Quote:
Originally Posted by MTN Medic
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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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.)