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Prevention is better than Cure

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Page 1: Prevention is better than Cure. 3 Golden Rules Three golden rules to avoid dying from altitude illness: 1.Learn the early symptoms of altitude illness

Prevention is better than Cure

Page 2: Prevention is better than Cure. 3 Golden Rules Three golden rules to avoid dying from altitude illness: 1.Learn the early symptoms of altitude illness

3 Golden Rules

Three 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.

Page 3: Prevention is better than Cure. 3 Golden Rules Three golden rules to avoid dying from altitude illness: 1.Learn the early symptoms of altitude illness

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?

Page 4: Prevention is better than Cure. 3 Golden Rules Three golden rules to avoid dying from altitude illness: 1.Learn the early symptoms of altitude illness

Altitude- what happens up high?

Page 5: Prevention is better than Cure. 3 Golden Rules Three golden rules to avoid dying from altitude illness: 1.Learn the early symptoms of altitude illness

The problem of altitude

• Decrease in pressure• Not enough Oxygen• Usually noticed above 2500m

Page 6: Prevention is better than Cure. 3 Golden Rules Three golden rules to avoid dying from altitude illness: 1.Learn the early symptoms of altitude illness

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

Page 7: Prevention is better than Cure. 3 Golden Rules Three golden rules to avoid dying from altitude illness: 1.Learn the early symptoms of altitude illness

Altitude Illness

AMS

HAPEHACE

Page 8: Prevention is better than Cure. 3 Golden Rules Three golden rules to avoid dying from altitude illness: 1.Learn the early symptoms of altitude illness

Remember, some people take longer to adjust.

We are all different.

Page 9: Prevention is better than Cure. 3 Golden Rules Three golden rules to avoid dying from altitude illness: 1.Learn the early symptoms of altitude illness

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?

Page 10: Prevention is better than Cure. 3 Golden Rules Three golden rules to avoid dying from altitude illness: 1.Learn the early symptoms of altitude illness

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

Page 11: Prevention is better than Cure. 3 Golden Rules Three golden rules to avoid dying from altitude illness: 1.Learn the early symptoms of altitude illness

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

Page 12: Prevention is better than Cure. 3 Golden Rules Three golden rules to avoid dying from altitude illness: 1.Learn the early symptoms of altitude illness

S • HEADACHEand one or more of:

– Tiredness

– Dizziness

– Nausea or if severe vomiting

– Poor sleep

AMS

Page 13: Prevention is better than Cure. 3 Golden Rules Three golden rules to avoid dying from altitude illness: 1.Learn the early symptoms of altitude illness

• 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

Page 14: Prevention is better than Cure. 3 Golden Rules Three golden rules to avoid dying from altitude illness: 1.Learn the early symptoms of altitude illness

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

Page 15: Prevention is better than Cure. 3 Golden Rules Three golden rules to avoid dying from altitude illness: 1.Learn the early symptoms of altitude illness

Duff’s* High Altitude Triangle

AMS

Hypothermia (Cold)

Dehydration (thirsty) Hypoglycaemia (hungry)

* Conceived by our great leader JD

Page 16: Prevention is better than Cure. 3 Golden Rules Three golden rules to avoid dying from altitude illness: 1.Learn the early symptoms of altitude illness

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

Page 17: Prevention is better than Cure. 3 Golden Rules Three golden rules to avoid dying from altitude illness: 1.Learn the early symptoms of altitude illness

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

Page 18: Prevention is better than Cure. 3 Golden Rules Three golden rules to avoid dying from altitude illness: 1.Learn the early symptoms of altitude illness

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

Page 19: Prevention is better than Cure. 3 Golden Rules Three golden rules to avoid dying from altitude illness: 1.Learn the early symptoms of altitude illness

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

Page 20: Prevention is better than Cure. 3 Golden Rules Three golden rules to avoid dying from altitude illness: 1.Learn the early symptoms of altitude illness

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!

Page 21: Prevention is better than Cure. 3 Golden Rules Three golden rules to avoid dying from altitude illness: 1.Learn the early symptoms of altitude illness

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 !

Page 22: Prevention is better than Cure. 3 Golden Rules Three golden rules to avoid dying from altitude illness: 1.Learn the early symptoms of altitude illness

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?)

Page 23: Prevention is better than Cure. 3 Golden Rules Three golden rules to avoid dying from altitude illness: 1.Learn the early symptoms of altitude illness

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

Page 24: Prevention is better than Cure. 3 Golden Rules Three golden rules to avoid dying from altitude illness: 1.Learn the early symptoms of altitude illness

3 Golden Rules

Three 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.

Page 25: Prevention is better than Cure. 3 Golden Rules Three golden rules to avoid dying from altitude illness: 1.Learn the early symptoms of altitude illness

Questions?

• What questions do you have about altitude and AMS?