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KIN 424 - Medical Aspects of Sport > Module 6 - Athletes at High Altitude: Medical Aspects > Flashcards

Module 6 - Athletes at High Altitude: Medical Aspects Flashcards

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1
Q

What is the Himalayan Rescue Association?

A
  • Non-profit Nepali Run Organization
  • Mandate to reduce illness & mortality in the Himalayas
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2
Q

What does the Himalayan Rescue Association do?

A
  • Educate: Foreigners and Nepalese
  • Medical Care for Travellers
  • Medical Care for Locals (subsidized by foreigners)
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3
Q

Where is the Himalayan Rescue Association Located?

A
  • 3 Permanent Clinics in Nepal
  • 1 Emergency Clinic: Lake Gosainkunda (LangTang Region)
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4
Q

What does the Manang Aid Post in Nepal do?

A
  • Operate an aid post
  • Daily lecture to trekkers and guides
  • House calls to villagers and nearby monasteries
  • Organise Evacuations when Necessary
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5
Q

How many Staff does the Manang Aid Post in Nepal have?

A
  • 3 Physicians
  • 1 RN
  • 1 Cook
  • 1 Chef de Maison
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6
Q

How does altitude acclimatization work?

A

Increased
- Ventilation
- Cardiac Output
- Hemoconcentration

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7
Q

What does Altitude Acclimatization do?

A
  • enhances Oxygen Delivery
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8
Q

What is the best way to undergo altitude acclimatization?

A

Occurs over days to months
- Graded ascent where possible

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9
Q

How long before sleep improvements are seen in altitude acclimatization?

A
  • First few days
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10
Q

What happens after weeks to months of altitude acclimatization?

A
  • Red Blood Cell mass increases
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11
Q

What are the Altitude Illness Syndromes?

A
  • Acute Mountain Sickness (AMS)
  • High Altitude Cerebral Oedema (HACE)
  • High Altitude Pulmonary Oedema (HAPE)
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12
Q

What are the confirmed risk factors for Acute Mountain Sickness?

A
  • Rate of Ascent
  • Previous History of AMS
  • Exertion
  • Obesity
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13
Q

What are some unconfirmed but possible risk factors for Acute Mountain Sickness?

A
  • Previous Neck Dissection
  • Dehydration
  • Infection
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14
Q

What are the symptoms of Acute Mountain Sickness?

A
  • Headache
  • Sleep Disturbance, Insomnia
  • Anorexia, Nausea, Vomiting
  • Light-headedness, dizziness
  • Fatigue
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15
Q

What are some other possible explanations for symptoms of Acute Mountain Sickness?

A
  • Dehydration
  • Hangover
  • Migraine
  • Overexertion
  • Viral Illness
  • Subarachnoid Haemorrhage
  • Carbon Monoxide Exposure
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16
Q

What is High-Altitude Cerebral Oedema?

A
  • Believed to be the severe end of the AMS spectrum
  • Can be lethal within 12 hours
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17
Q

What are the symptoms of High-Altitude Cerebral Oedema?

A

AMS Symptoms Plus:
- Ataxia
- Confusion
- Lethargy
- Altered level of consciousness

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18
Q

What is High-Altitude Pulmonary Oedema?

A
  • Most lethal altitude illness
  • Separate Condition from AMS/HACE: often co-exist
  • Onset after 2-5 days
  • Aggravated by cold, exertion
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19
Q

What are the risk factors of High-altitude Pulmonary Oedema (HAPE)?

A
  • Rate of Ascent
  • Exertion
  • Previous History
  • Primary Pulmonary Hypertension
  • Unilateral Pulmonary Artery
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20
Q

What are the Symptoms of High-Altitude Pulmonary Oedema (HAPE)?

A
  • Dyspnoea at Rest
  • Cough
  • Bloody Cough: Pink Frothy Sputum
  • Poor Exercise Tolerance
  • Orthopnoea
  • Febrile (fever)
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21
Q

What is the problem with medications for Altitude Illness Prevention?

A
  • Most medications are not Permitted by WADA
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22
Q

What medications for altitude illness prevention are not permitted by WADA?

A
  • Acetazolamide
  • Dexamethasone
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23
Q

What medications are used for AMS and HACE?

A
  • ACetazolamide
  • Dexamethasone
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24
Q

What medications for altitude illness are permitted?

A
  • Tadalafil (Cialis): previously monitored
  • Nifedipine
25
Q

What medications are used to prevent High-Altitude Pulmonary Oedema?

