Sunday, October 28, 2012

Acute Mountain Sickness

Altitude Sickness (Acute Mountain Sickness)

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Acute altitude sickness is the mildest and most common form. Because more people are traveling to areas of high elevation for skiing and mountain climbing, acute altitude sickness has become a greater public health concern. Roughly one fourth of Colorado ski area vacationers, two thirds of climbers on Mount Rainier, and half the people who fly to the Khumbu region of Nepal develop acute altitude sickness.

AMS - Acute Mountain Sickness is generally the first sign of altitude sickness, with any combination of the following symptoms , headache, insomnia, fatigue, nausea, n lack of appetite, dizziness, shortness of breath during exertion,swelling of extremities, and social withdrawal.

If left untreated, AMS, can quickly worsen into either HIGH Altitude Cerebral Edema ( HACE) , or High Altitude Pulmonary Edema ( HAPE).
As AMS progresses into HACE, fluid leaks into the brain, there is a loss of coordination and balance ( a condition known as ataxia), and, if untreated, the patient will slip into a coma and die.

HAPE
High altitude pulmonary edema (HAPE), an advanced form of acute altitude sickness, causes the following progression of symptoms:
Shortness of breath at rest
Gurgling respirations
Wet cough with frothy sputum
Possible fever
Respiratory failure
Onset of HAPE can be gradual or sudden. HAPE typically occurs after more than one day spent at high altitude. With HAPE,fluid leaks into the lungs, producing a frothy cough, sometimes pink in color, which will eventually accumulate, and drown the person if they don't receive urgent medical care.

HACE
High altitude cerebral edema (HACE) can begin with confusion.

A person developing HACE begins having trouble keeping up with the group.
Next, walking and coordination become impaired.
As the brain continues to swell, lethargy and then coma will develop.
If left untreated, HACE will ultimately result in death.

Altitude Sickness Causes

Altitude sickness develops when the rate of ascent into higher altitudes outpaces the body's ability to adjust to those altitudes.< BR>
Altitude sickness generally develops at elevations higher than 8,000 feet (about 2,400 meters) above sea level and when the rate of ascent exceeds 1,000 feet (300 meters) per day.

The following actions can trigger altitude sickness:
Ascending too rapidly
Overexertion within 24 hours of ascent
Inadequate fluid intake
Hypothermia
Consumption of alcohol or other sedatives
One way to avoid altitude sickness is allowing the body to get used to the altitude slowly.

Acclimatization is the process by which the body adjusts to high altitudes. The goal of acclimatization is to increase ventilation (breathing) to compensate for lower oxygen content in the air.
To compensate for this extra ventilation, blood needs to have a lower pH. In response, the kidneys excrete bicarbonate into the urine, which in turn lowers the body's pH to accommodate for this extra respiratory effort.

When to Seek Medical Care
If symptoms such as headache or shortness of breath do not improve promptly with simple changes, visiting a doctor may be helpful if descent is inconvenient and a doctor is available.
Descend immediately if shortness of breath at rest, mental confusion or lethargy, or loss of muscle coordination develop. Symptoms of most people with acute altitude sickness improve by the time they reach a medical facility, which is usually located at a lower altitude.

When to Seek Medical Care
If symptoms such as headache or shortness of breath do not improve promptly with simple changes, visiting a doctor may be helpful if descent is inconvenient and a doctor is available.
Descend immediately if shortness of breath at rest, mental confusion or lethargy, or loss of muscle coordination develop. Symptoms of most people with acute altitude sickness improve by the time they reach a medical facility, which is usually located at a lower altitude.

Altitude Sickness Treatment

Descending to lower altitudes or delaying further ascent are treatments for acute altitude sickness until symptoms are gone.
A Gamow bag may be used if descent is not feasible.
Oxygen (2-4 liters per minute) will improve oxygen saturation of blood.
Aspirin or acetaminophen (Tylenol) may be taken for headache.
For nausea, the doctor may prescribe prochlorperazine (Compazine), an antinausea medication that also enhances the body's ability to increase the breathing rate in response to low-oxygen environments.
Sleeping pills for insomnia should not be taken. They are potentially dangerous because they can slow breathing.
Acetazolamide (Diamox) may be prescribed to hasten acclimatization.
Acetazolamide is a diuretic (a drug that increases urine output) that increases kidney excretion of bicarbonate. This decreases the blood pH, thereby stimulating extra breathing, which results in higher oxygen levels in the blood.
In addition, acetazolamide corrects nighttime pauses in breathing known as periodic breathing. Acetazolamide also improves symptoms of insomnia.
HAPE responds best to descent.

Oxygen, if available, should be provided.
Nifedipine (Procardia), a medication for high blood pressure, has been shown to be beneficial for HAPE.
Antibiotics may be given if a fever is present and pneumonia is possible.
For more severe cases of HAPE, continuous positive airway pressure (CPAP) mask ventilation can be used. Although uncomfortable to wear, the CPAP mask helps by increasing the pressure of the inhaled air.
If this intervention fails, a tube may be placed through the mouth and into the airway. This, along with assisted ventilation, is required to treat respiratory failure.
The only definitive treatment for HACE is descent.

Dexamethasone (Decadron, a steroid) may be beneficial.
Generally, if dexamethasone is considered, then a plan for descent should be in place unless descent is impossible.
Some people, after receiving dexamethasone, may feel so much better that they want to continue ascending. Under no circumstance should this be allowed.
Oxygen may be helpful.
A Gamow bag may buy time until descent is possible.
Anyone with HACE or HAPE should be kept as comfortable as possible.

Exertion of any type should be minimized, even during descent.
This means that it may be necessary to arrange descent for the ill person by whatever means available (helicopter, snowmobile, or mule, for example).

Altitude Sickness Prevention
Altitude sickness is preventable. The body needs time to adjust to high altitude. Physical conditioning has no bearing on this.
For people who do not know the rate at which their bodies adjust to high altitude, the following preventive measures are recommended.
If traveling by air to a ski area above 8,250 feet (2,500 meters), incorporate a layover of 1-2 days at an intermediate altitude.
Avoid physical exertion for the first 24 hours.
Drink plenty of fluids, and avoid alcoholic beverages.
Consume a high-carbohydrate diet.
If mountain climbing or hiking, ascend gradually once past 8,000 feet (2,400 meters) above sea level.
Increase the sleeping altitude by no more than 1,000 feet (300 meters) per 24 hours. The mountaineer's rule is "climb high, sleep low." This means that on layover days, a climber can ascend to a higher elevation during the day and return to a lower sleeping elevation at night. This helps to hasten acclimatization.

The doctor may prescribe acetazolamide (Diamox) to prevent acute altitude sickness. This medication speeds acclimatization.
If rapid ascent is unavoidable, as in rescue missions, or if a person is prone to developing HAPE, the doctor may also prescribe nifedipine (Procardia). Nifedipine is normally used to treat high blood pressure.
Prevention of high altitude cerebral edema (HACE) is the same as for acute altitude sickness.

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