1/3. Assessment of high altitude tolerance in healthy individuals.The most reliable prediction of high altitude tolerance can be derived from the clinical history of previous comparable exposures. Unfortunately, there are no reliable tests for prediction prior to first-time ascents. Although susceptibility to AMS is usually associated with a low hypoxic ventilatory response (HVR), there is too much overlap with the range of normal values, which precludes measuring HVR or O(2) saturation during brief hypoxia for reliable identification of susceptibility to AMS. A low HVR and an exaggerated rise in pulmonary artery pressure with (prolonged) hypoxia, or exercise in normoxia, are markers of susceptibility to high altitude pulmonary edema (HAPE). These tests can not be recommended for routinely determining high altitude tolerance because the prevalence of susceptibility to HAPE is low and because specificity and sensitivity of these tests are not sufficiently established. On the other hand, HAPE may be avoided in susceptible individuals by ascent rates of 300 m per day above an altitude of 2000 m. Since prediction of risk of mountain sickness is difficult, it is important during the physician consultation prior to ascent to consider the altitude profile, the type of ascent, the performance capacity, the history of previous exposures, and the medical infrastructure of the area.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/3. Use of the Gamow Bag by EMT-basic park rangers for treatment of high-altitude pulmonary edema and high-altitude cerebral edema.As part of an emergency medical system protocol, national park service rangers certified at the level of an emergency medical technician-basic (EMT-B) are taught to recognize and treat high-altitude pulmonary edema and high-altitude cerebral edema. In sequoia and Kings Canyon National Parks, this is done with the assistance of physician on-line medical control as a backup. High-altitude pulmonary edema and high-altitude cerebral edema are both potentially fatal altitude illnesses that can be particularly problematic in the backcountry, where evacuation may be delayed. We report a case of high-altitude pulmonary edema and high-altitude cerebral edema occurring at moderate altitude that was successfully treated by park rangers with the Gamow Bag.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
3/3. High-altitude medicine.As more people enjoy the outdoors, high-altitude illness is increasingly becoming a problem that family physicians across the country must treat. High-altitude illness, which usually occurs at altitudes of over 1,500 m (4,921 ft), is caused primarily by hypoxia but is compounded by cold and exposure. It presents as one of three forms: acute mountain sickness (AMS), high-altitude pulmonary edema (HAPE) and high-altitude cerebral edema (HACE). But high-altitude illness can have many other manifestations. Cardinal symptoms include dyspnea on exertion and at rest, cough, nausea, difficulty sleeping, headache and mental status changes. Treatment requires descent, and gradual acclimatization provides the most effective prevention. Acetazolimide is an effective preventive aid and can be used in certain conditions as treatment.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |