Finally I have good news.

[uglyEMT]

Congrats on the new job and at a beautiful location

Here is a great link from the American Family Physician from April 1998. It goes into the physiology, symptoms, and treatments of high altitude sickness

High- Altitude Medicine

emedicine article on physiology and symptoms of HACE

HACE

emedicine article on physiology and symptoms of HAPE

HAPE

I know HAPE and HACE are the extreme forms of problems but gives a great overview of the begins of the problems and are more inline with what someone will begin with. They also talk about preexisting conditions that may be exaserbated by the altitude.

as far as the SOP goes, sounds like here in NJ with not being able to do much. Mostly liability issues. As far as the NTG goes, can you administer patients own prescribed? Something to look into. Hopefully it will all be spelled out for you and you can get the extra info from the Doc.

Congrats again

[Richard B the EMT]

As far as the NTG goes, can you administer patients own prescribed? Something to look into.

Just advising as under NY State DoH and FDNY EMS Command's protocols, EMTs are allowed to "assist" patients in taking their own nitro pills (presumed standard confirmation that the patient and prescription names are the same, the pills are not expired, and the pills appear to not be "damaged"or contaminated from anything). FDNY Paramedics carry their own supply of the pills as a part of the drug bag setup.

[rat115]

Headache, dizziness, pale, SOB that doesn't resolve with sitting down and dehydration can all be included in altitude sickness.

We get people out here who've been up in the mountains and didn't realize that their constant low-grade headache was part of altitude sickness and end up calling us when they collapse or start vomiting as they return to the lower altitudes out here on the plains. It seems to be worse in the 16-28 y/o range.

This might help you a bit too.

http://www.webmd.com/a-to-z-guides/altitude-sickness-topic-overview

Ratty

[Lone Star]

Ok, not to sound too ignorant here....

In scuba diving, as you begin your ascent, you're going from an area of greater pressure to an area of lower pressure. By ascending too fast, forces blood gasses into bubbles in the circulatory system and within tissues.

Similarly, when one starts to ascend in altitude, they're going from higher pressures to lower pressures and 'thinner air'. I can understand the shortness of breath.

The questions I have are these:

1) Physilogically, are the blood gasses reacting as they would in decompression sickness?

2) When descending from an altitude (greater than 8,000 feet), does the body suffer through some sort of 'compression sickness'?

[chbare]

Lone Star, you pose a good question that is actually rather difficult to explain. You are correct in that the behaviour of gas at both high altitude and under pressure under the ocean are actually governed by the same physical principles. However, the physiology that occurs is different because the amount of change is much more dramatic under the ocean as compared to high altitudes. Simply diving under a pathetic 33 feet of water will essentially double the amount of pressure that you would experience at sea level. This is a dramatic change in pressure and results in dramatic changes in gas behaviour, while climbing to high altitudes is more subtle so to speak. However, decompression illness has been reported in people who were exposed to high altitude conditions suddenly and even in cases spending extended periods of time under super-atmospheric pressures in deep mines. So, a sort of crossover exists.

Allow me to explain this behaviour in a litle more detail.

First, all gas behaviour under "normal" conditions is described by something called the ideal gas law. (Well, quantum mechanics actually describes all matter behaviour, but the gas laws are easier to work with and a bit more general in nature IMHO.)

The ideal gas law is written as such: PV = nRT

P = pressure, V = Volume, n = number of moles of gas present, T = temperature of the gas in question, R = a gas constant

So, there is basically equivalence in the pressure and volume of a gas and the temperature and amount of gas present.

From this core formula we can derive several other formulae that describe specific aspects of gas behaviour.

One such law is known as Dalton's law:

Dalton's law basically says that the total pressure of a gas mixture is the sum of the partial pressures of all the individual gasses in the mixture.

Take our atmosphere for example, we basically have nitrogen and oxygen (to make it easy, we have 80% nitrogen and 20% oxygen) At sea level, the entire pressure of out atmosphere is about 760 mmHg. 80% of 760 is 608 mmHg and 20% of 760 is 152 mmHg of oxygen. So, Dalton's law dictates that Oxygen (152) + Nitrogen (608) = The total pressure of 760 mmHg.

So, let's apply Dalton's law to high altitudes. Let's say I take a trip to Denver Colorado. In Denver, the atmospheric pressure is about 76% (0.76) that of the pressure at sea level. 76% of 760 = 578 mmHg. The total pressure of atmosphere in Denver is only 578 mmHg. The % of oxygen and nitrogen remains the same, but we simply have less pressure to deal with. So, 20% of 578 is 116 mmHg. At sea level we have a partial pressure of oxygen of 152 mmHg, but in Denver we only have a pressure of 116 mmHg.

This is all dictated by Dalton's law of partial pressures. Clearly, as we go up in altitude, we have a lower partial pressure of oxygen. But, notice that the pressure difference in a little over a mile of atmosphere is only about 182 mmHg. This is rather pathetic compared to the dramatic increase of an entire 760 mmHg with a change of only 33 feet of water.

Under water, Dalton's law does play a role, but another gas law takes a more prominent role. Henry's law states that the pressure of a gas dissolved in a liquid is proportional to the pressure of a gas surrounding that liquid. Therefore, at sea level where I am experiencing 760 mmHg, the pressure of gas dissolved in my blood cannot exceed 760 mmHg because Henry's law basically says that I would need to have more pressure around me in order to have more pressure dissolved in my body. A simple experiment with a can of soda demonstrates Henry's law. Open the soda and you notice fizzing, well the pressure of dissolved gas in the can is greater than around the can, as such, the gas begins to leave the can. Another experiment you can do is to take an open can of soda and place it in a suction container. Pull the yankaheur catheter off the suction tubing of your ambulance and hook it to the closed and sealed suction container. Turn the suction on and lower the pressure within the suction container and you should notice fizzing as gas rushes out of the soda can. This is very much akin to a diver rushing to the surface where pressure is significantly lower.

Another law that is also involved is known as Boyle's law. This basically says volume and pressure are inversely proportional

Hope that helps. Also remember, these laws also assume a constant, unchanging variable such as temperature.

OP, good job on getting a job. Tough times for employment and you managed to become employed, that's always a good thing.

Take care,

chbare.

[daedalus]

Ok, not to sound too ignorant here....

In scuba diving, as you begin your ascent, you're going from an area of greater pressure to an area of lower pressure. By ascending too fast, forces blood gasses into bubbles in the circulatory system and within tissues.

Similarly, when one starts to ascend in altitude, they're going from higher pressures to lower pressures and 'thinner air'. I can understand the shortness of breath.

The questions I have are these:

1) Physilogically, are the blood gasses reacting as they would in decompression sickness?

2) When descending from an altitude (greater than 8,000 feet), does the body suffer through some sort of 'compression sickness'?

The problem with high altitude is the lower barometric pressure and lower pressure of inspired oxygen (PiO2). You have air at high altitudes, and the gasses present are in the same proportions as at sea level (O2 is still 21% of the air), however, there is less air in general. Think of the molecules making up the mixture we call "air" as being more spaced out and less abundant at high altitude. Without proper acclimatization, hypoxia is the primary offending agent behind AMS, HAPE, and HACE. Where as decompression issues from diving relate to how gasses dissolve into solution (blood) at different pressures.

For example, HAPE is a form of pulmonary hypertension brought in by hypoxic pulmonary vasoconstriction. Hydrostatic pulmonary edema develops, and hence you get the name HAPE.