Altitude related illness

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Altitude related illness

  1. 1. Altitude Related Illness Steven Podnos MD
  2. 2. Definition• A multitude of medical problems are associated with ascent to altitude, ranging from minor to life threatening• Hypoxia is considered a causative feature, but other elements of causation are uncertain
  3. 3. Syndromes• Minor-impaired sleep• Major:• Acute Mountain Sickness (AMS)• High Altitude Pulmonary Edema (HAPE)• High Altitude Cerebral Edema (HACE)
  4. 4. AMS• Almost universal with rapid ascent• Vague and inconsistent symptom complex:• Poor sleep, irritability, Headache, Dyspnea, GI symptoms, Dizziness
  5. 5. AMS Factors• Individual susceptibility• Altitude over 7000 feet• Rapid ascent• Pathophysiology –theory- hypoxia leads to increased Cerebral Blood Flow, then edema due to hydrostatic pressure and capillary leak
  6. 6. AMS-Treatment• Slow careful ascent prevents AMS• Acclimatization at an altitude or slight descent helps• O2 resolve symptoms• Acetazolamide (Diamox)-125-250mg BID begun one day before ascent and continued for two more days is effective• Steroids are effective-prevention and Rx
  7. 7. HAPE• 1-3 days after ascent• Cough, SOB, fatigue, can have bloody sputum• Signs: fever, rales, cyanosis• Hypoxia, tachycardia, tachpnea• Cause unclear-may be result of focal hyperperfusion of PAs
  8. 8. HAPE-Rx• Descent 1-3K feet very effective• O2• Hyperbaric bags
  9. 9. HACE• Severe AMS• Mental Status Changes/Ataxia• Leads to severe impairment /death• May be rapidly progressive, even during sleep• Usually occurs after a few days at altitude
  10. 10. HACE Rx• Rapid descent• O2• Steroids• Hyperbaric bag
  11. 11. Special Problems with Altitude• CAD-slightly increased risk of exercise induced ischemia.• COPD-mild increased symptoms (? Used to hypoxia), mild increased long term mortality• Asthma-cold dry air is a trigger, but reduced allergens and reduced air density are helpful• Sickle Cell disease-avoid altitude-even planes

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