Chapter 136; Altitude Sickness Flashcards
Name as many DDX for acute mountain sickness as possible?
Tension Headache Viral Syndrome Alcohol Withdrawl/Intox CO poisoning Dehydration Caffeine Withdrawl Migraine Infection ICH/Mass Venous Sinus Thrombosis Aute Angle Glaucoma / Ocular process
What is the treatment for Acute Mountain Sickness?
Hypoxia - Supplemental Oxygen
Headache - NSAIDS
Nausea - Prochlorperazine - stimulates hypoxic vent resp
Interstitial Fluid - Acetazolamide 250mg BID (mild diuretic)
Resp Alkalosis - Acetazolamide ( Bicarb exc in kidney)
HVR - Acetazolamide (same reason as above)
Adjuncts: Dexamethasone 8mg then 4mg q6
Reduces inflam and reduce ICP
Can also be used acutely to reduce symptoms to get safely back down
What are some methods to prevent Acute Mountain Sickness (AMS)?
- Gradual or Staged Accent - Acclimatization
- Altitude of Sleep should not be more than 1600 ft per day.
“Climb high sleep low” - Lots of fluids
- Avoid overexertion
- Prophylactic medication - acetazolamide, dex, 02 )
What is High-Altitude Pulmonary Edema?
Alveolar and interstitial edema resulting from pulmonary hypertension secondary preferential vasoconstriction and reduced NO
What are Symptoms of HAPE?
Resting Dyspnea Cough Anorexia Cyanosis Tachypnea/Tachycardia
What is the treatment for HAPE?
Supplemental Oxygen
If severe; nifidipine 30mg slow release q12
+/- acetazolamide 125mg bid +/- tadalafil 10mg BID
What is High Altitude Cerebral Edema (HACE)?
Global cerebral dysfunction caused by vasogenic cerebral edema thought to be initiated by hypocarbia and subsequent increased cerebral blood flow with saturated counterregulatory mechanisms
What are signs of High Altitude Cerebral Edema (HACE)?
Severe Headache Ataxia ** Altered Mental Status** Nausea / Vomiting Seizure Coma/Death Other signs of Increased ICP **Most sensitive signs
What is one technique to non-invasively monitor ICP in the setting of High Altitude Sickness?
Serial Optic Nerve Sheath Diameter measurements using Ultrasound
What is the treatment for HACE?
Oxygen R/O other causes of AMS Hypervent diuresis (careful may be vol deplete) Hypertonic solutions (mannitol / hyperS)
High Altitude Retinal Hemorrhages; when do they occur and what is their treatment?
Typically above 17000 feet but can occur at any altitude
May notice a central scotoma
Typically resolve without treatment
Incidence is unknown because many are only picked up incidentally
Why does HAPE worsen COPD but not Asthma?
In Asthma, it is typically a reversible process whereas COPD is a continuum of worsening hypoxia and pulmonary hypertension. Vasoconstriction from hypoxia at these higher altitudes can worsen their pulmonary hypertenison and induce cor pulmonale. Asthma at higher altitudes will have less triggers (pollen etc) to induce bronchospasm in the first place.
