OEC 6th Edition Chapter 28

The height or vertical elevation above a fixed point is known as:

A) ascent.

B) elevation.

C) altitude.

D) ataxia.

C) altitude.

The concentration of oxygen at sea level is approximately:

A) 35%.

B) 43%.

C) 40%.

D) 21%.

D) 21%.

As altitude increases:

A) barometric pressure increases.

B) the proportion of oxygen decreases.

C) the concentration of oxygen per cubic foot decreases.

D) air density becomes greater.

B) the proportion of oxygen decreases.

You are teaching a class on acute mountain sickness. When one of your students asks you to explain the term acclimatization in relation to AMS, your best response would be which of the following statements?

A) "Physiologic changes that increase the body's ability to adjust to extreme changes in temperature."

B) "Physiologic changes that decrease the body's need for oxygen at high altitudes."

C) "Physiologic changes that decrease the body's need for slow ascents."

D) "Physiologic adjustments that increase the delivery of oxygen to cells."

D) "Physiologic adjustments that increase the delivery of oxygen to cells."

Which of the following processes does not occur during acclimatization?

A) An increase in respiratory rate and depth

B) Dilation of pulmonary blood vessels

C) An increase in red blood cell production

D) An increase in heart rate

B) Dilation of pulmonary blood vessels

You are working at a mountain resort and are presented with a 50-year-old woman who states that she does not feel well. From your assessment, which of the following findings would seemingly indicate that the patient is being adversely affected by the high altitude?

A) Vomiting after eating large meals

B) An elevated blood glucose level with no history of diabetes

C) A heart rate of 62 beats per minute

D) A complaint of feeling short of breath on exertion

D) A complaint of feeling short of breath on exertion

In an otherwise healthy individual, the presence of a headache and feelings of sickness at high altitude is known as:

A) a high-altitude migraine.

B) acute mountain encephalitis.

C) acute mountain sickness.

D) high-altitude pulmonary edema.

C) acute mountain sickness.

Labored breathing at rest and audible chest congestion herald the development of a serious, potentially life-threatening stage of what altitude-related condition?

A) Acute mountain sickness

B) Peripheral edema

C) HAPE

D) Khumbu cough

C) HAPE

You are with a group of hikers on the third day of an 11,000-foot mountain ascent. One of the hikers has not been feeling well for a couple of days. Today, members of the group notice that he is having difficulty getting dressed and speaking. From your training in outdoor emergency care, you recognize that these signs and symptoms are most often associated with:

A) acute mountain sickness.

B) peripheral neuropathy.

C) frostbite.

D) HACE.

D) HACE.

The most effective method for preventing high-altitude illness is to:

A) make gradual ascents.

B) maintain adequate hydration and eat a high-carbohydrate diet.

C) take medications such as Diamox.

D) avoid drinking alcohol.

A) make gradual ascents.

You are asked to speak to a college group that is planning a ski trip to the Alps. In order to help them plan for reducing their risks for developing altitude-related illnesses, you suggest all of the following except:

A) plan a layover day at between 6,000 feet and 8,000 feet.

B) drink 3-4 quarts of fluid a day.

C) do a lot of heavy physical exertion early in the trip to help them acclimate.

D) sleep at an elevation that is lower than where they will be skiing.

C) do a lot of heavy physical exertion early in the trip to help them acclimate.

Your family is planning a ski trip to a resort that is at about 10,000 feet of elevation. You suggest that you spend the first two nights of the trip at a hotel where the elevation is about 6,500 feet. When your children protest that they are in good shape and want to go immediately to the resort, you explain that you are concerned about altitude sickness and:

A) "Physical fitness does not necessarily prevent altitude sickness."

B) "Just because you children are fit and don't need the gradual change doesn't mean your mom and I don't need it."

C) "Your mom and I will exercise more before the trip so that maybe we can reduce the delay to one night."

D) "I'll see if I can get some medication so that we don't need to stop over at the lower elevation."

A) "Physical fitness does not necessarily prevent altitude sickness."

You are working at the summit of a 9,000-foot mountain. A 60-year-old woman is brought to you, complaining of headache, fatigue, and shortness of breath. You prepare to do your assessment and recognize that your goal is to:

A) give her some ibuprofen to ease her headache.

B) determine whether this is an emergent condition so that you can initiate life-saving treatment.

C) get the patient lying down to relieve her presenting symptoms?

D) find out if she has an inhaler that she can use to relieve her shortness of breath.

B) determine whether this is an emergent condition so that you can initiate life-saving treatment.

Given that 50 percent of patients with HAPE also have symptoms of AMS, it is important that you ask patients if they have had which of the following groups of signs/symptoms?

A) Headache, blurred vision, peripheral edema

B) Harsh cough, itchy skin, nausea

C) Difficulty sleeping, vomiting, ataxia

D) Fatigue, nausea, difficulty sleeping

D) Fatigue, nausea, difficulty sleeping

In order to assess for a key symptom of HACE, you would ask patients to:

A) walk a straight line heel to toe.

B) take a deep breath and let you know if it hurts.

C) tell you if their rings are fitting tightly.

D) read an eye chart.

A) walk a straight line heel to toe.

A patient at a mountain ski resort has notable shortness of breath. She denies any past medical history and takes no medications. After applying oxygen, you realize that the fundamental treatment to helping this patient improve is to:

A) descend to a lower altitude.

B) administer a respiratory medication by a metered-dose inhaler.

C) position her in a left lateral recumbent position.

D) place her in a supine position with her legs elevated.

A) descend to a lower altitude.

You have a 32-year-old male patient who just arrived at the aid room on the top of a 9,000-foot peak. He is exhibiting signs of altitude sickness and HAPE. You recognize that the final key to a successful outcome of treatment is to:

A) get him to lie down so his symptoms do not worsen.

B) start him on O2 while waiting for him to be transported.

C) prevent further body cooling by covering him with blankets.

D) recognize the patient's signs and descend to a lower elevation.

D) recognize the patient's signs and descend to a lower elevation.

Your group of climbers has reached an elevation of 8,500 feet. One of the climbers is increasingly short of breath and now has audible chest congestion. Your party has a limited supply of oxygen, which you immediately apply to the climber at 15 LPM via a nonrebreather mask. Based on your assessment that the climber has HAPE, you recognize that the next necessary treatment is:

A) a rapid descent of at least 1,500 to 3,000 feet.

B) to administer diuretics such as Diamox to reduce the patient's pulmonary edema.

C) to get the patient to a physician who can administer dexamethasone.

D) to place the patient in the shock position.

A) a rapid descent of at least 1,500 to 3,000 feet.

When treating an AMS patient, use high-flow oxygen to keep saturation at least what percentage?

A) 88%

B) 94%

C) 97%

D) 98%

B) 94%

You are accompanying a team of hikers up a high mountain. The next morning, you are summoned to a tent and find one of the climbers confused and complaining of a headache. His airway is patent, and his respirations are 24 per minute. He has no medical history and was in good health until found ill this morning by his friend. Suspicious of high-altitude cerebral edema (HACE), which of the following actions should you take?

A) Immobilize the patient

B) Provide high-flow oxygen

C) Insert an oropharyngeal airway

D) Administer oral glucose

B) Provide high-flow oxygen

How does altitude affect amount of oxygen available to cells

Air at 10,000 feet oxygen taken in with each breath only 69% of that taken in at sea level

Acute mountain sickness (AMS)

Caused when rate of ascent outpaces body adjustment. Symptoms are mild to moderate headache, nausea, and dyspnea on exertion, symptoms can decrease as body acclimatizes

High altitude pulmonary edema (HAPE)

Causes are fluid buildup in lungs from excessive pressure in pulmonary artery, HAPE most common cause of altitude related deaths. Symptoms are patients may present with persistent dry cough and cyanosis, audible chest congestion is sign of life threatening condition 

High altitude cerebral edema (HACE)

Deadly condition in which the brain swells. About 3% of AMS patients go on to develop HACE. Characterized by symptoms that progress from headache to ataxia to altered mental status, drowsiness, and difficulty speaking. Hallucinations and psychotic behavior can be observed

General management of altitude illness

Fundamental treatment is descent to lower elevation. Provide initial treatment to correct ABCDs issues, administer high flow oxygen via nonrebreather. Keep patient warm, anticipate vomiting

Drowning

Is process of respiratory impairment by submersion in a liquid. Patient panics, becomes submerged, gasps and swallows water. May hyperventilate then hypoventilate. Will become unresponsive and aspirate and go into cardiac arrest

Swimmer’s ear

Is acute bacterial infection of auditory canal. Occurs when external canal stays wet for prolonged period. Symptoms are severe ear pain and yellowish discharge

Management of drowning

• Remove the patient from water with spinal precuations if necessary

• Assess for breathing and carotid pulse, begin CPR with two breaths if no pulse, rescue breathing if pulse 

• Maneuvers to remove water may cause vomiting and delay CPR

• Provide high flow oxygen, monitor for shock, keep patient warm

Scuba diving descent emergencies

Barotrauma

Scuba diving ascent emergencies

Arterial gas embolisms, decompression sickness

Barotrauma 

Can occur as the external pressure compresses air-filled structures of the body like the sinuses, lungs, and intestines. Squeeze is a term used to describe this, most common in the ears. Increased external pressure cannot equalize with internal pressure and the eardrum is ruptured

Arterial gas embolisms

 occur when a diver ascends without exhaling and the air in their lungs expands and ruptures alveoli. Gas enters the bloodstream resulting in air emboli

Decompression sickness

Or the bends, occurs in divers who ascend too rapidly or do repeated dives without recovery. Nitrogen gas in the bloodstream expands and forms bubbles as it comes out of solution, large bubbles can cause joint and abdominal pain.

Mammalian diving reflex

a physiological response in air-breathing vertebrates that occurs when holding your breath and submerging your face in cold water, which conserves oxygen by slowing the heart rate and redirecting blood flow to vital organs like the brain and heart