a number needed to treat of 4.CONCLUSION: Budesonide was ineffective for the prevention of acute mountain sickness, and acetazolamide was preventive of severe acute mountain sickness taken just before rapid ascent.
View details for PubMedID 28668540