Questions and Answers
What is the typical onset time for symptoms of Acute Mountain Sickness (AMS) after arriving at altitudes over 8000 feet?
Which treatment is recommended to reduce symptoms of AMS if acclimatization fails after 24 hours?
How long after ascent will most patients with AMS typically resolve without treatment?
What is the hallmark sign of High-Altitude Cerebral Edema (HACE)?
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What is the appropriate action to take if a patient exhibits altered consciousness due to HACE?
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What symptoms are typically associated with High-Altitude Pulmonary Edema (HAPE)?
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Which medication can be administered to treat nausea and vomiting in a patient with AMS?
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What should be maintained in terms of oxygen saturation for a patient experiencing HAPE during treatment?
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At what altitude does acute altitude illness commonly occur in travelers?
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Which medication is specifically contraindicated during the treatment of HAPE?
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What factor is unique to HACE compared to AMS and HAPE?
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Which condition is most accurately associated with very high altitudes ranging from 3500 to 5500 m?
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What physiological change often occurs at high altitudes to compensate for decreased oxygen levels?
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What is the primary risk factor for developing high-altitude illness?
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What symptom is often the first indication of altitude exposure?
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Which altitude is defined as extreme altitude and poses significant health risks without supplemental oxygen?
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What percentage of travelers may experience symptoms of acute altitude illness when rapidly ascending above 2500 m?
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Which of the following is NOT one of the three main illnesses associated with high-altitude exposure?
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What characterizes wet non-fatal drowning?
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Which of the following is a common physical sign observed after a person is rescued from drowning?
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What is the primary physiological response that begins drowning episodes?
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What is the major component of morbidity and mortality associated with drowning?
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Which group is considered at higher risk for drowning incidents?
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What typically occurs during the drowning process leading to hypoxemia?
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What is a potential late-onset symptom of drowning injuries?
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Which condition may arise due to the aspiration of water during a drowning event?
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What is a common cardiovascular complication observed in nonfatal drowning victims?
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Which threshold volume of water aspiration is cited as significant for blood volume changes in drowning victims?
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What is considered the most critical initial treatment for victims of submersion injury?
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Which factor significantly influences patient outcomes in drowning incidents?
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What is the recommended action if a hypothermic drowning patient has weak pulses?
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What condition must be monitored during the management of drowning victims?
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What is the primary purpose of continuous pulse oximetry in managing drowning victims?
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What is one potential reason for neurologic deterioration in drowning victims?
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In an asymptomatic drowning patient, what is the advised observation time frame before discharge?
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What indicates a need for intubation in a drowning victim?
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What electrolyte imbalance is typically associated with freshwater drowning?
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Which is a possible cause of chest discomfort in drowning victims?
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Which management phase involves immediate resuscitation efforts following a drowning incident?
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What characteristic changes in ECG might suggest myocardial ischemia after drowning?
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Study Notes
High-Altitude Definitions
- High altitude: 1500 to 3500 m (4,950 to 11,500 ft); causes decreased exercise performance and increased ventilation at rest.
- Altitude illness commonly occurs with rapid ascent above 2500 m (8,200 ft).
- Very high altitude: 3500 to 5500 m (11,500 to 18,050 ft); PaO2 falls below 60 mm Hg, SaO2 drops below 90%.
- Extreme altitude: above 5500 m (roughly 18,000 ft); marked hypoxemia, hypocapnia, and impossible successful acclimatization.
Altitude-Related Illness
- Acute altitude illness occurs at elevations >2500 m, affecting 25% of rapid ascenders.
- Symptoms include hypoxia and hypothermia, influenced by rapid ascent, exertion, prior illness, and sea level residency.
- Compensatory responses: increased ventilation, respiratory rate (RR), heart rate (HR), and cardiac output (CO).
- Main altitude illnesses: Acute Mountain Sickness (AMS), High-Altitude Cerebral Edema (HACE), High-Altitude Pulmonary Edema (HAPE).
High-Altitude Headache
- Often the first and sometimes only symptom following altitude exposure.
- Treatment: Oxygen (if available), NSAIDs, or Acetaminophen.
Acute Mountain Sickness (AMS)
- Onset occurs 6-10 hours after reaching altitudes >8000 ft; symptoms may resolve within 72 hours without treatment.
- Symptoms: Headache (HA), fatigue, anorexia, nausea/vomiting (N/V), persistent dizziness, frequent awakening during sleep.
- Treatment involves halting ascent, monitoring, and acclimatization; descent is necessary if symptoms worsen.
- Acetazolamide, Ginkgo biloba, and symptom relief medications (NSAIDs, prochlorperazine) recommended.
High-Altitude Cerebral Edema (HACE)
- Rare condition occurs due to rapid ascent.
- Signs and symptoms: ataxic gait, altered consciousness, headache, N/V, hallucinations, hypoxemia, seizures, cranial nerve palsy.
