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14 Cards in this Set
- Front
- Back
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PV= |
nRT; P is pressure, V is volume, n is the amount of the substance, R is the ideal or universal gas constant, and T is the temp |
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35 year old WF experiences symptoms of severe joint pain while flying at 8000' (ascending to 10000' cabin altitude) after a near drowning episode (no deeper than 10') that occurred 12 hrs prior to take off. what is the presumptive diagnosis? what is the initial treatment? what does this case illustrate about individual tolerances? |
decompression sickness; treatment is O2 or descending the plane; individuals are different |
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89 y/o WM ultra runner celebrates completion of the LT-100 in a record personal time of 25 hrs. shortly after crossing the finish line he begins hyperventilating, wheezing, and demonstrating respiratory distress with cyanosis. he is a non-smoker without a history of asthma. he lives at sea level. what is the diagnosis? is there any urgency? what actions should be taken immediately? |
high altitude pulmonary edema; urgent; start O2 and take him down in altitude |
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respiratory and cardiovascular changes with altitude |
hypoxic hypoxia; decreased pAO2 --> carotid body response --> hyper ventilation --> respiratory alkalosis; increased renal excretion of HCO3; increased HR --> decreased stoke volume --> right ventricular hypertrophy, increased PA pressure, hypoxic pulmonary vasoconstriction; compensation includes increased Hct |
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acute mountain sickness (AMS) |
headache (early), nausea, vomiting, insomnia, fatigue, lassitude, dizziness, predisposition related to less CSF (less accommodation to brain swelling?); moderate to severe cases likely due to cerebral edema; continuum with HACE? |
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high altitude cerebral edema (HACE) |
pathophysiology, individual susceptibiliity and relationship to AMS/HAPE not fully understood; sx's due to increased ICP; cytotoxic (intracellular)/1 degree vasogenic --> leaking of proteins across BBB; MRI substantiated leakage- mechanical loss of autoregulatory (ischemia, neuro adrenergic and cholinergic activation) and increased ICP --> herniation --> death |
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high altitude pulmonary edema (HAPE) |
life threatening; usually occurs above 2500m; individuals are predisposed- probably defective alveolar fluid clearance and maybe a defect in the pulmonary epithelia, pulmonary NO levels 30% lower in HAPE prone individuals; altitude --> hypoxic pulmonary vasoconstriction |
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hypothemia |
severe accidental hypothermia may occur; transition from cold to shiver to severe; diminished cerebral blood flow and O2 req; appear clinically dead; active core rewarming indicated; keep dry; no tea, coffee, or alcohol |
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third spacing phenomenon |
commonly observed in ultra athletes, surgical, burn, trauma, and sepsis pts; peripheral and abdominal swelling; 2 phases= loss and reabsorption; increased cap permeability and/or lymphatic system obstruction; imbalances in fluid volume, colloidal osmotic pressure, Na/albumin observed |
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management of third spacing |
fluid volume replacement with isotonic solutions in otherwise normal individuals; crystalloid (electrolyte) and colloid (protein) may be needed (remember albumin comprises 60% intravascular protein); monitor weight, bp, urine output, cardiac function, and mental status; typically reverses within 24-72 hrs; echocardiography/cardiac fxn (if indicated) |
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effects of altitude training |
enhances RBC production; more efficient training occurs; self selection of athletes (phenotype/genotype); change in muscle physiology (mito fxn improves); live/sleep high train low; short and long term adaptation occur |
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a plausible mechanism for high altitude pulmonary edema (HAPE) is: a. defect in pulmonary CO2 synthesis b. defect in pulmonary epithelial NO synthesis c. defect in RBC complement (C3) synthesis d. defect in pulmonary epithelial C3 synthesis e. none of the baove |
defect in pulmonary epithelial NO synthesis |
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third spacing is a common phenomenon observed in ultra athletes. which of the following best describes the underlying pathophysiology? a. decreased capillary permeability coupled with lymphatic obstruction b. increased capillary permeability coupled with lymphatic obstruction c. significant colloid and crystalloid retention d. b and c e. none of the above |
b and c; (she didn't say if this was the answer) |
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a 79 y/o high altitude ultra athlete complains of severe headache, nausea, and vomiting. he was given the presumptive diagnosis of AMS. which of the following are correct re. AMS: a. AMS pts may have predisposing factors b. cerebral edema always occurs c. headache is a typical early symptom d. a and c e. all of the above |
a and c; (she didn't say if this was the answer) |
