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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
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