Case Reports: Altitude Related Illnesses: Mt. Everest North Side 2007 - PowerPoint PPT Presentation

Loading...

PPT – Case Reports: Altitude Related Illnesses: Mt. Everest North Side 2007 PowerPoint presentation | free to view - id: 117aa6-MTBiN



Loading


The Adobe Flash plugin is needed to view this content

Get the plugin now

View by Category
About This Presentation
Title:

Case Reports: Altitude Related Illnesses: Mt. Everest North Side 2007

Description:

trekking vacation to Advanced Base Camp, and Lhakpa Ri/North Col, ... P W Barry and A J Pollard, Altitude Illness, BMJ 2003;326;915-919. Case Report: Treatment ... – PowerPoint PPT presentation

Number of Views:73
Avg rating:3.0/5.0
Slides: 38
Provided by: Office2368
Category:

less

Write a Comment
User Comments (0)
Transcript and Presenter's Notes

Title: Case Reports: Altitude Related Illnesses: Mt. Everest North Side 2007


1
Case Reports Altitude Related Illnesses Mt.
Everest North Side 2007
2
Case Number 1
  • 35 year old healthy male
  • trekking vacation to Advanced Base Camp, and
    Lhakpa Ri/North Col, Everest
  • medications none
  • allergies none

3
Shegar, Tibet (4350m) 2 days
4
Base Camp Mt. Everest, North Side (5300m) 4 days
5
ABC (6440m) (3 days travel)
6
Case Number 1 (cont)
  • CC exhausted, pale, insomnia, and vomiting
  • unable to sleep throughout the night
  • vomiting 2 times, nauseated, loss of appetite
  • not drinking, and urinating little

7
Case Number 1 (cont)
  • T36.5 RR20 (unlaboured) HR105 BP140/60
    O2sats56-61
  • Pale
  • Chest clear
  • No ataxia, but walks slowly
  • Normal mental status
  • No peripheral edema, decreased urine output

8
Diagnosis?
  • HAPE
  • HACE
  • Dehydration
  • AMS
  • C D
  • All of the above

9
Lake Louise Score
  • Based on
  • symptoms headache, gastrointestinal upset,
    fatigue, sleep hygeine
  • signs mental status, ataxia, and peripheral
    edema
  • score out of 23, but based on serial examinations

10
Why do we become ill at altitude?
  • High Altitude 1500 - 3500m (5000-11500 ft)
  • Very High Altitude 3500 - 5500 m (11500 - 18000
    ft)
  • Extreme Altitude 5500m and above (gt 18000 ft)

11
Physiology at Altitude
12
Pathophysiology of Acute Mountain Sickness (AMS)
  • Theories
  • Impaired Hypoxic Ventilatory Response (HVR)
    leading to further hypoxia
  • Hypoxia --gt oxygen free radicals --gt BBB leakage
    cerebral vasodilatation --gt cerebral edema
  • Sodium and water retention when exercising
    correlates with AMS
  • Unknown

1. Mason, N.P., The Physiology of High altitude
An Introduction to the Cardio-Respiratory
Changes Occurring on Ascent to Altitude, Current
Anaesthesia and Critical Care, 2000, 11
34-41. 2. Ward et al., High Altitude Medicine
and Physiology, 3rd Ed., Arnold Publishing, 2000.
Pp. 46-49, 83-90, 114-115 3. Law and Bukwirwa,
The Physiology of Oxygen Delivery Issue 10
(1999) Article 3 pp 1-2 http//www.nda.ox.ac.uk
/wfsa/html/u10/u1003
13
Treatment
  • Increase HVR acetazolamide 125mg po OD-BID
    (alkalinizes urine, acidifies blood, mild
    metabolic acidosis, subsequent hyperventilation,
    increased oxygenation)
  • Decrease cerebral edema dexamethasone 8mg
    IM/po x 1, then 4mg IM/po QID
  • Stop further ascent
  • Descend if not better in 24 hoursDescend urgently
    if signs of HAPE or HACE

P W Barry and A J Pollard, Altitude Illness,
BMJ 2003326915-919
14
Case Report Treatment
15
Case No. 2
  • 37 yo Columbian arriving to advanced base camp
    short of breath and hearing gurgles in his chest

16
Further Questions? DDx?
  • not on diamox, but on aspirin
  • phx HAPE when in Aconcagua (6000m) 2 years ago,
    and HAPE at base camp a week ago (!!!)
  • ascent from Kathmandu (900m) to base camp (5800m)
    in 3 days by jeep
  • DDx HAPE, pneumonia, chf, (ARDS), (barotrauma)

17
Case No. 2 (cont)
  • On Examination
  • T36.5, HR110, RR30, O2 sats54-58, BP130/80
  • Chest crackles at bases

18
High Altitude Pulmonary Edema (HAPE)
  • similar to non-cardiogenic pulmonary edema

19
HAPE Pathophysiology
  • decreased intrinsic nitrous oxide release
    (vasodilator)
  • hypoxic pulmonary vasoconstriction exaggerated,
    heterogeneous, pulmonary venules
  • Normal left ventricle function, but increased
    pulmonary artery systolic pressure
  • Increased hydrostatic pressure (not inflammation)
    resulting in leaking across endothelial barrier,
    across basement membrane
  • decreased alveolar fluid clearance by respiratory
    endothelium (correlated with decreased number of
    endothelial sodium channel proteins)

Schoene, High Alt Med Bio Vol. 5, No. 2, 2004,
pp. 125-135
20
HAPE Treatment
  • vasodilator nifedipine (sildenafil?)
  • Oxygen
  • descent or pressure bag (if unable to descend)
  • alveolar clearance (salmetrol, antioxidants)
  • for the case dexamethasone, acetazolamide

Schoene, High Alt Med Bio Vol. 5, No. 2, 2004,
pp. 125-135
21
Evacuation manpower
22
Case No. 4 Logistics
Interim Camp 5800m
23
Case No. 4
  • You are at base camp (5400m) for rest
  • Half of the expedition team is hiking up to ABC,
    and calls you from IC via radio
  • Korean Climber has been found in a tent without
    support, c/o RLQ pain
  • Expeditioner, who is also a MD, suspects
    appendicitis....

24
Are you ready?
  • Preparation for remote care medicine

25
Preparation
Who Your Team
26
Preparation
Who else? Your team
27
Preparation
Who else? Other teams
28
Preparation
Medical Inventory
29
Medical Kit
What? How much? Where?
30
Communications
31
Location North Col (7000m) Medical Management?
32
Closest medical care?
ABC the view from North Col
33
Beyond North Col 7000m
Medical Management? Possible?
34
Summit 8848m
Medical management?
35
Evacuation?
how? where? when?
36
Evacuation
Distance? Time? Ability?
37
Questions?
Leukonychia/Everest Nails
About PowerShow.com