Altitude Sickness

Question 1

Above __ ft is when sig hypoxia occurs (Sats <90%)

Answer 1

1200ft

Question 2

The__________

of oxygen stays the same in our atmosphere but the ____________is what changes

Answer 2

1. percentage

2. partial pressure

Question 3

Above _______ ft is considered the death zone as prolonged stay here results in hypoxia induced tissue
death.

Answer 3

22000

Question 4

Acclimatization:
Step 1
First the ___________ detect hypoxia so it influences the medullary center to increase the respiratory
drive and increase your minute volume.

Answer 4

carotid body

Question 5

Acclimatization:
Step 2
Then you will have a \_\_\_\_\_\_\_\_\_\_ which will turn the medullary center on to \_\_\_\_\_\_\_\_\_ the
respiratory drive.
This happens after \_\_\_\_ days

Answer 5

1. . Respiratory alkalosis
2. decrease
3. 1.5 days

Question 6

Acclimatization:
Step 3
Now is when the ______ kick in and __________ to compensate for respiratory alkalosis ,

Answer 6

1. kidneys

2. excrete bicarbonate

Question 7

Acclimatization:
Step 4
Now
you can _______your ___ rate again .

Answer 7

increase RR rate

Question 8

Acclimatization:
Step 5
Additionally, there is ___________ release with VC triggering suppression of ____ and ______ this
will result in a _______.

Answer 8

1. catecholamine
2. Aldosterone/ADH
3. Diuresis

Question 9

Acclimatization:
Step 5
You ________ the total number of rbc via _____ but this is late change and can take up to ___ days.

Answer 9

1 increase

2. EPO
3. 90

Question 10

Acclimatization:

Enhancers (2)

Answer 10

Caffeine

Chocolate

Question 11

Acclimatization:

Inhibitors (2)

Answer 11

ALCOHOL

sedatives

Question 12

Acute Mountain Sickness prophylaxis

Answer 12

Acetazolamide

Question 13

SxS Acute Mtn Sickness

Typically within __ hrs

Answer 13

n/v malaise and headache associated with hypoxia

48hrs

Question 14

Is acute mtn sickness typically self-limited resolution of sx?

Answer 14

Yes

Question 15

Can moderate cases of Acute mtn sickneesss stay at elevation?
When should they descend?

Answer 15

yes

High Lake Louise Score

Question 16

What can happen if severe cases of acute mtn sickness dont descend?

Answer 16

HACE or HAPE

Question 17

Descending ___m can be helpful w/ Acute mtn sickness symptoms?

Answer 17

500m

Question 18

Syndromes of altitude range from ___ to ___

Answer 18

HAH to HACE

Question 19

__ is the end stage process of acute mountain sickness: where there is vasodilation of capillary beds
then over perfusion

Answer 19

HACE

Question 20

HACE is results in _____ (loss of autoregulation of capillary beds) that eventually leads to ____

Answer 20

Vasogenic edema

Cell death

Question 21

HACE
Early manifestations:
Late Manifestations:

Answer 21

Early on manifested by headache, ataxia.

Later by altered mentation, lethargy, seizures, death

Question 22

Standard Tx of HACE

Answer 22

DESCEND!

O2, Acetazolaminde, dexamethazone, hyperbaric chamber

Question 23

If you cannot descend with HACE, second line (non rx)

Answer 23

portable hypobaric chamber

Question 24

Do oxygen, dexamethasone and acetazolamide prevent death in HACE?

Answer 24

No, they just delay it. NEED TO DESCEND

Question 25

__ is pulmonary edema not due to HF, but is ____ induced vasoconstriction.

Answer 25

HAPE | Hypoxia

Question 26

HAPE: periphery _____ and sum total. there is _____ of particular tissues causes capillary leak & _____.

Answer 26

1. Vasodilates 2. overperfusion 3. edema

Question 27

HAPE can start at _____ft

Answer 27

8000ft

Question 28

HAPE SxS

Answer 28

Cough then dyspnea at rest then crackles then tachypnea

Question 29

Mild cases of HAPE can be treated with ___?

Answer 29

O2 and Nifedipine

Question 30

Moderate & severe cases of HAPE tx?

Answer 30

Descend

Question 31

HAPE pts with crackles regardless of O2 status Tx

Answer 31

Descend

Question 32

Takes __ days to acclimatize maximally

Answer 32

7

Question 33

Normal Physiologic Responses to Acclimatization | What happens to RAAS?

Answer 33

Suppressed due to the bicarbonate diuresis and suppression of aldosterone.

Question 34

Normal Physiologic Responses to Acclimatization: | Vessels

Answer 34

Peripheral VC triggers baroreceptors (carotid sinus) to suppress secretion of ADH and aldosterone resulting in diuresis

Question 35

Normal Physiologic Responses to Acclimatization: | Lungs

Answer 35

Lung: Increase in Pulmonary vascular resistance Pulmonary vessels constriction due to hypoxemia Respiratory Rate Increased ventilation @ 4921 ft There is an increase of oxygen delivery to the tissues

Question 36

O2 dissociation curve in response to acclimatization?

Answer 36

Shift to right- offload O2 to tissues easier.

Question 37

How does caffeine, cocoa, GC's and Acetazolamine help you acclimatize?

Answer 37

Forced bicarbonate diuresis

Question 38

Does age/gender play a difference in altitude sickness?

Answer 38

No

Question 39

Lake Louise score 2-4

Answer 39

Mild stop ascent acetazolamide 125or 250mg bid

Question 40

Lake Louise Score | 5-9

Answer 40

moderate descend O2

Question 41

Lake Louise Score | 10-15

Answer 41

severe O2 Acetazolamide 250 mg and dexamethasone 10mg immediate descent Pressure Bag (Gamow Bag)

Question 42

T/F: pts w/HACE can have weakness to a point of not being able to move can have personality changes

Answer 42

True

Question 43

HAH Tx?

Answer 43

Stop ascent acclimatize Acetazolamide 125 or 250mg bid Or descend 500m

Question 44

T/F: HAPE pts can start to deteriorate over hours?

Answer 44

true.

Question 45

Bottom line HAPE tx?

Answer 45

DESCEND