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High Altitude Illnesses - Dr. Wedmore

9/15/2013

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Acute Mountain Sickness (AMS)
  • HISTORICAL diagnosis  - feels like a bad hangover
  • Altitude + headache + (dizziness or nausea/vomiting or insomnia or anorexia)
  • Previous history of AMS most important predictor, followed by total height and speed of ascent.
  • Tx - ASA, APAP, Acetazolamide 250mg PO BID treatment, Descent.
  • Prophylaxis
  1. Acetazolamide 125mg PO BID 24hrs PTA x 72 hours,
  2. Ibuprofen
  3. Ginkgo Biloba 120mg PO BID (for your hippie/granola friends)
  4. Dexamethasone 4mg PO q8h
Picture
High Altitude Cerebral Edema (HACE)
  • # 1 cause of death at altitude
  • AMS + progressive neuro findings/ataxia
  • Tx - Descent, O2, Dexamethasone 8mg x1, then 4mg q6h

High Altitude Pulmonary Edema (HAPE)
  • Different pathophys than Cardiac pulm edema
  • Normal PCWP - not a fluid overload problem, rather a fluid distribution problem, NO lasix!!
  • Hypoxia causes vasoconstriction causing leaking capillaries which worsens hypoxia and vasoconstriction
  • HAPE death spiral negative feedback loop. Takes 2-4 days
  • Cough, dyspnea, fatigue, leukocytosis common
  • 50% overlap of HACE and HAPE
  • Tx - Descent resolves symptoms quickly (min 1000m), 02, nifedipine
  • Prophylaxis - Nifedipine 30-60mg QD, Salmeterol 125mg inh q12h, dexamethasone, diamox if mild,  viagra/cialis

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  • RESIDENCY
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