altitude disease
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Altitude
SicknessMahesa R.
111 0211 134
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Altitude - Related Illnesses
Acute Mountain Sickness (AMS)High Altitude Pulmonary Edema (HAPE)High Altitude Cerebral Edema (HACE)High Altitude Retino athyHigh Altitude Peri heral Edema
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Acute Mountain Sickness !
Incidence
Sudden ascent " #$%$$$ &eet ('$$$ meters) ! '$
Sudden ascent " # %$$$ &eet ! *+ Can occur in those ,ith no rior roblems ,ithaltitude e osure
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Acute Mountain Sickness !
Etiology
.y ically occurs at altitude " /$$$ &eet
Rarely occurs at altitude 0$$$ to /$$$ &eet1o redeliction based on gender More likely i& !–Ra id ascent
–2ack o& acclimati3ation
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Acute Mountain Sickness !
Patho hysiology
Much indi6idual 6ariation in susce tibility7asically due to hy obaric hy o ia o&altitudeAlso in6ol6es tendency &or &luid retention(e&&ect o& antidiuretic hormone)
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s
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Acute Mountain Sickness !
E acerbating 5actorsSudden ascentE ertion soon a&ter arri6al
Alcohol intakeSedati6es (slee ing ills)1arcotics
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Acute Mountain Sickness !
Sym tomsHeadache1ausea
Anore ia2assitude?2ike a hango6er?
Insomnia4ecreased urination:nset ty ically / to ; hours a&ter ascent
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Acute Mountain Sickness !
4i&&erential 4iagnosis4ehydrationHy othermia
E haustionRes iratory in&ectionHy er6entilation syndrome
Psychiatric disorders4rug into icationCarbon mono ide oisoning (as &romtent heaters or sto6es)
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Acute Mountain Sickness !
Pro hyla isAcclimati3ation–Staging o& ascent
–4elaying e ertionMedication choices !–Aceta3olamide (4iamo ) ;+$ mg P: bid or tid–4e amethasone (4ecadron) mg P: tid or @id
–Should start either med ; hours rior to ascent
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Progression o& Acute MountainSicknessI& ascent is continued or acceleratedby a atient ,ith untreated AMS%
HAPE or HACE may occur and deathmay result
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High Altitude Pulmonary Edema
(HAPE)Is a non-cardiogenic ulmonary edemarelated to altitudinal hy o ia
Can be &atal i& atient is unable todescend:ccurs in # to ; o& atients @uicklyascending to " #;%$$$ &eetCan occur e6en in ,ell &it andacclimati3ed indi6iduals
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High Altitude Pulmonary Edema !
:nsetsually begins ; to *; hours a&ter arri6al
at altitude
Can occur% but uncommon% at altitude/$$$ to #;%$$$ &eet:nset usually at night
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High Altitude Pulmonary Edema in 2ong-term Mountain Residents
H>A>P>E> has been re orted in atientsacclimati3ed to high altitude ,ho
,ent to lo, altitude &or " #$ days% Bthen returned to high altitude.ermed ?reentry ulmonary edema?
Ab t t
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Abru t ascent
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High Altitude Pulmonary Edema !
Sym toms
sual se@uence !–Cough dys nea at rest achy chest ain
rogressi6e cough rogressi6e rales&rothy s utum hemo tysis &rankres iratory &ailure
Chest -ray a earance is 6ariable !
–Patchy in&iltrates (o&ten right " le&t)–I& se6ere% may be bilateral ?,hiteout?
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High Altitude Cerebral Edema
(HACE)2ess common than HAPEPossibly a malignant &orm o& AMS
Can be &atal or result in ermanent neurologicdisability (stroke-like syndromes):nset is gradual ! usually o6er ; to ' days
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High Altitude Cerebral Edema !
Sym tomsSe6ere headacheCon&usion
Agitation irritability1ausea emesisAta iaHallucinations Sei3uresComa
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High Altitude Cerebral Edema !
5ield .reatment:12F e&&ecti6e treatment is descent ! atleast '$$$ &eet
R adGuncts !–High &lo, :; hy er6entilation–4e amethasone aceta3olamide–5urosemide mannitol
–7en3odia3e ines di henylhydantoin i&sei3ures occur
–A6oid e ertion during descent–Hy erbaric bag i& a6ailable
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In-Hos ital .reatment o&
Sus ected HAPE or HACEAir,ay breathing circulationHigh &lo, o ygen - intubation Bhy er6entilationChest -rayI9 de amethasone B aceta3olamideCheck A78 B carbo yhemoglobin
Consider to B drug screenHead C. i& abnormal mental statusAdmit to ICConsider hy erbaric :; R (call nearest chamber)
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High Altitude Retinal HemorrhageIncidence is ;$ to $ abo6e # %$$$ &eetsually does not a&&ect 6ision (unless
macular bleed)sually asym tomatic4iabetics at higher risksually no R or descent needed
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Altitude Illnesses !
Summary7est treatment is re6ention !–Acclimati3ation staging ascent–
A6oiding alcohol B sedati6es–Medication ro hyla isI& sym toms suggest HAPE or HACE !–start o ygen
–arrange immediate assisted descent–de&initi6e &ollo,u care in a medical &acilitya&ter descent% e6en i& sym toms abate
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ltra6iolet 2ight eratitis
(?Sno, 7lindness?)9 radiation increases &or e6ery '$$
meters increase in altitude
Cornea absorbs 97 (belo, '$$ nm)2ens cataracts can result &rom chronice osure to 9 radiation " '$$ nmHigh e osure le6els can cause corneal burnin J # hour Sym toms usually take 0 to #; hours tode6elo (same as &or ?,eldersK arc keratitis?)
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Sno, 7lindness Sym toms B SignsEye ain8ritty sensation o& eyes
2ight sensiti6ity.earingConGuncti6al inGectionChemosisEyelid s,elling
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Sno, 7lindness !
.reatmentRemo6e contact lenses.o ical anesthetic ! single dose only–
.etracaine or ro aracaine–Re etiti6e use may damage cornea: hthalmic antibiotic ointment–Erythromycin% gentamicin% or
sul&acetamideEye atch &or #; to ; hoursMost should heal in J ; hoursMay need oral narcotics &or ain
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Sno, 7lindness !
Pre6entionShould choose sunglass lenses that arerated to transmit J #$ o& 97
Side shields or &ull goggles needed tore6ent e osure &rom side bounceSunglasses should al,ays be secured ,itha neck loo ,hen mountain climbing
I& sunglasses are lost% makeshi&t rotecti6eshields can be made by cutting thin slits inieces o& cardboard
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