Altitude sickness

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					Altitude Sickness
                    Altitude
 High Altitude
 5000 ft to 11,500 ft
  – Minor decrease in O2
    transport (SaO2 >
    90%)
  – Altitude sickness
    common with rapid
    ascent above 8200
    feet
                   Altitude
 Very High Altitude
 11,500 ft to 18,000 ft
  – Maximum SaO2
    < 90% ; Pa02 < 60 torr
  – Most common range
    for serious altitude
    sickness
                      Altitude
 Extreme  Altitude
 > 18,000 ft
  – Severe hypoxemia,
    hypocapnia
  – Deterioration outstrips
    acclimatization
                   Altitude
 Mount  Everest
 29,028 ft
  – Unacclimatized person
  – Unconscious in 45 seconds
  – Dead in 4 to 6 minutes
         Altitude Pathophysiology
Hyperventilation to
 compensate for
 decreased FiO2
                            Alkalosis


                                        Episodic respiratory
                                        arrests during sleep


         Suppression of breathing
              during sleep
  Altitude Pathophysiology

                            Increased         Cerebral
                          cerebral blood       edema
   Vasodilation
                               flow



Hypoxia            Increased                   Pulmonary
                   Capillary
                  Permeability                   edema

                                 Peripheral
                                  edema           Increased
                                                 cold injury
                                                     risk
  Altitude Sickness Symptoms
 Mild   Acute Mountain Sickness
  –   Headache           –   Dizziness
  –   Malaise            –   Dyspnea on exertion
  –   Anorexia           –   Dry cough
  –   Nausea, vomiting   –   Decreased urine output


      Any AMS symptoms are due to altitude
            until proven otherwise
High Altitude Cerebral Edema
 Lassitude
 Headache
 Mental   dullness
 Ataxia
 Focal   defects
  – Paralysis
  – Paresthesias
High Altitude Pulmonary Edema
 Dyspnea at rest
 Fatigue, weakness
 Orthopnea
 Hemoptysis, blood-tinged sputum
 Cyanosis
 Rales
   HAPE/HACE Treatment
 Stopascent!!
 Descend immediately if:
  – No improvement with treatment
  – Ataxia, decreased LOC, pulmonary edema
 Minimize     exertion
 Bed   rest
     HAPE/HACE Treatment
 Oxygen
 Pulmonary edema
    – CPAP or PEEP
    – Possible hyperbaric chamber
    – No lasix or morphine (non-cardiogenic)
   Cerebral edema
    – Steriods (Dexamethasone)

				
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posted:4/12/2008
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