Module 6 - Athletes at High Altitude: Medical Aspects Flashcards
What is the Himalayan Rescue Association?
- Non-profit Nepali Run Organization
- Mandate to reduce illness & mortality in the Himalayas
What does the Himalayan Rescue Association do?
- Educate: Foreigners and Nepalese
- Medical Care for Travellers
- Medical Care for Locals (subsidized by foreigners)
Where is the Himalayan Rescue Association Located?
- 3 Permanent Clinics in Nepal
- 1 Emergency Clinic: Lake Gosainkunda (LangTang Region)
What does the Manang Aid Post in Nepal do?
- Operate an aid post
- Daily lecture to trekkers and guides
- House calls to villagers and nearby monasteries
- Organise Evacuations when Necessary
How many Staff does the Manang Aid Post in Nepal have?
- 3 Physicians
- 1 RN
- 1 Cook
- 1 Chef de Maison
How does altitude acclimatization work?
Increased
- Ventilation
- Cardiac Output
- Hemoconcentration
What does Altitude Acclimatization do?
- enhances Oxygen Delivery
What is the best way to undergo altitude acclimatization?
Occurs over days to months
- Graded ascent where possible
How long before sleep improvements are seen in altitude acclimatization?
- First few days
What happens after weeks to months of altitude acclimatization?
- Red Blood Cell mass increases
What are the Altitude Illness Syndromes?
- Acute Mountain Sickness (AMS)
- High Altitude Cerebral Oedema (HACE)
- High Altitude Pulmonary Oedema (HAPE)
What are the confirmed risk factors for Acute Mountain Sickness?
- Rate of Ascent
- Previous History of AMS
- Exertion
- Obesity
What are some unconfirmed but possible risk factors for Acute Mountain Sickness?
- Previous Neck Dissection
- Dehydration
- Infection
What are the symptoms of Acute Mountain Sickness?
- Headache
- Sleep Disturbance, Insomnia
- Anorexia, Nausea, Vomiting
- Light-headedness, dizziness
- Fatigue
What are some other possible explanations for symptoms of Acute Mountain Sickness?
- Dehydration
- Hangover
- Migraine
- Overexertion
- Viral Illness
- Subarachnoid Haemorrhage
- Carbon Monoxide Exposure
What is High-Altitude Cerebral Oedema?
- Believed to be the severe end of the AMS spectrum
- Can be lethal within 12 hours
What are the symptoms of High-Altitude Cerebral Oedema?
AMS Symptoms Plus:
- Ataxia
- Confusion
- Lethargy
- Altered level of consciousness
What is High-Altitude Pulmonary Oedema?
- Most lethal altitude illness
- Separate Condition from AMS/HACE: often co-exist
- Onset after 2-5 days
- Aggravated by cold, exertion
What are the risk factors of High-altitude Pulmonary Oedema (HAPE)?
- Rate of Ascent
- Exertion
- Previous History
- Primary Pulmonary Hypertension
- Unilateral Pulmonary Artery
What are the Symptoms of High-Altitude Pulmonary Oedema (HAPE)?
- Dyspnoea at Rest
- Cough
- Bloody Cough: Pink Frothy Sputum
- Poor Exercise Tolerance
- Orthopnoea
- Febrile (fever)
What is the problem with medications for Altitude Illness Prevention?
- Most medications are not Permitted by WADA
What medications for altitude illness prevention are not permitted by WADA?
- Acetazolamide
- Dexamethasone
What medications are used for AMS and HACE?
- ACetazolamide
- Dexamethasone
What medications for altitude illness are permitted?
- Tadalafil (Cialis): previously monitored
- Nifedipine
What medications are used to prevent High-Altitude Pulmonary Oedema?
- Tadalafil (Cialis)
- Nifedipine
What level of activity should you perform during the first few days of altitude acclimatization?
- Decreased Intensity
What level of activity should you perform during the first few days of altitude acclimatization?
- Decreased Intensity
What is the hydration and nutrition recommendation for activity at high altitudes?
- Maintain hydration: dehydration prone
- High CHO diet
What does previous history determine about altitude illness?
- Important for rare conditions: HAPE and probably HACE
- Not as helpful for AMS
What is the treatment for altitude illness?
Permitted
- Descent
- Oxygen
Not Permitted
- Most medications
What is a Gamow Bag?
- Inflates to 2 psi
- Simulated descent
- Equivalent to 1600 metre descent
- Temporizing measure
How does Ultraviolet Radiation play into high-altitude activity?
Increased
- intensity
- potential for burns
- potential for snow blindness
- reflection off snow or water
How does high altitude impact the immune system?
Immunosuppression
- Susceptibility to infection
What is the recommendation for the immune system when ascending to high altitudes?
- Stay up to date on immunizations
How can having Refractive Eye Surgery impact your experience at high altitudes?
- Transient blurring due to drying and corneal edema
- Resolves on Descent
What are the recommendations for someone who has had refractive eye surgery when ascending to high altitudes?
- Artificial tears
- Full goggles may help
How is Asthma impacted by high-altitude activity?
- Not clinically worse
What are the recommendations for someone with Asthma when ascending to high altitude?
- have a medication supply
- monitor temperature
How does high-altitude activity impact those with Coronary Artery Disease?
- No increased incidence
What is important to know about children when they ascend to high altitudes?
- History may be difficult to know
How are people with sickle cell trait impacted by high altitudes?
Heterozygous Hbs
- At risk for splenic infarctions
At what height do athletes experience altitude illness?
- typically above 2500m (8000’)
At what height do athletes usually do destination altitude training?
- typically 1800-2500m
How does intense exercise at high altitudes change the picture?
- AMS reported at 1950 - 2100m in athletes at training camps
- Incidence up to 44%
What is recommended for training at high altitudes?
- Lower intensity on the first few days
What is common with endurance athletes regarding iron?
- Low iron stores
Why do endurance athletes have low iron stores?
- Increased red cell destruction
- Sweat loss of iron
- Impaired iron absorption post-exercise
What is iron necessary for?
- Red Cell Synthesis
What is the recommended protocol for iron management at high altitudes for endurance athletes?
- Test and treat early
- Treatment: for specific iron deficient non-anaemia groups
What does Hypoxia do to sleep?
- Directly Impares
Why does Hypoxia impact sleep?
- More Frequent arousals
- Less restful - impacting recovery
Why is sleep impacted at high-altitude training?
- Hypoxia
- Jet lag
- Poor sleep environment
What are the recommendations for improving sleep at high altitudes?
- 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
What are the recommendations for using sleep medications at high altitudes?
- Consider carefully: adverse effects
- Consult with a physician
- Safe at altitude
What sleep medications are permitted?
- Temazepam
- Zolpidem
- Zaleplon
What sleep medication is prohibited?
- Acetazolamide
What are some altitude pre-acclimatization strategies?
- Intermittent hypoxia training: tents and camps
- Avoid illness, dehydration, and sleep debt on arrival
What does prolong
