Dr. Bart presents today’s Morning Report!
ACUTE ALTITUDE ILLNESS
| Intermediate Altitude | High Altitude | Very High Altitude | Extreme Altitude |
| 5000 to 8000 ft | 8000 to 14000 ft | 14000 to 18000 ft | >18000 ft |
| Denver | Himalayas |
PATHOPHYSIOLOGY:
-Sense decreased arterial oxygenation –> increased ventilation –> respiratory alkalosis –> renal excretion of bicarb
-Maximum ventilatory acclimization after 4 to 7 days
-Increased erythropoietin
-Increased diuresis, hemoconcentration
-Decreased SV, Increased HR
-Pulmonary vasoconstriction
TREATMENT: OXYGEN, DESCEND (NOT necessarily to sea level, 3290 ft), hyperbaric bags, acetazolamide, dexamethasone (HACE), nifedipine (HAPE)
ACUTE HYPOXIA:
-Sudden and severe insult
-Symptoms: dizziness, dimmed vision, LOC
ACUTE MOUNTAIN SICKNESS (>7000 to 8000 ft):
-Headache, GI upset, dizziness, sleep disturbance, irritability, sleepiness
-Fluid retention and peripheral edema in contrast to diuresis of acclimatization
-Proportional to rate of ascent, especially sleep altitude
-NOT related to physical fitness
-2/2 hypobaric hypoxia
-If mild –> self limited
HIGH ALTITUDE PULMONARY EDEMA:
-Most lethal, recognize early!
-Sx:
EARLY: dry cough, DOE, rales, low for altitude Sa02%.
LATE: tachycardia, tachypnea, dyspnea at rest, weakness, productive cough, cyanosis –> then HACE
-Risks: heavy exertion, rapid ascent, excessive salt ingestion, use of sleep medication, h/o susceptibility, PULMONARY HYPERTENSION
-Hydrostatic edema, most often on second night
HIGH ALTITUDE CEREBRAL EDEMA:
–ATAXIA (most sensitive), AMS, stupor, coma
-Increased ICP, CN palsies
-Usually associated with pulmonary edema
OTHER CONSIDERATIONS:
-HYPOXEMIA MAXIMAL DURING SLEEP
-Don’t forget about associated injuries:
– hypothermia, frostbite, trauma, UV keratitis, dehydration, and lightning injury
-Ibuprofen as preventative measure?
-PAINS, 2012
-RCT trail in Annals of Emergency Medicine
-n=89, randomized to ibuprofen or placebo 6 hours prior to ascent
-43% developed symptoms in ibuprofen group vs 69% in placebo group
-Inflammatory response or masking headaches?
References:
- Hackett PH, Hargrove J.Chapter 216. High-Altitude Medical Problems. In:Tintinalli JE, Stapczynski J, Ma O, Cline DM, Cydulka RK, Meckler GD, T. Tintinalli’s Emergency Medicine: A Comprehensive Study Guide, 7e. New York, NY: McGraw-Hill; 2011.http://accessmedicine.mhmedical.com.newproxy.downstate.edu/content.aspx?bookid=348&Sectionid=40381698. Accessed April 27, 2015.
- Hill, Adam, et al. “Current Practice for Management of Acute Altitude Illness, Frostbite, and Snake Envenomation.” EM Practice Guidelines Update. Sep 2012, Vol 4, No 9.
- Lipman et al. “Ibprofen prevents atlitude illness: a randomized controlled trial for prevention of altitude illness with nonsteroidal anti-inflammatories” Ann Emerg Med 2012 Jun; 59 (6) 484-90.
- Rothwell, Seen. “High Altitude Illness.” Life in the Fast Last Lane. http://lifeinthefastlane.com/high-altitude-illness
Jay Khadpe MD
Latest posts by Jay Khadpe MD (see all)
- Morning Report: 7/30/2015 - July 30, 2015
- Morning Report: 7/28/2015 - July 28, 2015
- IN THE STRETCHER INSTEAD OF BESIDE IT - July 22, 2015
- Morning Report: 7/14/2015 - July 14, 2015
- Morning Report: 7/10/2015 - July 10, 2015