Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

GP ACRRM > Travel Medicine > Flashcards

Travel Medicine Flashcards

1
Q

From what age can someone be vaccinated against Hepatitis A

A

12 months

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What kind of virus is hepatitis A

A

RNA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

How long can the hepatitis A virus survive outside of a host?

A

Weeks in water, marine sediment, shellfish or soil

Several hours on hands, longer in food kept at room temperature

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Is the hepatitis A virus susceptible to heat or freezing?

A

No

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Transmission of hepatitis A

A

Foecal-oral route

Can also occur (mostly through this route) via direct person-to-person contact, sexual contact and blood transfusions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Incubation period of hepatitis A

A

15-50 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

How does the outcome of hepatitis A infection differ between children and adults?

A

Children are generally asymptomatic whereas 75% of infected adults will develop icteric disease

This is why in areas with high endemic rates, children tend to be infected early thus clinical disease is uncommon in locals

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Most common causes of hepatitis A infection in Australians

A

Travel to an area with higher rates

Common outbreaks from contaminated food/water

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Should we check for natural immunity against hepatitis A prior to vaccination?

A

Yes - in those born prior to 1950 and in those with a past history of unexplained hepatitis or jaundice

(If anti-HAV IgG present, vaccination not required)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Presentation of hepatitis A

A 
Prodromal phase:
	- Lasts 4-10 days
	- Fever, malaise, weakness
	- Anorexia, nausea and vomiting
Acute hepatitis phase:
	- Dark urine often first sign
	- Jaundice and pale stools 1-2 days later
	- Associated with gradual resolution of systemic prodromal symptoms
	- Hepatic pain and pruritus may occur

Liver function returns to normal within a month usually
10% can have prolonged or relapsing symptoms over 6-9 months, however chronic infection does not occur

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Management of hepatitis A

A

Supportive only

Vaccination not required in someone who has been infected

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Contraindications to hepatitis A vaccination

A

Allergy to previous HAV vaccine or components
Allergy to Yeast if giving HepA/B combination vaccine

Safe in all others (including pregnancy, immunosuppression etc. - though seroconversion rates may be lower)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Who should you recommend Hepatitis A vaccination to?

A
  • ATSI children (routine vaccination schedule)
  • Travellers to intermediate or high endemicity areas (Asia, Africa, South America, SouthEast Europe and Middle East)
  • Those living in remote areas
  • Occupational risk (healthcare workers, especially in ATSI communities)
  • Those with lifestyle risk (IVDU, MSM)
  • Pre-existing chronic liver disease or chronic hep B/C infection
  • those with intellectual disabilities
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

How many doses required to complete Hepatitis A primary vaccination course?

A

2
1st provides at least 12 months immunity
2nd should be given 6-18 months after first (recommendation depends on brand)

Boosters not considered to be necessary at current

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What pathogens cause enteric fever

A

S. typhi or S. paratyphi

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Where are the highest endemic rates of typhoid/paratyphoid

A

Indian subcontinent

Also high in Asia (except Japan and Singapore), Africa and Middle East

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is the risk of a traveller contracting enteric fever

A

1:3000 for a traveller spending 4+ weeks in a high risk area

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

How common is it to develop carrier status after typhoid fever

A

Up to 5% will continue to shed the pathogen for >1y

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Typical incubation period for typhoid/paratyphoid

A

7-14 days (range 3-60)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Clinical presentation of typhoid/paratyphoid (enteric fever)

A 
Fever - increases with disease progression
Dull frontal headache
Malaise
Myalgia
Anorexia
Dry cough
Less commonly:
Constipation (sometimes diarrhoea in children)
Abdo pain
Relative bradycardia
Splenomegaly
Rash "Rose spots"
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What is the typical typhoid rash

A

Rose spots

  • erythematous blanching papules, mostly on anterior trunk (also on back and proximal limbs)
  • 2-3mm in diameter
  • each lasts 3-5 days
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Potential complications of typhoid

A

(Typically occurring after 14 days of illness)

  • GI bleeding
  • bowel perforation (most commonly ileal)
  • typhoid encephalopathy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Tests to diagnose typhoid

A

No test is really ideal

Gold standard is blood culture

May also be sporadically cultured in urine or stool

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

To whom would you recommend a typhoid vaccination

A

Anyone >2y travelling to moderate-high risk countries

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

How soon before travel should typhoid vaccination be provided

A

At least 2 weeks prior to travel

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Are repeat doses required for typhoid vaccination?

