High Altitude Maladies

7/30/2019 High Altitude Maladies

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High Altitude Maladies

Deepak Dass


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Distribution of Mountainous Areas of the World


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FeetAltitude

Low Sea Level - 5,000

Moderate 5,000 8,000

High 8,000 14,000

Very High 14,000 18,000

Extreme 18,000 higher

Physiological Effects

Altitude illness and decreased

performance predominant

None

Mild, temporary altitude sickness

Altitude sickness may occur

Humans can function only for a short period

of time with acclimatization

Classification of Altitude


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Low barometric pressure

Oxygen deficiency Harsh terrain

Low temperature

Wind chill factor

Solar radiation

Environmental conditions at high altitude


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Ventilation

Diffusion

Circulation

Diffusion

Ambient

Alveolar

Arterial

Systemic

Capillary

Mitochondria

Oxygen Transport Cascade

Oxygen Transportation at High Altitude


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Acclimatization

Key Features:

The depth and frequency of respiration increases, this is known as hyperventilation Pressure in pulmonary arteries increases

More red blood cells are produced to increase the oxygen carrying capacity

The body produces more of certain enzymes that facilitate the release of oxygen from

haemoglobin to the body tissues

There is increased urination

Acclimatization is the temporarily acquired ability to withstand reduced oxygen level

Elevation specific.

Acclimatization vary markedly among individuals physiology


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High altitude Illnesses

AMS Acute Mountain Sickness

HAPE

High Altitude Pulmonary Edema

HACE High Altitude Cerebral Edema

Altitude illness may be an interrelated spectrum :

AMS HAPE

HACE


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AMS Acute Mountain Sickness

Defined as Headache plus one or more symptom:

Anorexia, nausea or vomiting

Fatigue or weakness

Dizziness or lightheadedness

Difficulty sleeping

If ascent is continued or accelerated by a patient

with untreated AMS it may progress to HAPE or

HACE.

A total score of 3 or more from the questions

below (6 or more = severe AMS)

Lake Louise Score


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HAPE High Altitude Pulmonary Edema

Is a non-cardiogenic pulmonary edema related to altitudinal hypoxia Can be fatal if patient is unable to descend

Occurs in individuals quickly ascending to > 12,000 feet

Can occur even in well fit and acclimatized individuals

Cough dyspnea at rest achy chest pain progressive

cough progressive rales frothy sputum hemoptysis

frank respiratory failure

Usual sequence of symptoms :


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HACE High Altitude Cerebral Edema

Less common than HAPE Possibly a malignant form of AMS

Can be fatal or result in permanent neurologic disability

Onset is gradual : usually over 2 to 3 days

Symptoms:Severe headache, Confusion, Agitation / irritability, Nausea, Ataxia,

Hallucinations, Seizures, Coma


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Cold Injury

I Degree II Degree III Degree IV Degree

Superficial Deep


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Soldiers at High Altitude

The spectrum of activities encompassedby military operations is very broad

In combat, the proficiency with which a

task is performed may affect mission

accomplishment and have life-and-death

consequences

Time and place of exposure are oftendictated by tactical considerations

Altitude illness and other medical

conditions related to the mountain

environment can jeopardize the units

mission


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Defence Institute of Physiology and Allied Sciences

Nitric Oxide Therapy

(inhalation of 15ppm NO + 50% O2)Aloe vera Cream to prevent cold injury

Intermittent Hypoxic Training

Acclimatization protocol

Nutrition at altitude

Yoga at altitude

Molecular mechanism of high altitude exposure


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Pilgrim at High Altitude

Thousands of pilgrims travel to high altitude regions in

the Himalayas to pray.

Awareness level of high altitude illness among pilgrims

is low

Ascend without proper acclimatization

Due to over enthusiasm, many people try to concealtheir illnesses or keep ascending even in the face of

altitude illness which may be life threatening


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Properly acclimatize through gradual and slow rate of ascent.

Take adequate rest during the first few days of induction to high altitude and do not

overexert.

Avoid dehydration by constantly drinking water of lukewarm temperature.

Do not disregard initial symptoms of any illness, inform medical support immediately.

Carry nutritious snacks that contain sugar and other carbohydrates for instant energy

sources. Consume small amount regularly so as to maintain a steady flow of bodyfuel all day. Avoid alcoholic beverages and smoking.

Clothing should be wind-proof, dry, and well insulated, with adjustable ventilation.

Dress in layers so that clothing may be adjusted for overcooling, overheating,

perspiration and external moisture, put on raingear before getting wet. Sweat from

exertion must be wiped dry.

Cover exposed parts sufficiently to avoid cold injury. Do not touch metal with bare

hands. Use suitable snow goggles while in snow-bound areas.

Trekking in a group can be reassuring and can increase the chances of survival on

the event of distress.

Its prudent to rule out any prior medical conditions before embarking on a

sojourn/trekking to high altitude.

Some Tips to Stay Healthy at High Altitude


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Thank You for Your Time

Deepak Dass

[email protected]
mailto:[email protected]:[email protected]

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High Altitude Maladies