Suggested Addition to Wilderness Medical Society Snow Burial Guidelines

In our opinion, point-of-care ultrasound diagnosis of HACE should not be based on single-point ONSD values but rather on serial measurements over time.Practitioners should be aware of the limitations of B-scan ultrasonography and always correlate the obtained images with the available clinical information.Owing to the lack of evidence and the practical limitations of the A-scan, we currently recommend the use of the B-scan for the evaluation of patients with a clinical suspicion of HACE.A comparison of A-scan and B-scan techniques for the detection of HACE could be an interesting topic for future research.In conclusion, we believe that serial ONSD measurement using B-scan ultrasonography can be a valuable tool to assist in the diagnosis of patients with HACE in remote, high altitude environments.