下面是pdf連結.
WILDERNESS MEDICAL SOCIETY CLINICAL PRACTICE GUIDELINES Wilderness Medical Society Clinical Practice Guidelines for the Prevention, Diagnosis, and Treatment of Acute Altitude Illness: 2024 Update Andrew M. Luks, MD1 ; Beth A. Beidleman, ScD2 ; Luanne Freer, MD3 ; Colin K. Grissom, MD4 ; Linda E. Keyes, MD5 ; Scott E. McIntosh, MD, MPH6 ; George W. Rodway, PhD, APRN7 ; Robert B. Schoene, MD8 ; Ken Zafren, MD9,10; Peter H. Hackett, MD11
重點
1. 輕度至中度AMS可以考慮原地休息治療.
2. AMS治療 1-3 天之後如果症狀仍未改善或惡化. 建議下撤
3. 罹患AMS應該停止海拔上升.
4. 丹木斯通常放在預防AMS的角色. 不是治療AMS的優先用藥(可用.但不是必要)
5. 類固醇可治療中度至重度AMS(如果輕微AMS可吃止痛藥物就好), 這時候可用丹木斯作為類固醇的輔助治療
6. AMS緩解之後, 可服用丹木斯以加速高度適應(如果行程還沒下撤, 海拔還會繼續提升)
7. 發生高海拔腦水腫 HACE, 如果附近有醫院, 建議先至醫院使用氧氣治療, 治療目標是將血氧濃度提升到 90%
8. 在沒有充足醫療資源的地區, 一旦懷疑罹患HACE, 必須馬上下降, 無法下降時, 可考慮補充氧氣或攜帶型加壓艙.
WILDERNESS MEDICAL SOCIETY CLINICAL PRACTICE GUIDELINES Wilderness Medical Society Clinical Practice Guidelines for the Prevention, Diagnosis, and Treatment of Acute Altitude Illness: 2024 Update Andrew M. Luks, MD1 ; Beth A. Beidleman, ScD2 ; Luanne Freer, MD3 ; Colin K. Grissom, MD4 ; Linda E. Keyes, MD5 ; Scott E. McIntosh, MD, MPH6 ; George W. Rodway, PhD, APRN7 ; Robert B. Schoene, MD8 ; Ken Zafren, MD9,10; Peter H. Hackett, MD11
重點
1. 輕度至中度AMS可以考慮原地休息治療.
2. AMS治療 1-3 天之後如果症狀仍未改善或惡化. 建議下撤
3. 罹患AMS應該停止海拔上升.
4. 丹木斯通常放在預防AMS的角色. 不是治療AMS的優先用藥(可用.但不是必要)
5. 類固醇可治療中度至重度AMS(如果輕微AMS可吃止痛藥物就好), 這時候可用丹木斯作為類固醇的輔助治療
6. AMS緩解之後, 可服用丹木斯以加速高度適應(如果行程還沒下撤, 海拔還會繼續提升)
7. 發生高海拔腦水腫 HACE, 如果附近有醫院, 建議先至醫院使用氧氣治療, 治療目標是將血氧濃度提升到 90%
8. 在沒有充足醫療資源的地區, 一旦懷疑罹患HACE, 必須馬上下降, 無法下降時, 可考慮補充氧氣或攜帶型加壓艙.
9. 對於懷疑HACE的患者, 都應該使用類固醇
10. 當發生HACE治療成功之後, 會不會在同一行程發生第二次 HACE, 目前沒有這種案例報告(以前沒發生. 但並不是以後不會遇到). 但應注意避免再次發生(海拔不要提升太快, 每上升1000公尺排一個休息日. 使用預防性藥物等等)
10. 當發生HACE治療成功之後, 會不會在同一行程發生第二次 HACE, 目前沒有這種案例報告(以前沒發生. 但並不是以後不會遇到). 但應注意避免再次發生(海拔不要提升太快, 每上升1000公尺排一個休息日. 使用預防性藥物等等)
下面中文使用google翻譯
AMS/HACE 治療建議方法
應注意排除症狀和體徵與 AMS 和 HACE 相似的疾病,例如一氧化碳中毒、脫水、疲憊、低血糖、體溫過低和低鈉血症。患有 AMS 的人應避免移動到較高的睡眠高度。患有輕度至中度疾病的人(表 2)可能會保持在當前海拔高度,並應密切觀察症狀的進展。使用非鴉片類止痛藥治療頭痛等症狀,使用止吐藥物治療噁心和嘔吐等症狀就足夠了。如果經過 1 至 3 天的適當幹預後症狀惡化或未能改善,則應開始下降以治療 AMS。
AMS/HACE 治療建議方法
應注意排除症狀和體徵與 AMS 和 HACE 相似的疾病,例如一氧化碳中毒、脫水、疲憊、低血糖、體溫過低和低鈉血症。患有 AMS 的人應避免移動到較高的睡眠高度。患有輕度至中度疾病的人(表 2)可能會保持在當前海拔高度,並應密切觀察症狀的進展。使用非鴉片類止痛藥治療頭痛等症狀,使用止吐藥物治療噁心和嘔吐等症狀就足夠了。如果經過 1 至 3 天的適當幹預後症狀惡化或未能改善,則應開始下降以治療 AMS。
患有嚴重 AMS 的人應停止上升並下降到海拔較低的地方。乙醯唑胺和地塞米松通常不是治療輕度 AMS 所必需的,但對於中度至重度病例可能有用。在這些情況下,應強烈考慮在下降時使用地塞米松。雖然乙醯唑胺有助於適應環境,但它可能更適合預防 AMS,而不是治療 AMS。儘管如此,對於中重度病例,也可以考慮與地塞米鬆一起治療或在無法獲得地塞米鬆的情況下進行治療。這兩種藥物都可以透過改善症狀並允許個人依靠自己的力量下降來促進下降。一旦症狀消退,患有 AMS 的人可能會恢復上升。如果症狀持續存在,則禁止進一步上升或重新上升至先前達到的高度。AMS 緩解後,應在重新治療期間使用預防劑量的乙醯唑胺。
在可以前往醫院或專科診所的地點發生 HACE 的個人應接受足以使 SpO2 達到 >90% 的補充氧氣。在遠離醫療資源的偏遠地區,應對任何疑似 HACE 受害者進行下降。如果下降不可行,則應使用補充氧氣或攜帶式高壓艙。所有患有 HACE 的人也應該開始服用地塞米松。沒有關於 HACE 解決後在同一旅行或探險期間重新出現的系統資料或病例報告。謹慎的做法是避免在這種情況下重新發生。
SUGGESTED APPROACH TO AMS/HACE TREATMENT
Care should be taken to exclude disorders whose symptoms and signs resemble those seen with AMS and HACE, such as carbon monoxide poisoning, dehydration, exhaustion, hypoglycemia, hypothermia, and hyponatremia. People with AMS should avoid moving to higher sleeping elevations. Those with mild-moderate illness (Table 2) may remain at their current altitude and should be closely observed for progression of symptoms. It is sufficient to treat symptoms such as headache with nonopioid analgesics and nausea and vomiting with antiemetics. Descent should be initiated for AMS if symptoms worsen or fail to improve after 1 to 3 d of appropriate interventions. Persons with severe AMS should cease ascending and descend to lower elevation. Acetazolamide and dexamethasone are generally not necessary for treatment of mild AMS but may be useful in moderate-severe cases. In these cases, dexamethasone should be strongly considered along with descent. While