High altitude illnesses....My personal fast review

Hi Guys!!!!.....In this post I'd like to cover maybe the biggest issue in Expedition Medicine: High altitude related illnesses….and this is my personal fast review:

Hypobaric hypoxia found at high altitudes (especially over 2400m) is a strong stressor for the body especially in unacclimatized or not correctly acclimatized persons and may produce from a simple Headache, to Mountain sickness, to life-threatening conditions such as Acute polmonary Edema and Acute Cerebral Edema.

Prevention is of the utmost importance:

1.     Staged ascent:

-First camp no higher 2400m.

 Increase of no-more 300-600m per night.

 OR

 Two nights at same altitude for every increase of 600m.

-If expedition starts above 2700m: First two nights must be spent acclimatizing.

-Just a TIP: ”climb high,sleep slow”: proceed higher during the day, return to a lower elevation to sleep.

2.     Diet rich in carbohydrates may aid acclimatization and prevent High altitude illness.

3.     Is important to avoid excessive exercise until ucclimatized.

4.     High altitude increases fluid losses, Thus adeguate hydration ( maybe judged by Clear urine) is helpful.

5.     Drug Prophylaxis (Just for persons with previous history of AMS or forced rapid ascent):

-Acetazolamide: 

250 mg twice/day orally, starting day before ascent.

-Dexamethasone (Just people intolerant to Acetazolamide or forced ascent to altitude over 4.200m - for instance in case of rescue operations):

4 mg every 8h orally.

High altitude Headache (HAH):

Usually is the First unpleasent symptom of High altitude exposure.

-Feautures:

·       Occurs with an ascent greater than 2500m.

·       developes within 24h after ascent and resolves 8h after descent.

·       Can be defined HAH if has two of the Following characteristics:

-Bilateral.

-frontal or fronto-temporal.

-dull or pressing quality.

-aggravated by exertion, coughing, bending, movements, straining.

-Treatment:

Ibuprofene, Aspirin or Paracetamole/Acetaminophene.

Acute Mountain Sickness:

-Feautures:

Headache                                                                                       

+

At least One of:

                          -Anorexia

                          -Nausea/Vomiting

                          -dizziness

                          -disturbed sleep

                          -lassitude

-Treatment:

·       Stop ascent and wait for improvement.

·       O2 to reach and mantain SpO2>90%.

·       Acetazolamide: 250 mg twice/day orally (If intolerant: Dexamethasone 4 mg every 8h orally).

·       Treatment of Symptoms: -Haedache: Aspirine or Paracetamole/Acetaminophene.

                                                              -Nausea: Promethazine.

HAPE (High Altitude Pulmonary Edema)

-Feautures:

Dyspnea on exertion, fatigue, dry cough, that can proceed to frothy sputum, crackles on lung auscultation.

-Treatment:

·       immediate Descent of 600m-1200m.

·       If descent is impossible:a Portable hyperbaric bag is a temporary lifesaving device (50 min. in bag - 10 min. break every hour).

·       O2 to reach and mantain SpO2>90%.

·       Nifedipine 10mg oral.

HACE (High Altitude Cerebral Edema)

-Feautures:

Headache

 +

Change in the level of consciousness.

-Treatment:

·       Immediate descent of 600m-1200m

      (Portable Hyperbaric chamber as temporizing measure if descent is impossible).

·       O2 to reach and mantain SpO2>90%.

·       Dexamethasone: 8-12 mg by the route fastly available, than 4 mg every 6 hours until simptoms subside.

....And This is it....!!!!!!!!

I tried to be as fast and schematic as possible.....

…..Hoping you Enjoy.....

Just have a good day on the Edge............................