A

Only 3 yearly boosters are required. The primary course is just the one dose.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Treatment of typhoid

A 
Azithromycin
OR ciprofloxacin (as long as not acquired in India or SouthEast Asia)

Note that fever takes 3-5 days to subside despite antibiotic therapy, and patients may feel worse during this time

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

High risk areas for malaria

A

Highest risk generally: Africa, Oceania
Moderate: Asia, South America
Low: Central America

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Most common malarial parasite in Africa v Asia

A

Africa; Plasmodium falciparum

Asia/Pacific: Plasmodium vivax

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Different malaria parasites and their incubation periods

A

P. falciparum 9-14 days (non-relapsing)
P. Malariae 18-40 days (non-relapsing)
P. vivax 12-18 days usually, some strains up to 10 months (relapsing)
P. ovale 12-18 days (relapsing)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Recommendations for non-medical prophylaxis against malaria

A

Personal protection methods from dusk to dawn (when anopheles mosquito is active)

  • light, loose, long clothing covering arms and legs
  • Insect repellent containing 20-40% DEET
  • mosquito nets +/- permethrin impregnantion
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Main malaria chemoprophylaxis options

A

Doxycycline 100mg/day from 2 days prior to exposure to 4 weeks after
Mefloquine 250mg/week for 2-4 weeks prior, for 4 weeks after
Malarone 1 tab daily from 1 day prior to 1 week after

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Contraindications to doxycycline

A

Age <8y
Pregnancy
Breastfeeding

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Common side effects to doxycycline

A

Nausea, indigestion, photosensitivity, vaginal candidiasis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Benefits of using doxycycline as malarial chemoprophylaxis

A

Cheap
Protects against some other tropical diseases
Can be commenced at short notice
Suitable for long term use

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Downfalls of using doxycycline as malarial chemoprophylaxis

A

Contraindications

Unsuitable for use in children <8y

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Contraindications to mefloquine

A 
1st trimester of pregnancy
Children <5kg
History of epilepsy
Psychiatric illness (including anxiety and depression)
Cardiac conduction disorders
Other medications that prolong QT
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

Common side effects of mefloquine

A 
Headache
Nausea
Sleep disturbance
Vivid dreams
Dizziness
Rarely: precipitate depression/anxiety/psychosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

Benefits of using mefloquine as malarial chemoprophylaxis

A

Can be used long term

Suitable for children

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

Downfalls of mefloquine as malarial chemoprophylaxis

A

Cost
Potential side effects
Contraindications
Needs to be started 2-4 weeks prior to travel

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

Contraindications to malarone

A

Pregnancy, breastfeeding

42
Q

Common side effects of malarone

A

Headache, nausea

43
Q

Benefits of using malarone as malaria chemoprophylaxis

A

Minimal side effects
Paediatric dose available
Can be commenced at short notice (1 day prior to exposure)

44
Q

Downfalls of using malarone as malaria chemoprpphylaxis

A

Very expensive

Not licensed for use long term (due to lack of data, not known risks)

45
Q

Clinical presentation of malaria

A 
Fever in returned traveller - may come and go or be constant
PLUS influenza-like symptoms mostly
- chills
- headache
- myalgia/arthralgia
- malaise
- profuse sweating
- nausea, lack of appetite
- diarrhoea
- abdominal pain
- cough
- anaemia +/- jaundice
Symptoms CAN occur intermittently
46
Q

Signs of severe malaria

A 
Seizures
Confusion
Kidney failure
Acute respiratory distress syndrome
Coma
47
Q