- Diagnosis typically requires imaging (CT/MRI) to rule out other causes.
- Treatment includes immediate descent, dexamethasone, oxygen therapy, and possibly hyperbaric treatment.
High-Altitude Pulmonary Edema (HAPE)
- Develops within 1-4 days after rapid ascent and may follow AMS.
- Signs and symptoms: decreased exercise tolerance, dyspnea on exertion, cough, tachycardia/tachypnea, fatigue, low-grade fever, cyanosis, audible rales, possible pink/blood-tinged sputum.
- Vital signs indicate hypoxemia and may show patchy lung edema on chest X-ray.
- Treatment necessitates descent, oxygen therapy, nifedipine, inhaled beta-agonists, and potentially hyperbaric therapy.
Terminology
- Drowning: Respiratory impairment caused by submersion in liquid.
- Fatal Drowning: Death due to drowning with no recovery.
- Non-Fatal Drowning: Survival after submersion, which may lead to temporary or permanent effects.
- Wet Non-Fatal Drowning: Survival following liquid aspiration into lungs.
- Dry Non-Fatal Drowning: Survival following asphyxia from reflex laryngospasm.
Risk Factors
- High vulnerability in children and males.
- Substance use (ETOH/drug) increases risk.
- Seizure disorders can lead to complications.
- Hypoxia can result in respiratory and cardiac arrest.
Signs and Symptoms
- Post-rescue: anxiety, vomiting, wheezing, altered level of consciousness (LOC).
- Physical symptoms: tachypnea, retractions, and cyanosis.
- Respiratory signs can be delayed, appearing up to 6 hours after incident.
- Assess for potential additional injuries, including head trauma and spinal injuries.
Submersion Pathophysiology
- Drowning initiates panic and loss of normal breathing, leading to breath-holding and struggles for air.
- Reflex inspiratory efforts can cause hypoxemia either through aspiration or laryngospasm.
- Cerebral hypoxia is a major contributor to morbidity and mortality.
Pulmonary Pathophysiology
- Fluid aspiration leads to varying degrees of hypoxemia.
- Fresh and salt water can both wash out surfactant, leading to conditions like noncardiogenic pulmonary edema and ARDS.
- Symptoms may include shortness of breath, crackles, and wheezing; radiographs may show variable pulmonary edema.
Neuro Pathophysiology
- Hypoxemia and ischemia can result in neuronal damage, cerebral edema, and increased intracranial pressure.
- 20% of nonfatal drowning victims may sustain neurological damage despite successful cardiopulmonary resuscitation (CPR).
Cardiac Pathophysiology
- Potential arrhythmias (sinus tachycardia, bradycardia, atrial fibrillation) often arise from hypothermia and hypoxemia.
- Diving and swimming can provoke fatal arrhythmias in those with congenital long QT syndrome.
- ECG changes may indicate myocardial ischemia linked to factors like takotsubo cardiomyopathy or hypothermia.
Salt Water vs Fresh Water Drowning
- Earlier views suggested significant differences between saltwater and freshwater drowning impacts.
- Critical threshold for blood volume changes is approximately 11 mL/kg aspirated; nonfatal victims rarely exceed 3-4 mL/kg.
- Water temperature and contaminants can influence patient outcomes.
Management of Submersion Injuries
- Management phases: prehospital care, emergency department (ED) care, and inpatient care.
- Immediate resuscitation by bystanders significantly improves outcomes.
- Priority is generally given to ventilation; rescue breathing should start quickly upon reaching stable surfaces.
- CPR should be initiated after confirming absence of breath and assessing for weak pulses in hypothermic victims.
- Intubation is indicated for neurologically deteriorating patients or those with inadequate oxygenation.
Trauma Evaluation and Care Protocols
- Remove wet clothing, conduct imaging for other injuries.
- Continuous monitoring of pulse oximetry and capnography is crucial.
- Administer inhaled beta-adrenergic agonists for bronchospasm and monitor cardiac activity through EKG.
- Rule out hypothermia and evaluate underlying disorders through relevant lab tests (ECG, CBC, CMP, UDS, cardiac enzymes).
Prognosis and Outcomes
- Survival rates vary, reported as high as 75%; neurologic deficits occur in about 6% of survivors.
- Some studies indicate a mortality rate of 74%, with 4% surviving with severe disabilities.
- Poor prognosis factors include:
- Submersion duration exceeding 5 minutes.
- Basic life support initiation taking longer than 10 minutes.
- Total resuscitation efforts lasting more than 25 minutes.
- Age over 14 years.
- Low Glasgow Coma Scale scores.
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Description
This quiz covers the definitions and effects of altitude on health, specifically focusing on altitude illness and the complications of high-altitude exposure. Understand the classifications of high altitude and the physiological responses to low oxygen environments. Ideal for students studying environmental science or physiology.
