HIGH ALTITUDE ILLNESS for IMC

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Slide1: 

Following are the slides from my talk on high altitude illness (HAI). They summarize the main points in HAI development, diagnosis, treatment and prevention. For full tutorials on HAI and other mountaineering-related health issues, check MedCom UIAA and ISMM websites. For practical medical advices, check-up and drug prescription, contact your GP or a specialist in sport medicine. Ludmila Boublikova

HIGH ALTITUDE ILLNESS: 

HIGH ALTITUDE ILLNESS            

HIGH ALTITUDE ILLNESS: 

HIGH ALTITUDE ILLNESS (MedCom UIAA and ISMM guidelines) 1. High altitude 2. Acclimatization 3. High altitude illness: AMS HACE HAPE 4. Treatment of HAI 5. Prevention of HAI 6. Specific groups of people in high altitude 7. Other high altitude-related health problems

HIGH ALTITUDE : 

HIGH ALTITUDE altitude > 2 500 m (8 000 ft) main problem: decreased availability of oxygen causing a disorder of normal breathing other factors: low temperature low air humidity high UV radiation

REACTION TO HIGH ALTITUDE: 

adequate  acclimatization insufficient  high altitude illness REACTION TO HIGH ALTITUDE adaptation

ACCLIMATIZATION : 

a gradual process of the body adaptation to high altitude ACCLIMATIZATION Symptoms/changes: 1. breathing:  hyperventilation (breathing deeper and faster)  shortness of breath during exertion  changed breathing pattern (periodic breathing) and frequent awakening at night 2. blood circulation:  tachycardia (increased heart rate)  decreased maximum heart rate  higher number of red blood cells 3. body fluid balance:  increased urination (altitude diuresis)

HIGH ALTITUDE ILLNESS (HAI) : 

Forms of HAI: (Lake Louise definition) HIGH ALTITUDE ILLNESS (HAI) I. acute mountain sickness (AMS) II. high altitude cerebral edema (HACE) III. high altitude pulmonary edema (HAPE) a disease caused by hypoxia in high altitude that is beyond the ranges the body can tolerate

ACUTE MOUNTAIN SICKNESS (AMS): 

ACUTE MOUNTAIN SICKNESS (AMS) symptoms caused by mild brain swelling due to hypoxia mild to severe incidence 25 – 85 % usually appears 6 – 12 hours after an ascent

Slide9: 

DIAGNOSIS:  headache + 1 or more of the following symptoms:  loss of appetite, nausea, vomiting  fatigue, weakness  dizziness, light-headedness  difficulty sleeping in the setting of a recent gain in altitude above 2 500 m ACUTE MOUNTAIN SICKNESS (AMS)

ACUTE MOUNTAIN SICKNESS (AMS): 

Predisposing factors: 1. rate of ascent 2. altitude reached (sleeping altitude) 3. individual susceptibility (genetic) other: exertion permanent residence in  1000 m above sea certain diseases (cardiopulmonary, blood) no significant association with: age gender physical fitness ACUTE MOUNTAIN SICKNESS (AMS)

HIGH ALTITUDE CEREBRAL EDEMA (HACE): 

severe swelling of the brain with deterioration of brain functions the most severe form of AMS, end-stage of AMS incidence 0.1 - 5 % often manifests at night can progress rapidly, lethal in few hours to 2 days HIGH ALTITUDE CEREBRAL EDEMA (HACE)

HIGH ALTITUDE CEREBRAL EDEMA (HACE): 

HIGH ALTITUDE CEREBRAL EDEMA (HACE) DIAGNOSIS: at least 2 of the following symptoms:  AMS  ataxia (loss of coordination of movements)  mental status changes (quantitative or qualitative) in the setting of a recent gain in altitude above 2 500 m

HIGH ALTITUDE CEREBRAL EDEMA (HACE): 

HIGH ALTITUDE CEREBRAL EDEMA (HACE) Predisposing factors: like in AMS HACE usually develops from AMS

HIGH ALTITUDE CEREBRAL EDEMA (HACE): 

HIGH ALTITUDE CEREBRAL EDEMA (HACE) PEOPLE WITH HACE ARE OFTEN CONFUSED AND MAY NOT RECOGNISE THEIR DISORDER !

