See Acute High Altitude Sickness.
Diagnosis
Definition:
How is the diagnosis made?*
H&P (Pertinent H&P findings including med review & key vital signs)
-Common presentation:
-Clinical Manifestations:
-Associated Conditions:
–Risk factors.
-Red flags:
-Complications:
Ddx & Etiology:
Diagnostic studies:
Assess severity/acuity:
Treatment
Treatment options, med s/e, and complications.
-Non-pharmacological.
-Pharmacological therapies.
-Prevention.
-Indications for a referral.
-Prognosis.
-Follow up.
Sample Assessment & Plan
Background
-Epidemiology,
-Pathophysiology
Antiemetics, NSAIDs or Tylenol (for headaches etc), Acetazolamide is used to treat AMS.
Source of the following: NEJM 2013
Symptoms usually resolve within 1 to 2 days when appropriate measures are taken.
Slow ascent with frequent stops at various levels is the safest way to prevent altitude sickness. Acetazolamide or dexamethasone can be used for both prevention and treatment.
Acute mountain sickness is common in people traveling to altitudes higher than 25000 meters (8200 ft). Symptoms include a headache and at least one of the following: nausea or vomiting, anorexia, dizziness or lightheadedness, fatigue or weakness, and difficulty sleeping.
Ataxia and altered mental status are signs of cerebral edema and occur with end-stage acute mountain sickness. This can progress to coma and death and requires prompt treatment and descent.
High-altitude pulmonary edema (HAPE) can occur without acute mountain sickness.
Headaches are the most common symptom of AMS. Others include fatigue, lightheadedness, and/or nausea.
The best way to prevent AMS is gradual ascent, but medications may also be effective in prophylaxis, especially if a rapid ascent such as in motorcycling, driving, or flying to altitude is planned.
1st line drug for preventing AMS is acetazolamide starting the day before the ascent. It is, however, contraindicated in patients with sulfa allergy.
The 2nd-line drug is dexamethasone, which should be used for prophylaxis in sulfa-allergic patients.
Dexamethasone is also used to treat severe AMS and HACE. Immediate descent is necessary for HACE and HAPE.
Further Reading / Reference
European Respiratory Review Mar 2017, 26 (143) 160096. Acute high-altitude sickness
Am Fam Physician 2010;82(9):1103-1110. Altitude illness: Risk factors, prevention, presentation, and treatment.
Cochrane Database Syst Rev 2017;(6):CD009761. Interventions for preventing high altitude illness: Part 1. Commonly- used classes of drugs.
N Engl J Med 2013;368(24):2294-2302. Acute high-altitude illnesses.
J Appl Physiol (1985). 2007 Apr;102(4):1313-22. Mechanisms of action of acetazolamide in the prophylaxis and treatment of acute mountain sickness.