Incubation period of malaria

A

7 days to several months or more after being bitten by infected mosquito (depends on specific parasite)

48
Q

Diagnosis of malaria

A

Blood smear microscopy: parasitised red cells
OR rapid diagnostic tests (less accurate, cannot differentiate between different species and cannot quantify)
PCR testing - takes a long time, but more sensitive than microscopy

49
Q

First line treatment of malaria

A

Artemether + lumefantrine (though there are additional considerations for specific species)

IV treatment for severe disease

Daily parasite count until negative
Repeat CBE and microscopy at 7 days and 28 days post treatment completion

50
Q

Individuals at highest risk for severe/complicated traveller’s diarrhoea

A
  • insulin dependent diabetics
  • congestive heart failure
  • advanced cancer
  • HIV infection
  • Inflammatory bowel disease/other bowel abnormalities
  • reactive arthritis
  • reduced gastric acidity
  • HLA-B27 positive individuals
51
Q

Most common causes for traveller’s diarrhoea

A 
Bacterial (50-80%)
- ETEC most common
- EIEC
- EAEC
- Shigella
- Campylobacter
- Salmonella
Norovirus (10-20%)
Protozoans only should be considered in those with diarrhoea >14 days or >72 hours despite 3 days antibiotics
52
Q

How effective is the cholera vaccine?

A

> 90% effective against vibrio cholera only

No significant evidence for reduction of traveller’s diarrhoea overall or of ETEC

53
Q

Recommendations for giving cholera vaccine

A

Consider in individuals with increased risk of severe of complicated traveller’s diarrhoea, OR in people travelling to an area with recent epidemic

54
Q

Recommendations for self-management of traveller’s diarrhoea

A

Hydration maintenance is main goal!
Oral rehydration solution always if diarrhoeal illness + loperamide
If symptoms worsen or persist >24 hours, add in antibiotics

If moderate-severe from the start, loperamide + antibiotics as initial management

55
Q

Recommended loperamide dose in setting of traveller’s diarrhoea

A

2 tabs (4mg) stat, then 1 tablet (2mg) after each bowel motion to max of 8 tabs per day

56
Q

Recommended antibiotics and dosing for self-management of traveller’s diarrhoea

A

Ciprofloxacin 500mg stat OR BD for 72 hours
Norfloxacin 400mg stat or BD for 72 hours
Azithromycin 500mg daily for 3 days

Kids:
Azithro 10-25mg/kg (make sure the pharmacist does not mix it up, give sterile water and instructions on how to doso)daily for 3 days OR
cipro/norflox 10mg/kg BD

Usually single dose is adequate, but if symptoms continue, continue for up to 3 days (if still persisting then take Tinidazole 2g stat in case of protozoa)

57
Q

Another name for schistosomiasis

A

Bilharzia

58
Q

Where is schistosomiasis sfound

A

Throughout Africa (mostly sub-Saharan), parts of Asia, South America, the Caribbean, the Middle East

59
Q

Typical incubation period of schistosomiasis

A

14-84 days (many people subclinical or asymptomatic)

60
Q

Where does schistosomiasis lodge

A

S. mansoni and S. japonicum lodge in the mesenteric venous plexus of the liver
S. haemtobium lodges in the venous plexus of the lower urinary tract

Note that Africa has both Mansoni and haematobium species endemic

61
Q

Route of infection with schistosomiasis

A

Direct skin contact with contaminated fresh water - even if only for 1 minute

62
Q

Advising travellers to prevent risk of schistosomiasis

A
  • advise no swimming in freshwater or wading through wetlands barefoot etc. in endemic areas EVEN FOR 1 MINUTE
  • Don’t listen to locals who claim the water is “safe”
  • DON’T listen to locals/other travellers who advise to take an immediate dose of praziquantel (ineffective and can worsen things)
  • encourage serological testing 3 months after exposure if does swim in the water, even if asymptomatic
  • warn of the serious complications (myocarditis, pericarditis, seizures, ataxia, motor paralysis)
63
Q

