Altitude Illness and Submersion Injuries

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Questions and Answers

What is the typical onset time for symptoms of Acute Mountain Sickness (AMS) after arriving at altitudes over 8000 feet?

24-36 hours

12-24 hours

1-2 hours

6-10 hours (correct)

Which treatment is recommended to reduce symptoms of AMS if acclimatization fails after 24 hours?

Continue ascent quietly

Administer acetazolamide (correct)

Rest without any intervention

Increase sleeping altitude

How long after ascent will most patients with AMS typically resolve without treatment?

1 week

24 hours

72 hours (correct)

48 hours

What is the hallmark sign of High-Altitude Cerebral Edema (HACE)?

Ataxic gait Signup and view all the answers

What is the appropriate action to take if a patient exhibits altered consciousness due to HACE?

Immediately descend at least 500 to 1000 meters Signup and view all the answers

What symptoms are typically associated with High-Altitude Pulmonary Edema (HAPE)?

Dyspnea on exertion and tachypnea Signup and view all the answers

Which medication can be administered to treat nausea and vomiting in a patient with AMS?

Prochlorperazine Signup and view all the answers

What should be maintained in terms of oxygen saturation for a patient experiencing HAPE during treatment?

Greater than 90% Signup and view all the answers

At what altitude does acute altitude illness commonly occur in travelers?

Above 2500 m Signup and view all the answers

Which medication is specifically contraindicated during the treatment of HAPE?

Beta-blockers Signup and view all the answers

What factor is unique to HACE compared to AMS and HAPE?

It manifests with ataxia and altered consciousness. Signup and view all the answers

Which condition is most accurately associated with very high altitudes ranging from 3500 to 5500 m?

Extreme hypoxia Signup and view all the answers

What physiological change often occurs at high altitudes to compensate for decreased oxygen levels?

Increased ventilation Signup and view all the answers

What is the primary risk factor for developing high-altitude illness?

Prior altitude sickness Signup and view all the answers

What symptom is often the first indication of altitude exposure?

Headache Signup and view all the answers

Which altitude is defined as extreme altitude and poses significant health risks without supplemental oxygen?

Above 5500 m Signup and view all the answers

What percentage of travelers may experience symptoms of acute altitude illness when rapidly ascending above 2500 m?

25% Signup and view all the answers

Which of the following is NOT one of the three main illnesses associated with high-altitude exposure?

Chronic Mountain Sickness (CMS) Signup and view all the answers

What characterizes wet non-fatal drowning?

Survival after aspiration of liquid into the lungs Signup and view all the answers

Which of the following is a common physical sign observed after a person is rescued from drowning?

Altered level of consciousness (LOC) Signup and view all the answers

What is the primary physiological response that begins drowning episodes?

Breath-holding due to panic Signup and view all the answers

What is the major component of morbidity and mortality associated with drowning?

Cerebral hypoxia Signup and view all the answers

Which group is considered at higher risk for drowning incidents?

Males of all ages Signup and view all the answers

What typically occurs during the drowning process leading to hypoxemia?

Breath-holding followed by inspiratory efforts Signup and view all the answers

What is a potential late-onset symptom of drowning injuries?

Respiratory distress Signup and view all the answers

Which condition may arise due to the aspiration of water during a drowning event?

Noncardiogenic pulmonary edema Signup and view all the answers

What is a common cardiovascular complication observed in nonfatal drowning victims?

Atrial fibrillation Signup and view all the answers

Which threshold volume of water aspiration is cited as significant for blood volume changes in drowning victims?

11 mL/kg Signup and view all the answers

What is considered the most critical initial treatment for victims of submersion injury?

Rescue breathing Signup and view all the answers

Which factor significantly influences patient outcomes in drowning incidents?

Presence of contaminants Signup and view all the answers

What is the recommended action if a hypothermic drowning patient has weak pulses?

Assess for pulses for at least one minute Signup and view all the answers

What condition must be monitored during the management of drowning victims?

Core body temperature Signup and view all the answers

What is the primary purpose of continuous pulse oximetry in managing drowning victims?

To monitor oxygen saturation levels Signup and view all the answers

What is one potential reason for neurologic deterioration in drowning victims?

Ischemia due to hypoxemia Signup and view all the answers

In an asymptomatic drowning patient, what is the advised observation time frame before discharge?

8 hours Signup and view all the answers

What indicates a need for intubation in a drowning victim?

Inability to protect the airway Signup and view all the answers

What electrolyte imbalance is typically associated with freshwater drowning?

Hyponatremia Signup and view all the answers

Which is a possible cause of chest discomfort in drowning victims?

Takotsubo cardiomyopathy Signup and view all the answers

Which management phase involves immediate resuscitation efforts following a drowning incident?

Prehospital care Signup and view all the answers

What characteristic changes in ECG might suggest myocardial ischemia after drowning?

ST depression and T wave inversion Signup and view all the answers

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.

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.