High Altitude sicknesss - Mountain Trekking in Nepal
The Mountain Altitude sickness, safety about this problems and well
medical treatments are most important things for you before trekking in
Nepal. The Acute Mountain Sickness is a kinds of illness of your body
action while you are on over 2400m elevation in the world. The sickness
caused by reduced air pressure and lower oxygen levels at high altitudes sickness - trekking in Nepal Himalaya. when you climb faster to high altitude or when your body not
able to reaction their elevation and natural things in a limit time then
you will get acute mountain sickness (AMS). Many trekkers are
considered about altitude sickness while high himalayas trekking in Nepal, Hiking Holidays and Tibet tours.
Symptoms of AMS
The symptoms of AMS are can be found many ways. It depend on the personalize. Most of are Nervous, Lungs, Muscles and Hearts, Changes Face and Changes of physical action. In most cases, symptoms are mild. Symptoms of mild to moderate acute mountain sickness may include:
Difficulty sleeping
Dizziness or light-headedness
Fatigue
Headache
Loss of appetite
Nausea or vomiting
(heart rate) Rapid pulse
with exertion Shortness of breath
Symptoms that may occur with more severe acute mountain sickness include:
Blue color to the skin (cyanosis)
Chest tightness or congestion
Consufion
Cough
Coughing up blood
Withdrawal from social interaction
Gray or pale complexion
Cannot walk in a straight line, or walk at all
Shortness of breath at rest
Related Oxygen Rate at Different Altitude
Altitude Oxygen Rate
In Meters In Feet
8.850 29.035 33%
8.000 26.247 36%
7.000 22.966 41%
6.000 19.865 47%
5.500 18.045 50%
5.200 17.061 52%
5.000 16.404 53%
4.500 14.764 57%
4.000 13.123 60%
3.500 11.483 64%
3.000 9.843 68%
Sea Level 100%
Facts on HAPE and HACE
HACE or HAPE occur in approximately 1 to 2% of people going to high altitude
HAPE and HACE may occur alone or together
HAPE is roughly twice as common as HACE
HAPE causes many more deaths than HACE
HAPE may appear without any preceding symptoms of AMS
HAPE is more likely in people with colds or chest infections
HAPE often comes on after the second night spent at a higher altitude
HAPE can develop even after descending from a higher altitude
HACE usually develops after symptoms of AMS have appeared and often gets rapidly worse during the night
HACE may develop in the later stages of HAPE
HACE (High Altitude Cerebral Edema)
Symptoms of HACE are caused by an accumulation of fluid in or around the brain. Typically symptoms and signs of AMS become worse and HACE develops. Someone with HAPE may also develop HACE.
Symptoms & signs
Severe headache, which often feels worse on lying down and is not relieved by ibuprofen, paracetamol or aspirin
Tiredness, severe fatigue
Nausea and or vomiting which may be severe and persistent
Loss of coordination, clumsiness. The victim needs help with simple tasks such as tying their shoelaces or packing their bag. They cannot do the finger-nose test
Staggering, falling. They cannot do the heel to toe walking test or the standing test
Blurred or double vision, seeing haloes around objects
Loss of mental abilities such as memory. They cannot do a simple mental arithmetic test
Confusion, hallucinations
Change in behavior (aggression, apathy, etc.)
Drowsiness, difficult to wake up, coma, death
Tests for HACE
Heel-to-toe walking test: The victim is asked to take 10 very small steps, placing the heel of one foot to the toes of the other foot as they go. Reasonably flat ground is necessary and the victim should not be helped
Standing test: The victim stands with eyes closed, feet together and arms by their sides
Finger-nose test: With eyes closed, the victim repeatedly and rapidly alternates between touching the tip of their nose with an index finger then extending this arm to point into the distance (a useful test if the victim is in a sleeping bag)
Mental arithmetic test: Give the victim a mental arithmetic test, eg. subtract 7 from 100, 7 from 93, and so on (but remember some people may be poor at arithmetic even at sea level)
If the victim cannot do any of the above tests easily (or refuses to cooperate), or show excess wobbling or falling over in the two first tests (be prepared to catch the victim if they fall over!), assume they are suffering from HACE. If in doubt about the victim performance, compare with a healthy individual. Be prepared to keep repeating these tests.
Treatment
Descend immediately (prompt descent will begin to reverse the symptoms). Descend as low as possible, at least 1000m /3280 ft. Descend at night or in bad weather if necessary. Carry the victim if possible, as the exertion of walking can make the illness worse
If descent is not immediately possible (eg. dangerous terrain or weather, not enough helpers or while waiting for a helicopter), oxygen or the use of a PAC and appropriate medications will keep the person alive until descent can be undertaken
Give oxygen:
i) From a bottle using a mask (2 to 4 L/min), OR
ii) By using a pressure bag (this is roughly the equivalent of 2 to 4 L of oxygen/min)
NB: If both oxygen and a pressure bag are available, give the oxygen while the bag is being prepared and after the victim comes out of the bag. Do not give oxygen inside the bag unless it is designed for this purpose and you have been trained to do so.