Presentation of acute schistosomiasis

A 
AKA Katayama fever (tends to occur in travellers from non-endemic countries)
Few weeks after exposure
- abdopain
- diarrhoea
- cough
- fever
- fatigue
\+/- hepatosplenomegaly 
\+/- eosinophilia
Spontaneous resolution over weeks
64
Q

Earliest symptom

of schistosomiasis

A

Mild itching/papular dermatitis at sign of parasite penetration 12-24 hours after infection
“Swimmer’s itch”

65
Q

Symptoms of chronic schistosomiasis infestation

A

Tends to occur more in persons from endemic areas
Depends on the species
S. mansoni and S. Japonicum (as they lodge in the liver vessels);
- diarrhoea/constipation
- blood in stool
- abdo pain
- colonic polyposis/portal hypertension, pulmonary hypertension can occur

S. haemotobium lodges in vessels of LUT

  • dysuria/cystitis
  • haematuria
  • long term: infertility, ureteral obstruction, hydronephrosis, bladder cancer
66
Q

Serious complications of acute schistosomiasis disease

A

Myocarditis
Pericarditis
Neurological manifestations (seizures, motor paralysis, ataxia)

67
Q

Diagnosis of schistosomiasis

A

In acute disease: based on exclusion of other infections and a thorough exposure history

Chronically:

  • test stool and/or END sample urine for ova
  • can also check serology, but can be difficult to interpret
68
Q

Who should be tested for chronic schistosomiasis infestation

A

All travellers to endemic areas who have had ANY freshwater exposure (3 months after return)
Migrants from endemic areas

69
Q

Treatment of schistosomiasis

A

Acute disease:
- supportive, need to discuss with ID specialist (mostly prednisolone, +/- antimalarials but they may worsen disease, so need to check with specialist!)

Periodic serological testing should then be undertaken

Chronic:
Praziquantel 20mg/kg per dose, 2 doses 4h apart
If had positive urine/stool, repeat samples 2-3 months after treatment
Serological testing should not be used as proof of cure
CBE can be repeated >12 weeks to ensure eosinophilia resolves

70
Q

Countries where Japanese Encephalitis occurs

A

Most Asian countries (except Singapore), Papua New Guinea, outer Torres Strait Islands of Australia

Occurs particularly in rural areas

71
Q

Months of most likely transmission of Japanese Encephalitis

A

India and SouthEast Asia (including Bali): year round
May-September in China, Korea and Japan
March - October in the further sound subtropical areas

72
Q

morbidity and mortality rate in Japanese Encephalitis

A

30% fatality rate of symptomatic infections in humans

60% of survivors (especially children) will have permanent neurological sequelae

73
Q

Risk factors of contracting Japanese Encephalitis

A

Dawn, dusk, or night visits to rice growing areas
Living in villages near rice paddies and farm animals
Soldiers/aid workers/missionaries/students/researchers in endemic areas in the wet season

74
Q

Risk factors for developing severe infection with japanese encephaltisi

A

Age >50y or child
Dual neurological infection (e.g. with mumps)
Compromised blood-brain barrier (e.g. Cochlear implants, shunts)
Pregnancy
Chronic conditions (solid organ transplants, hypertension, CVD, DM, CKD)

75
Q

Risk of Japanese encephalitis while pregnant

A

Risk of miscarriage in the first and second trimesters

76
Q

Pathogen/mosquito responsible for japanese encephalitis

A

Culex mosquito + specific flavivirus.
Enzootic cycle between vertebrate hosts (mostly pigs and egrets) and the mosquito

Feeds outdoors from dusk to dawn and breeds in flooded rice paddies and marsh environments

No person-to-person transmission

77
Q

Prevention of Japanese Encephalitis

A

Mosquito precautions
Avoidance of high risk activities (e.g. visiting rice fields dusk-dawn)
Advice about the disease to traveller to endemic areas
Advice about risks and benefits of vaccination