A
  • Tadalafil (Cialis)
  • Nifedipine
26
Q

What level of activity should you perform during the first few days of altitude acclimatization?

A
  • Decreased Intensity
26
Q

What level of activity should you perform during the first few days of altitude acclimatization?

A
  • Decreased Intensity
27
Q

What is the hydration and nutrition recommendation for activity at high altitudes?

A
  • Maintain hydration: dehydration prone
  • High CHO diet
28
Q

What does previous history determine about altitude illness?

A
  • Important for rare conditions: HAPE and probably HACE
  • Not as helpful for AMS
29
Q

What is the treatment for altitude illness?

A

Permitted
- Descent
- Oxygen
Not Permitted
- Most medications

30
Q

What is a Gamow Bag?

A
  • Inflates to 2 psi
  • Simulated descent
  • Equivalent to 1600 metre descent
  • Temporizing measure
31
Q

How does Ultraviolet Radiation play into high-altitude activity?

A

Increased
- intensity
- potential for burns
- potential for snow blindness
- reflection off snow or water

32
Q

How does high altitude impact the immune system?

A

Immunosuppression
- Susceptibility to infection

33
Q

What is the recommendation for the immune system when ascending to high altitudes?

A
  • Stay up to date on immunizations
34
Q

How can having Refractive Eye Surgery impact your experience at high altitudes?

A
  • Transient blurring due to drying and corneal edema
  • Resolves on Descent
35
Q

What are the recommendations for someone who has had refractive eye surgery when ascending to high altitudes?

A
  • Artificial tears
  • Full goggles may help
36
Q

How is Asthma impacted by high-altitude activity?

A
  • Not clinically worse
37
Q

What are the recommendations for someone with Asthma when ascending to high altitude?

A
  • have a medication supply
  • monitor temperature
38
Q

How does high-altitude activity impact those with Coronary Artery Disease?

A
  • No increased incidence
39
Q

What is important to know about children when they ascend to high altitudes?

A
  • History may be difficult to know
40
Q

How are people with sickle cell trait impacted by high altitudes?

A

Heterozygous Hbs
- At risk for splenic infarctions

41
Q

At what height do athletes experience altitude illness?

A
  • typically above 2500m (8000’)
42
Q

At what height do athletes usually do destination altitude training?

A
  • typically 1800-2500m
43
Q

How does intense exercise at high altitudes change the picture?

A
  • AMS reported at 1950 - 2100m in athletes at training camps
  • Incidence up to 44%
44
Q

What is recommended for training at high altitudes?

A
  • Lower intensity on the first few days
45
Q

What is common with endurance athletes regarding iron?

A
  • Low iron stores
46
Q

Why do endurance athletes have low iron stores?

A
  • Increased red cell destruction
  • Sweat loss of iron
  • Impaired iron absorption post-exercise
47
Q

What is iron necessary for?

A
  • Red Cell Synthesis
48
Q

What is the recommended protocol for iron management at high altitudes for endurance athletes?

A
  • Test and treat early
  • Treatment: for specific iron deficient non-anaemia groups
49
Q

What does Hypoxia do to sleep?

A
  • Directly Impares
50
Q

Why does Hypoxia impact sleep?

A
  • More Frequent arousals
  • Less restful - impacting recovery
51
Q

Why is sleep impacted at high-altitude training?

A
  • Hypoxia
  • Jet lag
  • Poor sleep environment
52
Q

What are the recommendations for improving sleep at high altitudes?

A
  • Quiet, dark, comfortable temperature environment
  • Caffeine, alcohol and nicotine interfere with sleep
  • Exercise in the late afternoon/early evening
  • Light Bedtime snack
  • Electronics and device interfere with sleep
  • Aggressive management of jet lag
53
Q

What are the recommendations for using sleep medications at high altitudes?

A
  • Consider carefully: adverse effects
  • Consult with a physician
  • Safe at altitude
54
Q

What sleep medications are permitted?

A
  • Temazepam
  • Zolpidem
  • Zaleplon
55
Q

What sleep medication is prohibited?

A
  • Acetazolamide
56
Q

What are some altitude pre-acclimatization strategies?

A
  • Intermittent hypoxia training: tents and camps
  • Avoid illness, dehydration, and sleep debt on arrival
57
Q

What does prolong

A

KIN 424 - Medical Aspects of Sport (11 decks)

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