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Old 03-27-2012, 19:15   #16
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Originally Posted by Underwhelmed View Post

Now all I gotta do is wait for DARPA to catch up.
I can tell you right now from first hand experience, DARPA is way ahead of you.
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Old 03-29-2012, 10:05   #17
miclo18d
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Another solution to AMS/HAPE/HACE

I hope I'm not butting in here too soon as I'm fairly new to the site.

I can certainly understand a discussion about the merits of this tx or that tx and you should always have a plan in place for AMS/HAPE/HACE when in the mountains, but you also have to consider what is really going to happen.

Nothing.

Now, what I'm talking about here is going into the mountains with steely-eyed-snake-eaters with hyper-alloy combat chassis. You know, those guys that where the funny looking green hats from France.

I served on two teams and deployed to mountainous regions in S. America ans the A-Stan (15,000ft in the Andes/ 7000-8000 ft in E. A-Stan). In all cases, I never treated one case of AMS, HAPE, or HACE (not that I didn't think my commanders weren't suffering from any or all of these from time to time). Not that I wasn't prepared (didn't have Gamow bags). Acclimatization and peak physical fitness (I know this can be difficult when your Team Daddy insists on taking you to M & D's Pancakes & Waffles once a week) is your #1 defense followed by Acetazolamide Prophylaxis and/or descent if it turns out to be acute.

Now when you move on to your local populaces, they should already be acclimatized to the region. If they are suffering from PE, it's probably isn't caused by the altitude.

If we are talking about civilian mountain climbers, then you probably aren't going to be treating them without medical authority to do so anyway so descent is your #1 option.

I know that your team guys want you to carry a prescription ED meds around with you so they can feel more potent, but really they might as well just ask the 3rd Group guys to get them some Rhino horns or the 1st Group guys for some tiger penis. It's gets about the same effect for those without ED.

What it really comes down to is this:

1.) $$$ -- Do you want to spend your med funds on making your team rock hard for the ladies and maybe/possibly treat HAPE/HACE?

2.) SPACE -- Do you want to use up the space in your aidbag with something you probably won't use and has only one purpose?

I would have told my guys to buy it on the local economy for their own conquests and saved the room for some Zpacks for when the Bravo came to me with drippy-drip that he got from some mountain girl and if any of them had suffered AMS/HAPE/HACE I would have treated symptomatically, descended or called in a MEDEVAC to get definitive tx.

Disclaimer: Not a scientific solution but a common sense one.

Last edited by miclo18d; 03-29-2012 at 10:06. Reason: grammar
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Old 03-29-2012, 20:10   #18
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I disagree with your reasoning. The prevalence of AMS above 15,000 is quite high (above 50% in unaclimatized climbers) and not treating is simply unsound medicine.

Wait until one of your patients progresses from AMS into HAPE/HACE. You will need a new set of drawers. I have treated such a patient and it was time and gear intensive and quite frankly scary as hell. WHEN you have one of these patients, you will realize to dangerous this line of thinking is.

BTW Acetazolamide is cheap as hell and team mates that get droopy ### that often need something other than a Z-pac, they need an education and an ass kicking.
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Old 03-29-2012, 20:22   #19
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BTW treating symptomatically with HAPE/HACE is treating an incpidous cause of death. How do you treat lungs filling with fluid/ brain swelling symptomatically? Preventative medicine is key at altitude...
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Old 03-30-2012, 08:14   #20
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Originally Posted by MTN Medic View Post
I disagree with your reasoning. The prevalence of AMS above 15,000 is quite high (above 50% in unaclimatized climbers) and not treating is simply unsound medicine.

Wait until one of your patients progresses from AMS into HAPE/HACE. You will need a new set of drawers. I have treated such a patient and it was time and gear intensive and quite frankly scary as hell. WHEN you have one of these patients, you will realize to dangerous this line of thinking is.

BTW Acetazolamide is cheap as hell and team mates that get droopy ### that often need something other than a Z-pac, they need an education and an ass kicking.
Sorry if I wasn't clear. If I'm not mistaken, I never disagreed with you. I said #1 Tx was descent. Get them out of the environment. My entire diatribe was on: the use of Nitrates (i.e. ED meds) as probably just looking for a zebra cure.

Sorry if I was not specific in not emphasizing prophylaxis (even though I mentioned it and advocated it when indicated) I carried Acetazolamide, lasix, manitol, and dex; I didn't carry Viagra. I also mentioned acclimatization.

And when do you treat fluid on the lungs or ICP? When it is symptomatic as in when you have determined HAPE/HACE. Hence symptomatic treatment.

AMS --

Lack of appetite, nausea, or vomiting
*Fatigue or weakness
****Dizziness or light headedness
*Insomnia
Pins and needles
*Shortness of breath upon exertion
*Nosebleed
Persistent rapid pulse
****Drowsiness
**General malaise
Peripheral edema (swelling of hands, feet, and face).

These are your more common S/S in AMS all of which I have experienced in the mountains of Ecuador, Peru, and Afghanistan. You experience these same S/S on a HALO jump. It doesn't mean you need Acetazolamide or to be treated for AMS/HAPE/HACE.

My common sense approach is about treating the patient not the possible illness.

Again, sorry if I wasn't clear. I was trying to insert a sense of humor into an otherwise dry medical discussion. (and yes, you also add two weeks of Doxy to your 18B's tx because he wouldn't use 1 of the 1000 condoms you bought for the team, that wasn't the point of my humor.)
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Old 03-30-2012, 11:36   #21
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Originally Posted by miclo18d View Post
(and yes, you also add two weeks of Doxy to your 18B's tx because he wouldn't use 1 of the 1000 condoms you bought for the team, that wasn't the point of my humor.)
Aint that the truth? My favorite line was:

Quote:
what's a condom?


My response:
Quote:
Well, what you have there... you might not need a condom because that thing makes your pecker fall off in 3 weeks...


Soooo gullible
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Old 04-02-2012, 06:08   #22
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Not wanting to hijack the thread but...

If they failed to use a condom and came to me after PCOD I would use sterile water instead of lidocain in the Roceph.

That pain usually kept me from having to treat anyone until a new guy got to the team. They usually would listen to you for the first deployment then they would go crazy on the next one. After the sterile water they would find the right balance. I will now dub it as 'Goldy Locks Syndrome'. I wish I had thought of that before I retired.

A lesson learn hard is a lesson learned well!
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Old 01-23-2013, 19:57   #23
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What about stacking either autologous or Xenotransplantation?

I was talking with an anesthesiologist about this the other day. Stacking would increase the likelihood of CVA. He recommends diamox (sp?) 2 days prior to altitude and 1 day at altitude. A plus is it's cheap as chips.

Last edited by NurseTim; 02-01-2013 at 18:27. Reason: New info
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Old 01-23-2013, 20:06   #24
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Quote:
Originally Posted by miclo18d View Post
Not wanting to hijack the thread but...

If they failed to use a condom and came to me after PCOD I would use sterile water instead of lidocain in the Roceph.

That pain usually kept me from having to treat anyone until a new guy got to the team. They usually would listen to you for the first deployment then they would go crazy on the next one. After the sterile water they would find the right balance. I will now dub it as 'Goldy Locks Syndrome'. I wish I had thought of that before I retired.

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