78
Q

Vaccines available for Japanese Encephalitis

A

Jespect/Ixiaro OR Imojev

Jespect/Ixiaro:

  • inactivated vaccine
  • 2 doses given 28 days apart (can try accelerated course 7 days apart if necessary)
  • Approved from 18y, can be given from 2mo
  • booster 1-2 years after primary course
  • Safe in pregnancy
  • approx $150 per dose

Imojev:

  • recombinant live vaccine (attenuated strain of yellow fever virus with JE genes)
  • single dose
  • booster maybe needed after 5y
  • booster for kids 1-2 yearsa fter primary dose
  • not suitable for children <9 mo
79
Q

Clinical features of Japanese Encephalitis

A

Widespread encephalomyelitis of white matter, thalamus, brainstem and spinal cord

In adults:
- headache
- meningism
- fever
- confusion/altered consciousness
(Can present as simple febrile illness, acute flaccid paralysis or aseptic meningitis)
Children often present with seizures (75%)

80
Q

Treatment of Japanese Encephalitis

A

Supportive management only

  • close observation
  • fluids, analgesia, antipyretics
81
Q

Diagnosis of Japanese Encephalitis

A

Serum or CSF specific anti-JE IgM antibodies

82
Q

Highest risk countries for rabies (11)

A

India, Nepal, Sri Lanka, Thailand, Philippines, Vietnam, El Salvador, Guatemala, Peru, Colombia, Ecuador

83
Q

Factors affecting how quickly rabies virus is taken up into CNS (thus how high risk a lesion is)

A

Density of nerve endings in bitten area (highest in the hands)
Proximity of bite site to CNS (highest in the face)
Severity of bite

84
Q

Incubation period of rabies

A

Ranges from 1-12 weeks to several years - dependent on site and severity of bite

85
Q

Clinical features of Rabies

A

Prodromal symtpoms:
(Non-specific)
fever, anorexia, cough, headache myalgia, sore throat, fatigue, vomiting, anxiety/agitation/apprehension
Parasthesiae or fasciculations can occur in proximity of the wound

“Furious encephalitic rabies” - classic, most common form
- aerophobia/hydrophobia
- disorientation
- bizarre or hyperactive behaviour
- autonomic instability (hypersalivation, hyperthermia, hyperventilation)
Death occurs within 12 days

“Paralytic/dumb rabies” - 30% of cases

  • more protracted and less distinctive
  • loss of sensation
  • weakness
  • pain
  • progressive flaccid paralysis
86
Q

Travel advice to prevent rabies

A

Avoid approaching stray animals
Stay aware of surroundings to avoid surprising stray dogs
Avoid carrying or eating food around monkeys
Avoid contact with bats (esp. cavers)

87
Q

Who should be offered rabies pre-exposure vaccination

A

High risk adults (veterinarians, animal handlers, wildlife officers, people living in or travelling to rabies endemic areas esp if >1 month)
Children living in or visiting rabies areas
People travelling to isolated regions with limited access to appropriate medical care

88
Q

Pre-exposure rabies vaccinations

A

Same as post-exposure vaccine but different delivery schedule
2 avail in Aus:
- Human diploid cell rabies vaccine (HDCV): inactivated virus, contains inactivated virus, neomycin and human serum albumin
- Purified chick embryo cell vaccine (PCECV): contains inactivated virus, neomycin, bovine gelatin, egg protein, chlortetracycline and amphotericin B

Both are given IM to deltoid if >12 mo
3x doses at 0, 7 and 28 days
Serological testing required for people with impaired immunity 2-3 weeks later
Safe in pregnancy

HDCV should be used for people with anaphylaxis to eggs

89
Q

Post-exposure wound care for possible rabies

A

Thorough wound cleansing and disinfection (lots of soap/detergent and water, followed by betadine)
Delay suturing where possible - infiltrate with HRIG and delay for at least several hours
ADT/Antibiotics as indicated