Give medications:
i) 8 mg of dexamethasone at once (by mouth, IV or IM) followed by 4 mg 6-hourly. Dexamethasone takes several hours to work. Stop it once below 2500m/8200ft AND after at least 3 days of treatment by tailing off the dose slowly (give the last 3 doses 12-hourly)
ii) Diamox 250 mg 8 to12-hourly
iii) Treat persistent vomiting with anti-vomiting medication
Prop the victim up in a semi reclining position as lying down flat may make their condition worse
Avoid even the slightest exertion if this is possible. Even walking a few steps may make their symptoms worse or reappear. Do not leave the victim alone.
If a person is turning blue or is falling into unconsciousness, give them rescue breathing before they stop breathing
HAPE (High Altitude Pulmonary Edema)
Symptoms of HAPE are due to the accumulation of fluid in or around the lungs. It may appear on its own without any preceding symptoms of AMS (this happens in about 50% of cases), or it may develop at the same time as AMS. HAPE can easily be mistaken for a chest infection or asthma: if in doubt treat for both.
Symptoms & signs
A reduction in physical performance (tiredness, severe fatigue) and a dry cough are often the earliest signs that HAPE is developing
Breathlessness. In the early stages of HAPE, this may mean just taking a bit longer to get one breath back on resting after mild exercise. Later on, there is marked breathlessness with mild exercise. Finally, breathlessness occurs at rest. Record the respiratory rate (NB: At 6000m/19700ft, class="normal" acclimatized respiration rate is up to 20 breaths per minute)
The dry cough may later become wet with frothy sputum, which may be bloodstained (pink or rust colored). This is a serious sign
Wet sounds in the lungs when breathing in deeply (place your ear on the bare skin of the victim back below the shoulder blades; compare with a healthy person). Note: There may be NO wet sounds in even quite severe HAPE: this is called dry HAPE.
There may be: mild fever up to 38.5ºC, a sense of inner cold, pains in the chest
Blueness or darkness of face, lips, tongue or nails due to lack of oxygen in the blood (cyanosis)
Drowsiness, difficulty waking up, coma, death
Treatment
Same general treatment as for HACE, EXCEPT:
Use oxygen or the PAC and appropriate medications will keep the person alive until descent can be undertaken Give medications:
i) Nifedipine. This should only be used if bottled oxygen or a pressure chamber is not available and the victim is warm and well hydrated. Give the modified release (MR) form of the tablets (20 mg 12-hourly for 2 or 3 days). If a fall in blood pressure occurs due to nifedipine (pallor, weak rapid pulse, dizzy on standing), treat as shock
ii) Diamox 250 mg 8 to 12-hourly
III) An asthma reliever spray (2 puffs 4-hourly) may help
Symptoms of AMS
The symptoms of AMS are can be found many ways. It depend on the personalize. Most of are Nervous, Lungs, Muscles and Hearts, Changes Face and Changes of physical action. In most cases, symptoms are mild. Symptoms of mild to moderate acute mountain sickness may include:
Difficulty sleeping
Dizziness or light-headedness
Fatigue
Headache
Loss of appetite
Nausea or vomiting
(heart rate) Rapid pulse
with exertion Shortness of breath
Symptoms that may occur with more severe acute mountain sickness include:
Blue color to the skin (cyanosis)
Chest tightness or congestion
Consufion
Cough
Coughing up blood
Withdrawal from social interaction
Gray or pale complexion
Cannot walk in a straight line, or walk at all
Shortness of breath at rest
Related Oxygen Rate at Different Altitude
Altitude Oxygen Rate
In Meters In Feet
8.850 29.035 33%
8.000 26.247 36%
7.000 22.966 41%
6.000 19.865 47%
5.500 18.045 50%
5.200 17.061 52%
5.000 16.404 53%
4.500 14.764 57%
4.000 13.123 60%
3.500 11.483 64%
3.000 9.843 68%
Sea Level 100%
Facts on HAPE and HACE
HACE or HAPE occur in approximately 1 to 2% of people going to high altitude
HAPE and HACE may occur alone or together
HAPE is roughly twice as common as HACE
HAPE causes many more deaths than HACE
HAPE may appear without any preceding symptoms of AMS
HAPE is more likely in people with colds or chest infections
HAPE often comes on after the second night spent at a higher altitude
HAPE can develop even after descending from a higher altitude
HACE usually develops after symptoms of AMS have appeared and often gets rapidly worse during the night
HACE may develop in the later stages of HAPE
HACE (High Altitude Cerebral Edema)
Symptoms of HACE are caused by an accumulation of fluid in or around the brain. Typically symptoms and signs of AMS become worse and HACE develops. Someone with HAPE may also develop HACE.
