1. PREDICTORS AND CLINICAL IMPLICATIONS OF MOUNTAIN SICKNESS
- Author
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Gržančić, Sandro, Mrakovčić-Šutić, Ines, Trobonjača, Zlatko, Kučić, Natalia, and Sotošek, Vlatka
- Subjects
controlled ascent ,BIOMEDICINE AND HEALTHCARE. Clinical Medical Sciences ,BIOMEDICINA I ZDRAVSTVO. Kliničke medicinske znanosti ,BIOMEDICINE AND HEALTHCARE. Basic Medical Sciences ,visinski edem mozga ,visinski edem pluća ,altitude sickness ,acetazolamide ,kontrolirani uspon ,acetazolamid ,high-altitude cerebral oedema ,acute mountain sickness ,visinska bolest ,BIOMEDICINA I ZDRAVSTVO. Temeljne medicinske znanosti ,high-altitude pulmonary oedema ,akutna visinska bolest - Abstract
Visinska bolest pokriva široki spektar bolesti, u rasponu od vrlo uobičajene visinske glavobolje, do rijetkog, ali po život opasnog visinskog edema mozga ili pluća. Dijagnoza u praksi može biti izazovna zbog subjektivnog izvješćivanja o težini simptoma, ali se uvijek za simptomatologiju smatra da je VB dok se ne dokaže suprotno. Prevencija je uvijek najbolji pristup kod svih oblika visinske bolesti, ponajprije kontroliranim postepenim usponom, a ne farmakološkom profilaksom. Acetazolamid je učinkovit za prevenciju AVB-a kod rizičnih pojedinaca, ali ga ne bi trebalo rutinski primjenjivati. Nifedipin za prevenciju VEP-a indiciran je samo u bolesnika s pozitivnom anamnezom na VEP-a ili plućnu hipertenziju. Prvi koraci za hitno liječenje VB-a su silazak i terapija kisikom. Spuštanje nije uvijek potrebno u bolničkim uvjetima, ali treba biti prioritet u udaljenom i nepristupačnom okruženju. Za liječenje VEP-a silazak i nifedipin predstavljaju prve terapijske postupke, dok se za tretman akutne visinske bolesti i VEM-a koristi deksametazon sa ili bez acetazolamida. Kasna dijagnoza i odgođeni silazak najčešći su problemi s kojima se kliničari susreću na terenu. Mnogi temeljni mehanizmi VB-a ostaju nejasni, ali nova istraživanja u ovom području mogu imati širu korist za razumijevanje hipoksije u drugim kliničkim okruženjima, kao i poboljšanje u prevenciji i upravljanju ovim brzorastućim kliničkim problemom., Altitude sickness covers a spectrum of diseases, ranging from the very common altitude headache, to the quite rare but often life-threatening high-altitude cerebral or pulmonary oedema. Diagnosis can be challenging due to subjective reporting of the severity of symptoms, but symptomatology is always considered to be altitude sickness until proven otherwise. Prevention is still the best approach for all forms of altitude sickness, preferably with an appropriate ascent rate rather than pharmacological prophylaxis. Acetazolamide has proven effective in preventing acute mountain sickness in at-risk individuals, but shouldn't be required in all cases. Nifedipine for the prevention of HAPO is indicated only in patients with a history of HAPO or pulmonary hypertension. The first steps to urgently treat altitude sickness are descent and oxygen therapy. Descent isn't always necessary in a hospital setting, but should be a priority in a remote and inaccessible environment. For the treatment of HAPO, descent and nifedipine are the first therapeutic procedures, while dexamethasone with or without acetazolamide is used for the treatment of acute mountain sickness and HACO. Late diagnosis and delayed descent are the most common problems encountered in the field. Although many of the underlying mechanisms of altitude sickness remain unclear, new research in this area may possibly have wider benefits in understanding hypoxia in other clinical settings, as well as improvements in the prevention and management of this rapidly growing clinical problem.
- Published
- 2020