S16C216 - high-altitude medicine

Question 1

AMS

Answer 1

• acute mountain sickness occurs at >7000 ft (2130m)
• h/a, GI disturbance, dizzy/light-headed, sleep disturbance
• grading system, mild is score of 10
• related to rate of ascent and sleeping at altitude
• cerebral edema, pulmonary edema, peripheral edema, antidiuresis
• tx: dexamethasone, acetazolamide
• ginkgo biloba for prevention

Question 2

Acute hypoxic syndrome

Answer 2

• sudden severe hypoxic insult (accidental decompression of aircraft cabin or failure of oxygen system of pilot of mountaineer)
• tx: adminster oxgyen or rapid descent

Question 3

HACE

Answer 3

• high altitude cerebral edema: progressive neurologic deterioration in someone with AMS or HAPE
• onset of ataxia and altered LOC heralds this condition
• raised ICP: 3rd/6th CN palsy
• tx: O2, descent, steroid, hyperbaric bag, acetazolamide
• descent is key

Question 4

HAPE

Answer 4

• high-altitude pulmonary edema, non-cardiogenic, from hydrostatic edema, pulm HTN
• Sx: dry cough, dyspnea, decr exercise tolerance, rales, low O2 sat
• tx: O2, descent
• prevention: nifedipine, ventolin

Question 5

Snow blindness (UV keratitis)

Answer 5

• UVA/B penetrate atmosphere to greater degree at higher altitude causing corneal burns-
• Sx: erythema, chemosis, eyelid swelling
• resolves w/in 24h, give analgesics and cool compresses