Ross altitude sickness Flashcards
A patient is running a marathon presents to the first aid tent. He is slightly confused with a temp of 103.4. Your next best action is which of the following?
A. give tylenol and let him go home
B. Give po fluids and let him go home
C. Have him urinate and look for blood
D. Send to higher level care for eval and treatment
D
at a very high altitude 12,000-18,000ft does all of you tissue acclimate?
no hypoxia occurs, <90% of tissues acclimate
True or false: The partial pressure decreases as a function of the barometric pressure?
True. Denver at 5280 air pressure is 17% less than sea level air so 17% less oxygen
What anatomical structure detects the decrease in arterial oxygenation? and what is the bodies response?
Chemoreceptors in the carotid body notice the decrease and communicate with the medullary respiratory neurons which then tell the body (through more steps) to increase ventilation
What is the ventilatory response when its your day one in high altitude?
Step 1. Hypoxia Step 2. Carotid body notices it Step 3. Medullary center stimulated Step 4. Respirations are increased Step 5. increased respirations blows off to much CO2 causing Respiratory alkalosis
Now you have been in altitude for 1.5 days. What is the body response?
Still hypoxia and wanting to stimulate medullary center, but the respiratory alkalosis is telling the medullary center to slow down breathing so your breathing now is slower.
Generally is there an increase in oxygen delivery to the cell when acclimating to high altitude?
No
When in high altitude your SNS activity is increased, this causes what effect.
- Causing decreased aldosterone release
- This causes or results in increased peeing
- Increased peeing decreases total fluid volume in the body.
- This causes decreased stroke volume
- Decreased stroke volume cause an increase in HR
When acclimating to high altitude do pulmonary vessels constrict or dilate due to hypoxia?
They constrict so pulmonary vascular resistance increases
On day two of ventilatory acclimation the kidneys excrete what to compensate for resp alkalosis?
They start to excrete sodium bicarb
If you know of someone who will be traveling and staying at high altitude what medication can you give them to help acclimate? and why?
Acetazolamide, this medication increases bicarbonate secretion
Peripheral VC triggers ________ to suppress secretion of _________ and aldosterone
baroreceptors
ADH
after 90 days of being in high altitude you will have an increase in what?
RBC and Hb along with erythropoiten release is increased in response to hypoxia
If there is no recent history of an ascent can someone have acute mountain sickness (AMS)
No there needs to be an ascent to have AMS
What symptoms would make you suspect AMS?
AMS is characterized by
- Headache
- Gi disturbance
- Dizziness
- Sleep disturbance
and of course history of an ascent
What is the treatment for AMS
- descent
- Acetazolamide 125mg po bid
- oxygen
What is the treatment for HAH and mild AMS?
- Stop ascent and try to acclimate
- Acetazolamide 125 or 250mg bid
- or descend 500m
What is the treatment for severe acute mountain sickness (not sure if its different than her just regular AMS but has other treatments in powerpoint)
- O2
- Acetazolamide and dexamethasone
- immediate descent
- pressure bag (gamow bag)
What are the two high altitude neurologic syndromes?
- High altitude headache (HAH)
2. High altitude cerebral edema (HACE)
What are the high altitude pulmonary syndromes?
- High altitude cough
- Purulent bronchitis
- Pulmonary hypertension
- High altitude pulmonary edema (HAPE)
A score of 2-4 from the lake louis acute mountain sickness self questionnaire is what kind of AMS?
Mild AMS
A score of 5-9 from the lake louis acute mountain sickness self questionnaire is what kind of AMS?
Moderate AMS
A score of 10-15 from the lake louis acute mountain sickness self questionnaire is what kind of AMS?
severe AMS
What is the main difference between HACE and AMS
Altered mental state occurs with HACE
If the cerebral edema from HACE doesnt go down what would be the next symptom?
uncal herniation which is bad news bears
Hace starts off ________ then becomes ________ edema?
- Vasogenic
2. Cytogenic
true or false: people with HACE have ataxia and altered mental status?
true
Would you expect someone to describe a weakness to a point of not being able to move if they have HACE?
yes
True or false: high altitude pulmonary edema is caused by the heart not being able to circulate blood as efficiently?
False it is non cardiogenic edema
What are the early signs of high altitude pulmonary edema?
early signs are exercise intolerance
What is the treatment for HACE?
- immediate descent
- oxygen
- dexamethasone 4mg, Acetazolamide
- Hyperbaric therapy
What is the treatment for HAPE?
- Minimize activity
- O2
- Nifedipine 10mg po, Acetazolamide
- Hyperbaric therapy
- or immediate descent
Is this pt a high risk or moderate risk for high altitude issues?
some one with CHF and sleep apnea
they should go to high altitude areas with caution (moderate)
Is this pt a high risk or moderate risk for high altitude issues?
Someone with moderate COPD and have had a CVA
they should go to high altitude areas with caution (moderate)
Is this pt a high risk or moderate risk for high altitude issues?
An elderly person with sickle cell trait?
The elderly part does not add any extra risk but the sickle cell trait does. They should use caution going to high altitude
What conditions should someone not go to high altitudes with?
- CHF uncompensated
- Pulmonary HTN
- Severe COPD
- sickle cell disease
