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CLINICAL SYNDROMES
Acute Mountain sickness
High Altitude Pulmonary Edema
Chronic Pulmonary hypertension
High Altitude Cerebral edema
Coronary / cerebrovascular insufficiency
Acute Mountain Sickness
Severity of symptoms as per altitude
Headache, insomnia, disturbed sleep
Nausea, vomiting, giddiness
Palpitations
Fatigue, breathlessness
Disinterest in work, lack of concentration,
depression, muscular weakness, drowsinesss
hangover
Prevention
Acclimatization
Proper fluid intake
Avoid smoking, alcohol, late dinner
AMS SYMPTOMATIC TREATMENT
Headache
Acetaminophen / ASA
Avoid narcotics (decrease HVR)
Nausea
Prochlorperazine (stemetil) 10mg PO /IM
AMS SPECIFIC TREATMENT
Acetazolamide
Prophylactic and curative
Carbonic anhydrase inhibitor
Causes bicarbonate diuresis and metabolic acidosis
Increased ventilation and arterial oxygenation
Dose 250 mg po tid
Dexamethasone
Reduces cerebral edema
Useful if acetazolamide not tolerated
Dose 8mg im/po followed by 4mg im/po q6h
High Altitude Pulmonary Oedema
Risk factors
Rapid Ascent above 3000 m
Physical exertion
H/O AMS or HAPO
Clinical features
Usually < 3 days; rarely up to 10 days
Dyspnoea, cough, palpitation, nausea vomiting,
chest discomfort, blood stained sputum
Cyanosis, tachycardia, hypertension, pulmonary
rales
MANAGEMENT OF HAPO
Evacuation to lower altitude
Oxygen
Recompression in chamber 1 atm X 16hrs
All cases of HAPO/ HACO in portable one man
recompression bag; 150 mm Hg (reduce
altitude by 6000); reduce to 50mm Hg every 5
min; recompress 150mm Hg(ensures air
circulation)
Bring patient out of bag 2 hourly for 15-20 min -
monitoring/ nursing
Diuretics
HAPE - TREATMENT
Stop Ascent!!!
Descend at least 2000 ft unless close clinical monitoring possible
If monitoring possible
Mild Cases
Bed Rest (1-2 days)
Moderate Cases
Bed Rest
Oxygen
HAPE TREATMENT ( CONT )
Severe Cases
Diagnostic criteria
presence of change in mental status
and /or ataxia in a person with AMS
Or
presence of both i.e change in mental status
and ataxia in a person without AMS
HIGH ALTITUDE CEREBRAL EDEMA : CLINICAL FEATURES
Global encephalopathy
Ataxia
Altered mentation
Seizures
Occasional CN palsies (due to increased ICP)
Papilledema
Retinal hemorrhage
Coma
Death due to brain herniation
HIGH ALTITUDE CEREBRAL EDEMA
Pathophysiology
Hypoxia induces neurohumoral and hemodynamic responses resulting in
1. over perfusion of microvascular beds
2. elevated hydrostatic pressure,
3. capillary leakage
4. edema
MRI FINDINGS .
Edema of splenium of
corpus callosum
HIGH ALTITUDE CEREBRAL EDEMA
Treatment
Descend 2000 feet and keep descending until symptoms resolved
Supplemental O2 (4-6 l /minute)
Dexamethasone 8mg iv then 4mg q6h iv
Hyperbaric chambers
Chronic Pulmonary Hypertension