altitude disease

8/16/2019 Altitude Disease

1/40

Altitude

SicknessMahesa R.

111 0211 134


2/40

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


3/40

Acute Mountain Sickness !

Incidence

Sudden ascent " #$%$$$ &eet ('$$$ meters) ! '$

Sudden ascent " # %$$$ &eet ! *+ Can occur in those ,ith no rior roblems ,ithaltitude e osure


4/40


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


5/40


6/40


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)


7/40


8/40


9/40

s


10/40


E acerbating 5actorsSudden ascentE ertion soon a&ter arri6al

Alcohol intakeSedati6es (slee ing ills)1arcotics


11/40


Sym tomsHeadache1ausea

Anore ia2assitude?2ike a hango6er?

Insomnia4ecreased urination:nset ty ically / to ; hours a&ter ascent


12/40


4i&&erential 4iagnosis4ehydrationHy othermia

E haustionRes iratory in&ectionHy er6entilation syndrome

Psychiatric disorders4rug into icationCarbon mono ide oisoning (as &romtent heaters or sto6es)


13/40


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


14/40


15/40

Progression o& Acute MountainSicknessI& ascent is continued or acceleratedby a atient ,ith untreated AMS%

HAPE or HACE may occur and deathmay result


16/40

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


17/40

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


18/40

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


19/40

Abru t ascent


20/40

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?


21/40


22/40


23/40


24/40


25/40

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


26/40

High Altitude Cerebral Edema !

Sym tomsSe6ere headacheCon&usion

Agitation irritability1ausea emesisAta iaHallucinations Sei3uresComa


27/40


28/40

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


29/40

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)


30/40

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


31/40


32/40


33/40


34/40

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


35/40

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?)


36/40

Sno, 7lindness Sym toms B SignsEye ain8ritty sensation o& eyes

2ight sensiti6ity.earingConGuncti6al inGectionChemosisEyelid s,elling


37/40


38/40

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


39/40

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


40/40

altitude disease

Documents