90
Q

Post-exposure prophylaxis to

rabies management in someone who does NOT have documented pre-exposure vaccination

A

rabies immunoglobulin should be instilled into the wound no later than 7 days after first rabies vaccine dose - give the remaining into the opposite side deltoid

Give rabies vaccine on day 0, 3, 7, 14, 28-30 (5 doses in total)

91
Q

Post-exposure rabies prophylaxis in someone who DOES have documented pre-exposure vaccination

A

Appropriate wound management
RIG not necessary
2x doses IM vaccine booster doses on days 0 and 3

92
Q

Altitude at which altitude sickness starts to occur

A

Unlikely to occur <2500m

93
Q

Large cities that travellers may not recognise are at risk of altitude sickness developing

A

Cusco, Peru (3400m)
Lhasa, Tibet (3600m)
La Paz, Bolivia (3700m)

94
Q

Physiological changes that occur with high altitude

A

Initial:

  • hyperventilation
  • increased sympathetic tone ( increase HR, BP and cardiac output)
  • vasoconstriction of pulmonary vasculature
  • cerebral vasodilation secondary to hypoxia

Later changes:

  • increased EPO -> increased Hb production
  • diuresis -> increased haematocrit
  • decreased muscle mass
  • increased vascularity
95
Q

Risk factors for altitude illness

A
  • ascending to >2800m in one day
  • prior history of AMS ascending >2800m
  • anyone ascending >500m/day at altitudes >3000m
  • Anyone with history of severe AMS or HAPE/HACE

Not related to physical fitness, alcohol, cigarettes, gender, load carried, recent respiratory illness etc.

96
Q

Absolute contraindications to high altitude travel

A 
Severe COPD
Unstable asthma
Severe IHD
Severe or uncontrolled heart failure
Pulmonary hypertension
Complicated pregnancy
97
Q

Relative contraindications to high altitude travel

A 
Moderate COPD
Stable angina
Previous cerebrovascular disease
Poorly controlled DM
Recurrent arrhythmias
Uncomplicated pregnancy >36 weeks gestation
98
Q

Recommendations to prevent altitude illness in travellers

A
  • slow ascent to allow for acclimatisation (300-500m/day >3000m altitude)
  • A day’s rest every 3-4 days
  • Resting in first 48h of arriving at places of high altitude
  • 24h delay after uncomplicated dive (1 week minimum after recompression therapy)
99
Q

Common high altitude conditions and other risks at high altitude

A 
High altitude headache (HAH)
Acute Mountain Sickness (AMS)
High altitude cerebral oedema (HACE)
High altitude pulmonary oedema (HAPE)
DVT more common at high altitudes (same recommendations as for flying)
100
Q

Medications that can be used for the PREVENTION of altitude illness

A

High altitude headache: Ibuprofen 600mg TDS (yes, 600 is not a typo)

Acute mountain sickness: Acetazolamide 125mg BD (off label use)

High altitude pulmonary oedema: Nifedipine SR 60mg daily (either 30mg 12 hourly or 20 mg 8 hourly) - does not reduce AMS

101
Q

Presentation and immediate management of high altitude conditions:

A

HAH: headache at high altitude, settles after 10-15 minutes wit oxygen, resolves with regular NSAID and decrease in altitude

AMS: Headache within 6-36 hours of high altitude PLUS either GI upset, fatigue/weakness, dizziness, difficulty sleeping. Usually resolves with 2-4 days rest and no further altitude rise, if severe needs O2 and dexamethasone to prevent HACE

HACE: AMS symptoms 24-36 hours after high altitude arrival PLUS impaired mental state and/or ataxia. Medical emergency: immediate reduction in altitude of at least 300m, IV dex and O2

HAPE: can develop independently of AMS 2-4 days after high altitude. Cough/dyspnoea/reduced exercise tolerance/chest tightness, creps/high RR and HR, cyanosis
Urgent rapid descent of 1000m at least, O2, nifedipine

GP ACRRM (14 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions