ALTITUDE SICKNES

dr. Chandra Sembiring

 ABOUT HRA PHERICHE AID POST

Now, the aid post has a modern look and comfortable facilities. At present this clinic has
become as good as a hospital. It can be said that HRA hospital is located at the highest
elevation in the world, which is located half way from the summit of the Mt. Everest to
Lukla.

http://http://www.himalayanrescue.org/hra-pheriche-aid-post.html
ACTIVITY PHOTOS
ACTIVITIES
ACTIVITIES
ACTIVITY PHOTOS
ACTIVITY PHOTOS
 Oxygen driving
pressure

AMS is caused by a lack of oxygen. Although the proportion of oxygen in the atmosphere
always remains the same (21%), as we go higher the "driving pressure" decreases.
 WHAT IS ACCLIMATIZATION?
• Acclimatization is a state of physiological "truce" between the
body of a visitor and the hostile low-oxygen environment of
high altitude. This truce permits the trekker of ascend
gradually.
• (This is distinct from "adaptation" - permanent change to the
organism, perhaps over thousands of years, perhaps even at a
genetic or evolutionary level, to facilitate survival at altitude.
Scientists are trying to decipher if the Sherpas or Tibetans have
made such an adaptation.)
• Hyperventilation
 Acclimatization
• How our bodies adjust
• Who? Everybody
• Why? Stimulation of Less Oxygen
• How?
Lungs – Breathe faster and deeper
Hearts – Faster and Stronger
Blood – More concentrated/pH Changes
Kidneys – more urine
- balances acid/base

Late – increased red blood cells

-more efficient metabolism

“Line of Acclimatization”
Normal Acclimatization
• Fast breathing
• +/- Difficulty Sleeping
• +/- Irregular breathing
• +/- Good Appetite
• > urine
Severe AMS
• Severe HEADACHE
• Vomiting
• Weak
• Can’t sleep
• Dizziness
• Marked fatique
• Symptoms haven’t gone away
Diagnose (Lake Louise Score)

• Mild AMS – A Lake Louise score

of 5 or less
• Moderate – Severe AMS – A Lake
Louise Score of 6 or more.
Acute Mountain Sickness
• Symptoms occur if you ascend FASTER than your body can
acclimatize. More likely when :
• - Dehydrated
• - Diarrhea
• - Cough/cold

• Symptoms will usually start 6-12 hours after reaching altitude

AMS is Preventable

1. Slow ascent – above 2500 m – 400 m/1500ft per day

Rest day every 3 – 4 days (1000 m)
2. Acclimatization hikes – Climb High, Sleep low
3. Drink plenty of fluids (3-4 liters per day)
AMS is Preventable
1. Avoid alcohol/sleeping pills/smoking
2. Be aware of early signs of AMS
3. Watch for AMS signs in others
Remember :
Any headache or shortness of breath above 2500 m is altitude illness
until proven otherwise
If in doubt : DESCEND!
AMS Treatment
• Do not go higher if symptoms continue
• Aspirin, paracetamol, ibuprofen OK and will not mask
dangerous headache.
• Rest and drink plenty of fluids
• Diamox (Acetazolamide) – 250 mg twice daily can be used
• How you feel in the morning is impotant!
• Consider descent if not improving
HACE = Brain Swelling
This is bad! Emergency!

• AMS +
• Altered mental status
• Confusion – Coma
• Hallucinations, Disorientation
• Unsteadiness (ataxia)
• Clumsy Walk
• Falling
• Heel/Toe
HACE Diagnosis
• Finger nose test –
• Heel-toe walking –
• Rombergs test –
• Mental tests
HACE Treatment
• Descent with a friend NOW!
• See doctor
• Oxygen
• Dexamethasone if available
• Diamox
• Pressure bag
• DESCENT is most important!
HAPE = fluid on lungs
• Most common cause of death at altitude
• May or may not have AMS/HACE (50%)
• Usually comes 2-3 days after arrival at altitude
• Symptoms – short of breath at rest, marked with activity
• Rapid heart rate and breathing
• Unable to keep up with others
• Cough – may be loose and even bloody
HAPE Treatment
• Descend with a friend
• Minimize exertion. Keep warm
• See doctor
• Oxygen
• Nifedipine if available
• Viagra/Sildenafil
• Gamow Bag (Pressure Bag)
Other Problems
• Snow Blindness
• Swelling
• Sunburn
• HAFE
• Eye hemorrhage
• Bronchitis (Khumbu Cough)
• Carbon Monoxide
• Sleeplessness/Periodic Breathing
• Frostbite/Hypothermia
• Water purification
• Gastroenteritis
• Earthquakes
Conclusions
• Altitude Can Kill
• Golden Rules :
• Altitude illness until proven otherwise
• Do not ascend with the symptoms
• If Symptoms worsen, descen
• Only ascend 300 – 400 meters/day; rest every 1000 meters
• Do not leave someone with symptoms alone
• Descent is the only definitive treatment

• SUPPORT ALTITUDE RESEARCH

Diamox (Acetazolamide)
• Reason to use/ dose :
1. Prevention of AMS = 125 mg twice daily
- If history of AMS
- If forced to go too fast (rescue)
2. To treat mild AMS while staying at same elevation (125 mg twice
daily)
3. To treat severe AMS (HACE) : 250 mg. Twice daily while descending
4. For restless sleep : 125 mg at bedtime
• Reason not to use :
• Pregnant
• Sulfa allergy
Diamox (Acetazolamide)
• How does it work?
• Help body acclimatize faster by breathing more
• Common Side Effects
• Urinate more
• Tingling of fingers
• Carbonated drinks taste flat
THANK YOU &

SEE
YOU