prevention is better than cure
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Prevention is better than Cure. 3 G olden Rules. Three golden rules to avoid dying from altitude illness: Learn the early symptoms of altitude illness and recognize when you have them. Remember, there may be only one person in a group with symptoms. - PowerPoint PPT PresentationTRANSCRIPT
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Prevention is better than Cure
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3 Golden RulesThree golden rules to avoid dying from altitude illness:
1. Learn the early symptoms of altitude illness and recognize when you have them. Remember, there may be only one person in a group with symptoms.
2. Never ascend to sleep at a new altitude with any symptoms of AMS.
3. Descend if your symptoms are getting worse while resting at the same altitude.
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Sometimes symptoms overlap from one illness to another
• Identifying the cause of the symptom is not always easy…
• Causes of stomach pain?• Causes of headache?
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Altitude- what happens up high?
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The problem of altitude
• Decrease in pressure• Not enough Oxygen• Usually noticed above 2500m
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The body’s solution
• Our bodies need to adjust– Breathe faster– Heart beats faster– Pee more– Make more red blood cells (later)
• …. But what happens if our bodies don’t adjust?
Acclimatisation
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Altitude Illness
AMS
HAPEHACE
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Remember, some people take longer to adjust.
We are all different.
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Who acclimatizes better?
Of the following, say which are better at acclimatizing: • Young or old• Fit or unfit• Female or male• Skinny or fat• Nepali or European• From Dharan or Barabise?
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Risk factors for developing altitude illness
• Individual susceptibility
• Ascent profile– 300 m per day
– Rest day every 3 days or 1000m
• Physical activity
• Fluid intake
• Avoid alcohol, caffeine & sedatives
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What is ‘normal’ for up there?
• Hands/ feet a bit puffy• Pee more• Breathe a bit faster and deeper• Heart beats a bit faster• Dreams
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S • HEADACHEand one or more of:
– Tiredness
– Dizziness
– Nausea or if severe vomiting
– Poor sleep
AMS
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• Any one symptom may indicate the onset of AMS at high altitude
• Treat as AMS unless proven otherwise
• The best treatment for AMS is prevention
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Treatment of AMS
• Mild: – Rest (don’t go higher)– Paracetamol or NSAIDs ± anti-emetic
• Moderate or Severe:– Descend, descend, descend!– Acetazolamide (Diamox) – Dexamethasone– Oxygen or PAC if available
• NB: should not delay descent
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Duff’s* High Altitude Triangle
AMS
Hypothermia (Cold)
Dehydration (thirsty) Hypoglycaemia (hungry)
* Conceived by our great leader JD
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HACE• “Severe AMS”• Fluid squashing the brain• Rarely occurs without being preceded by
AMS• Important signs:
– Severe headache unresponsive to painkillers
– Confusion– Physical clumsiness (ataxia)
• Presence of any of these signs at altitude:→ HACE until proven otherwise
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HACE - Treatment
• Descend, descend, descend!
• Carry, or at least help, the victim down
• Oxygen, (bottled or hyperbaric bag)
• Dexamethasone 8mg (IM if possible) – 4mg / 6 hourly thereafter
• Need medical follow up
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HAPE
• Fluid in the wrong place in the lungs• Classically: sudden onset after 24-48 hrs at new altitude• Often occurs without AMS• Severe cases can be complicated by HACE• Many symptoms but important ones:
– Cough and tiredness– Breathlessness out of proportion to exercise, especially breathlessness
at rest– Inability to lie flat– Presence of these at altitude = HAPE
• Predisposing factors:– genetic; respiratory infection; exercise; cold environment
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HAPE - Treatment
• Descend, descend, descend!• Carry, or at least help, the patient down down • Oxygen, (bottled or hyperbaric bag) • Nifedipine / Adalat® 20mg orally
– Ensure patient is warm & well hydrated– 10mg / 8 hourly thereafter
• Salbutamol / Ventolin® inhaler, or similar treatment spray– 2 puffs 4 hourly (best by ‘spacer’ ie plastic bottle)
• Consider assisted breathing• Treat for HACE if any doubt as to whether present or not
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Prevention is better than Cure!
• Walk slowly with a rest day for every 3-4 days• Do not make rapid ascent• Drink more fluids (3-4l/day)• Do not carry heavy pack• Do not smoke/drink alcohol/take sleeping pills• Look after each other• Recognize the symptoms early• Never send someone down alone!
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Acetazolamide / Diamox®
• Can be used for prevention and for treatment• Side effects
– Can be unpleasant: – Tingling/numbness of any body part!– Try before you go– Dose dependant
• Sulphonamide / sulphur allergy• Start night before ascent• Continue until reach maximum height & descending• Dose:
– Start with 125 mg x 2 / day– 250 mg x 2 / day if this doesn’t work– The lowest dose possible !
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Sleep at altitude
• Big problem for many people:
– Difficult to get off to sleep– Poor quality of sleep
• ↓ refreshing deep REM sleep • ↑ non-refreshing light sleep
– Periodic breathing• De-saturation• Repeated waking (20 – 30 times per hour?)
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Sleep at altitude2
• Acetazolamide / Diamox® at night can be very effective treatment
– early in evening (18.00)
– 125 mg initially
– ↑ to 250 mg if ineffective
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3 Golden RulesThree golden rules to avoid dying from altitude illness:
1. Learn the early symptoms of altitude illness and recognize when you have them. Remember, there may be only one person in a group with symptoms.
2. Never ascend to sleep at a new altitude with any symptoms of AMS.
3. Descend if your symptoms are getting worse while resting at the same altitude.
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Questions?
• What questions do you have about altitude and AMS?