acetazolamide facilitates acclimatization, it is likely better for the prevention rather than the treatment of AMS. Nonetheless, it may also be considered for treatment in moderate-severe cases along with dexamethasone or if dexamethasone is unavailable. Both medications may facilitate descent by improving symptoms and allowing the individual to descend under their own power. Individuals with AMS may resume ascending once symptoms resolve. Further ascent or reascent to a previously attained altitude is contraindicated if there are ongoing symptoms. After resolution of AMS, prophylactic doses of acetazolamide should be used during reascent. Individuals developing HACE in locations with access to hospitals or specialized clinics should receive supplemental oxygen sufficient to achieve an SpO2 of >90%. In remote areas away from medical resources, descent should be initiated in any suspected HACE victim. If descent is not feasible, supplemental oxygen or a portable hyperbaric chamber should be used. All persons with HACE should also be started on dexamethasone. There are no systematic data or case reports about reascent during the same trip or expedition following resolution of HACE. The prudent course is to avoid reascent in this situation.
在可以前往醫院或專科診所的地點發生 HACE 的個人應接受足以使 SpO2 達到 >90% 的補充氧氣。在遠離醫療資源的偏遠地區,應對任何疑似 HACE 受害者進行下降。如果下降不可行,則應使用補充氧氣或攜帶式高壓艙。所有患有 HACE 的人也應該開始服用地塞米松。沒有關於 HACE 解決後在同一旅行或探險期間重新出現的系統資料或病例報告。謹慎的做法是避免在這種情況下重新發生。
SUGGESTED APPROACH TO AMS/HACE TREATMENT
Care should be taken to exclude disorders whose symptoms and signs resemble those seen with AMS and HACE, such as carbon monoxide poisoning, dehydration, exhaustion, hypoglycemia, hypothermia, and hyponatremia. People with AMS should avoid moving to higher sleeping elevations. Those with mild-moderate illness (Table 2) may remain at their current altitude and should be closely observed for progression of symptoms. It is sufficient to treat symptoms such as headache with nonopioid analgesics and nausea and vomiting with antiemetics. Descent should be initiated for AMS if symptoms worsen or fail to improve after 1 to 3 d of appropriate interventions. Persons with severe AMS should cease ascending and descend to lower elevation. Acetazolamide and dexamethasone are generally not necessary for treatment of mild AMS but may be useful in moderate-severe cases. In these cases, dexamethasone should be strongly considered along with descent. While acetazolamide facilitates acclimatization, it is likely better for the prevention rather than the treatment of AMS. Nonetheless, it may also be considered for treatment in moderate-severe cases along with dexamethasone or if dexamethasone is unavailable. Both medications may facilitate descent by improving symptoms and allowing the individual to descend under their own power. Individuals with AMS may resume ascending once symptoms resolve. Further ascent or reascent to a previously attained altitude is contraindicated if there are ongoing symptoms. After resolution of AMS, prophylactic doses of acetazolamide should be used during reascent. Individuals developing HACE in locations with access to hospitals or specialized clinics should receive supplemental oxygen sufficient to achieve an SpO2 of >90%. In remote areas away from medical resources, descent should be initiated in any suspected HACE victim. If descent is not feasible, supplemental oxygen or a portable hyperbaric chamber should be used. All persons with HACE should also be started on dexamethasone. There are no systematic data or case reports about reascent during the same trip or expedition following resolution of HACE. The prudent course is to avoid reascent in this situation.
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