Symptoms & signs
Severe headache, which often feels worse on lying down and is not relieved by ibuprofen, paracetamol or aspirin
Tiredness, severe fatigue
Nausea and or vomiting which may be severe and persistent
Loss of coordination, clumsiness. The victim needs help with simple tasks such as tying their shoelaces or packing their bag. They cannot do the finger-nose test
Staggering, falling. They cannot do the heel to toe walking test or the standing test
Blurred or double vision, seeing haloes around objects
Loss of mental abilities such as memory. They cannot do a simple mental arithmetic test
Confusion, hallucinations
Change in behavior (aggression, apathy, etc.)
Drowsiness, difficult to wake up, coma, death
Tests for HACE
Heel-to-toe walking test: The victim is asked to take 10 very small steps, placing the heel of one foot to the toes of the other foot as they go. Reasonably flat ground is necessary and the victim should not be helped
Standing test: The victim stands with eyes closed, feet together and arms by their sides
Finger-nose test: With eyes closed, the victim repeatedly and rapidly alternates between touching the tip of their nose with an index finger then extending this arm to point into the distance (a useful test if the victim is in a sleeping bag)
Mental arithmetic test: Give the victim a mental arithmetic test, eg. subtract 7 from 100, 7 from 93, and so on (but remember some people may be poor at arithmetic even at sea level)
If the victim cannot do any of the above tests easily (or refuses to cooperate), or show excess wobbling or falling over in the two first tests (be prepared to catch the victim if they fall over!), assume they are suffering from HACE. If in doubt about the victim performance, compare with a healthy individual. Be prepared to keep repeating these tests.
Treatment
Descend immediately (prompt descent will begin to reverse the symptoms). Descend as low as possible, at least 1000m /3280 ft. Descend at night or in bad weather if necessary. Carry the victim if possible, as the exertion of walking can make the illness worse
If descent is not immediately possible (eg. dangerous terrain or weather, not enough helpers or while waiting for a helicopter), oxygen or the use of a PAC and appropriate medications will keep the person alive until descent can be undertaken
Give oxygen:
i) From a bottle using a mask (2 to 4 L/min), OR
ii) By using a pressure bag (this is roughly the equivalent of 2 to 4 L of oxygen/min)
NB: If both oxygen and a pressure bag are available, give the oxygen while the bag is being prepared and after the victim comes out of the bag. Do not give oxygen inside the bag unless it is designed for this purpose and you have been trained to do so.
Give medications:
i) 8 mg of dexamethasone at once (by mouth, IV or IM) followed by 4 mg 6-hourly. Dexamethasone takes several hours to work. Stop it once below 2500m/8200ft AND after at least 3 days of treatment by tailing off the dose slowly (give the last 3 doses 12-hourly)
ii) Diamox 250 mg 8 to12-hourly
iii) Treat persistent vomiting with anti-vomiting medication
Prop the victim up in a semi reclining position as lying down flat may make their condition worse
Avoid even the slightest exertion if this is possible. Even walking a few steps may make their symptoms worse or reappear. Do not leave the victim alone.
If a person is turning blue or is falling into unconsciousness, give them rescue breathing before they stop breathing
HAPE (High Altitude Pulmonary Edema)
Symptoms of HAPE are due to the accumulation of fluid in or around the lungs. It may appear on its own without any preceding symptoms of AMS (this happens in about 50% of cases), or it may develop at the same time as AMS. HAPE can easily be mistaken for a chest infection or asthma: if in doubt treat for both.
Symptoms & signs
A reduction in physical performance (tiredness, severe fatigue) and a dry cough are often the earliest signs that HAPE is developing
Breathlessness. In the early stages of HAPE, this may mean just taking a bit longer to get one breath back on resting after mild exercise. Later on, there is marked breathlessness with mild exercise. Finally, breathlessness occurs at rest. Record the respiratory rate (NB: At 6000m/19700ft, class="normal" acclimatized respiration rate is up to 20 breaths per minute)
The dry cough may later become wet with frothy sputum, which may be bloodstained (pink or rust colored). This is a serious sign
Wet sounds in the lungs when breathing in deeply (place your ear on the bare skin of the victim back below the shoulder blades; compare with a healthy person). Note: There may be NO wet sounds in even quite severe HAPE: this is called dry HAPE.
There may be: mild fever up to 38.5ºC, a sense of inner cold, pains in the chest
Blueness or darkness of face, lips, tongue or nails due to lack of oxygen in the blood (cyanosis)
Drowsiness, difficulty waking up, coma, death
Treatment
Same general treatment as for HACE, EXCEPT:
Use oxygen or the PAC and appropriate medications will keep the person alive until descent can be undertaken Give medications:
i) Nifedipine. This should only be used if bottled oxygen or a pressure chamber is not available and the victim is warm and well hydrated. Give the modified release (MR) form of the tablets (20 mg 12-hourly for 2 or 3 days). If a fall in blood pressure occurs due to nifedipine (pallor, weak rapid pulse, dizzy on standing), treat as shock
ii) Diamox 250 mg 8 to 12-hourly
III) An asthma reliever spray (2 puffs 4-hourly) may help
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