HIGH ALTITUDE PULMONARY EDEMA (HAPE): 

HIGH ALTITUDE PULMONARY EDEMA (HAPE) leak and accumulation of fluid in the lungs leading to respiratory failure not related to AMS, may occur without signs of AMS incidence 0.1 - 5 % often manifests at night (typically the second night of ascent) progresses rapidly, lethal within hours may lead to development of HACE

HIGH ALTITUDE PULMONARY EDEMA (HAPE): 

HIGH ALTITUDE PULMONARY EDEMA (HAPE) DIAGNOSIS: at least 2 of the following symptoms:  breathlessness at rest  cough  weakness, fatigue, drowsiness  chest tightness, fullness, congestion at least 2 of the following signs:  gurgling or rattling breaths, crackles or wheezing  central cyanosis (blue or dark purple lips)  fast breathing  increased heart rate in the setting of a recent gain in altitude above 2 500 m

HIGH ALTITUDE PULMONARY EDEMA (HAPE): 

HIGH ALTITUDE PULMONARY EDEMA (HAPE) Predisposing factors: 1. young fit males 2. exertion 3. cold

TREATMENT OF AMS: 

TREATMENT OF AMS Mild to moderate forms NEVER continue in ascent !!! consider - rest at the same altitude with hyperventilation - descent fluids mild analgesics (paracetamol, aspirin, ibuprofen) acetazolamide (Diamox®) Severe forms: treat like HACE

TREATMENT OF HACE: 

TREATMENT OF HACE immediate descent to the altitude where the person last slept well (500 - 1000 m if in doubts) oxygen event. hyperbaric bag acetazolamide (Diamox®) dexamethason

TREATMENT OF HAPE: 

TREATMENT OF HAPE no exertion immediate transport to the altitude where the person last slept well (500 - 1000 m if in doubts) oxygen event. hyperbaric bag event. PEEP, CPAP nifedipin

Slide21: 

PORTABLE HYPERBARIC CHAMBER (hyperbaric bag) air-impermeable bags that can be inflated to high pressure, simulating descent main types: Gamow Certec PAC (Portable Altitude Chamber)

Slide22: 

PORTABLE HYPERBARIC CHAMBER

Slide23: 

PORTABLE HYPERBARIC CHAMBER indications: HACE or HAPE when descent is impossible contraindications: absolute - lack of spontaneous breathing relative - middle ear congestion, claustrophobia

PREVENTION OF HAI: 

PREVENTION OF HAI 1. gradual ascent within the tolerance zone and good acclimatization individual; general rules usually apply  one night at altitude slightly below 3 000 m (10 000 ft)  at altitudes above 3 000 m, sleeping altitude increase  300 - 500 m (1 000 - 1 500 ft) per night  a second night at the same altitude for every 1 000 m (3 000 ft) of gained altitude

PREVENTION OF HAI: 

PREVENTION OF HAI 2. avoiding medications that cause depression of breathing  alcohol  sleeping pills, sedatives  strong (narcotic) painkillers

PREVENTION OF HAI: 

PREVENTION OF HAI 3. drugs  acetazolamide (Diamox®) 2 x 125 - 250 mg indications: forced rapid ascents medical history of repeated AMS  ginkgo biloba 2 x 80 - 120 mg  (inhaled beta-agonists, oral nifedipine) (may prevent HAPE)

Slide27: 

“THE GOLDEN RULES” If you feel unwell at altitude, it is high altitude illness until proven otherwise. Never ascend with symptoms of AMS. If you are getting worse or have HACE or HAPE, get down immediately.

SPECIFIC GROUPS OF PEOPLE IN HIGH ALTITUDE: 

SPECIFIC GROUPS OF PEOPLE IN HIGH ALTITUDE  older people  children  pregnant women  medication (malaria prophylaxis)  cold exposition (hypothermia, frost-bites)  people with pre-existing diseases

Slide29: 

CARDIOVASCULAR DISEASES responsible for 30 % of lethal accidents in the Alps (DAV, OEAV) the risk increases with the altitude may be the first manifestation of previously silent disease recommendation: medical examination + ETT for men 50 and people with other risks

OTHER HIGH ALTITUDE-RELATED DISEASES: 

OTHER HIGH ALTITUDE-RELATED DISEASES  high altitude deterioration  high altitude retinopathy  high altitude peripheral edema

Slide31: 

Medical Committee of UIAA www.uiaa.ch International Society for Mountain Medicine www.ismmed.org Links: