DOWNLOAD PDF MEDICINE FOR MOUNTAINEERING

Transcription

1 Chapter 1 : Dexamethasone - Wikipedia Medicine for Mountaineering & Other Wilderness Activities and millions of other books are available for Amazon Kindle. Learn more Enter your mobile number or address below and we'll send you a link to download the free Kindle App. Prevention[ edit ] Ascending slowly is the best way to avoid altitude sickness. Alcohol and sleeping pills are respiratory depressants, and thus slow down the acclimatization process and should be avoided. Alcohol also tends to cause dehydration and exacerbates AMS. Thus, avoiding alcohol consumption in the first 24â 48 hours at a higher altitude is optimal. Pre-acclimatization[ edit ] Pre-acclimatization is when the body develops tolerance to low oxygen concentrations before ascending to an altitude. It significantly reduces risk because less time has to be spent at altitude to acclimatize in the traditional way. Additionally, because less time has to be spent on the mountain, less food and supplies have to be taken up. Several commercial systems exist that use altitude tents, so called because they mimic altitude by reducing the percentage of oxygen in the air while keeping air pressure constant to the surroundings. Altitude acclimatization[ edit ] Altitude acclimatization is the process of adjusting to decreasing oxygen levels at higher elevations, in order to avoid altitude sickness. For high-altitude climbers, a typical acclimatization regimen might be to stay a few days at a base camp, climb up to a higher camp slowly, and then return to base camp. A subsequent climb to the higher camp then includes an overnight stay. This process is then repeated a few times, each time extending the time spent at higher altitudes to let the body adjust to the oxygen level there, a process that involves the production of additional red blood cells. This process cannot safely be rushed, and this is why climbers need to spend days or even weeks at times acclimatizing before attempting to climb a high peak. Simulated altitude equipment such as altitude tents provide hypoxic reduced oxygen air, and are designed to allow partial pre-acclimation to high altitude, reducing the total time required on the mountain itself. Altitude acclimatization is necessary for some people who move rapidly from lower altitudes to intermediate altitudes e. The Everest Base Camp Medical Centre cautions against its routine use as a substitute for a reasonable ascent schedule, except where rapid ascent is forced by flying into high altitude locations or due to terrain considerations. This change in ph stimulates the respiratory center to increase the depth and frequency of respiration, thus speeding the natural acclimatization process. An undesirable side-effect of acetazolamide is a reduction in aerobic endurance performance. Other minor side effects include a tingle-sensation in hands and feet. Although a sulfonamide ; acetazolamide is a non-antibiotic and has not been shown to cause life-threatening allergic cross-reactivity in those with a self-reported sulfonamide allergy. Prior to the onset of altitude sickness, ibuprofen is a suggested non-steroidal anti-inflammatory and painkiller that can help alleviate both the headache and nausea associated with AMS. It has not been studied for the prevention of cerebral edema swelling of the brain associated with extreme symptoms of AMS. In Chinese and Tibetan traditional medicine, an extract of the root tissue of Radix rhodiola is often taken in order to prevent the same symptoms, though neither of these therapies has been proven effective in clinical study. Oxygen enrichment[ edit ] In high-altitude conditions, oxygen enrichment can counteract the hypoxia related effects of altitude sickness. A small amount of supplemental oxygen reduces the equivalent altitude in climate-controlled rooms. Stationary oxygen concentrators typically use PSA technology, which has performance degradations at the lower barometric pressures at high altitudes. One way to compensate for the performance degradation is to utilize a concentrator with more flow capacity. The application of high-purity oxygen from one of these methods increases the partial pressure of oxygen by raising the FiO2 fraction of inspired oxygen. Other methods[ edit ] Increased water intake may also help in acclimatization [30] to replace the fluids lost through heavier breathing in the thin, dry air found at altitude, although consuming excessive quantities "over-hydration" has no benefits and may cause dangerous hyponatremia. Treatment[ edit ] The only reliable treatment, and in many cases the only option available, is to descend. Attempts to treat or stabilize the patient in situ at altitude are dangerous unless highly controlled and with good medical facilities. Symptoms abate in 12 to 36 hours without the need to descend. A Gamow bag is generally used only as an aid to evacuate severe AMS patients, not to treat them at altitude. See mate de coca. Steroids can be used to treat the symptoms of pulmonary or cerebral edema, but do not treat the underlying Page 1

2 AMS. Page 2

3 Chapter 2 : List of Mountain Sickness / Altitude Sickness Medications (7 Compared) - blog.quintoapp.com The updated ediiton of Medicine for Mountaineering provides comprehensive information and procedures for major and minor backcountry emergencies. Better than moleskin, even. No one is immune to blisters. However, blisters are preventable if you understand the conditions that cause them and they will heal faster if you know how to treat them properly. In the following article I begin by explaining what blisters are and why they occur. I then discuss techniques to prevent them from occurring, followed by guidelines for treating blisters that will hasten the healing process. Blisters can be caused by burns, allergic reactions, and fungal infections. Friction is the most common cause of hiking blisters. When your feet get hot and sweaty, your socks stick to your feet and begin to rub against the inside of your shoes or boots. The skin at the point of friction becomes red and irritated. Lymphatic fluid flows to the friction site gathering between the layers of skin to protect the area like a small balloon, eventually forming a bubble of fluid known as a blister. Blisters can also occur when your socks, boots or shoes get wet from the rain, snow, or a stream crossing. Blister Prevention The key to preventing blisters is to eliminate friction. Shoes and boots should be well broken in and you should make an effort to keep your socks as dry as possible by changing them when your feet get hot and sweaty or by taking your shoes or boots off periodically to let your feet and socks dry out when you take a snack break. If this means bringing along one or two extra pairs of socks, it may be well worth a few more ounces of pack weight. If you expect to do a lot of stream crossings you should consider bringing along a pair of sandals or crocs to wear instead of your boots to keep them dry. Bringing along a pair of camp shoes also gives your boots and socks an opportunity to dry for a longer period of time before you need to put them back on again. Conditions permitting, you may also want to re-evaluate a preference for leather hiking boots. Ultralight hikers who wear lightweight boots, running shoes or even sandals may experience fewer blisters because their footwear dries more quickly when it gets wet. Gore-Tex lined leather boots, on the other hand, can take days to dry out completely. Other effective ways to reduce friction include applying petroleum jelly to a hot spot or sprinkling foot powder or corn starch on your feet to prevent moisture buildup. If you feel a hot spot forming on your feet, you should stop to inspect it immediately and apply moleskin or tape to prevent it from turning into a blister later in the day. Some hikers also prefer wearing two sock layers, a liner which absorbs moisture and can be changed frequently, and a heavier outer sock. This moves the site of friction between the socks, away from your skin and a sock. Blister Treatment Blisters come in different shapes and sizes. The first stage in determining how to treat a blister is to assess it. Broken blisters that are leaking fluid should be disinfected and bandaged. Unbroken blisters that are painful should be pricked with a sterile needle and drained. These will heal by themselves and will be reabsorbed in a few days. If a blister has broken, it should be cleaned, disinfected and then bandaged. You can disinfect the would by irrigating it with chlorinated water, wiping it with an alcohol swab, or rubbing it with a dab of Purell. If the skin over the blister is ragged and dirty it should be carefully cut off. Otherwise it should be left intact to prevent infection. Before bandaging the wound, an antibiotic ointment should be applied. Research has shown that the application of Neosporin or triple antibiotic gel will kill off infecting bacteria after two applications and accelerate the healing process. Unbroken blisters that are painful should be drained. This is caused by the build up of fluid in the blister, so removing it will help relieve the pain. First swab the blister with alcohol to disinfect the area. Then, using your fingers, push the fluid to one side of the blister. Prick the side with the fluid using a needle that has been sterilized by alcohol, a lighted match or in boiling water. The needle should prick the blister horizontally at the point where the blister begins to rise above the skin. Leave the skin overlying the blister in place to prevent infection. Apply antibiotic gel to the site of the needle pricks and cover with a bandage. For small blisters, cover the entire blister with an adhesive bandage. For larger blisters cover the entire blister with a porous, plastic-coated gauze pad that will absorb any further drainage and allows the blister to breath and dry out. If the bandages get wet, reapply the antibiotic ointment and redress the blisters. After a few days, the skin under the blister should have healed and you can cut away the remaining dead skin. Other Folk Remedies If you hang around long distance hikers and backpackers long Page 3

4 enough, someone will suggest using Superglue to help heal a blister or make it possible to keep walking with one. This suggestion is actually a lot less far-fetched than it sounds. Superglue is widely used by surgeons to bond together organs or parts of the body that respond poorly to stitches. It is also effective in closing skin shears like cracked calluses where the sides of a wound must be bonded to accelerate healing. Superglue can be used to treat blisters by squirting it between top of a popped blister and the skin beneath it. This bonds the roof of the blister to the underlying skin reducing the risk of infection and creating a hardened shell over the blister site. The downside of this technique is that the solvents in the Superglue will hurt like hell when they are applied to the wound. To be on the safe side, make sure that you have sterilized the blister with alcohol before applying Superglue to it. Tincture of Benzoin is another bonding agent that can be also be used to seal the roof of the blister to the exposed skin underneath. It already contains alcohol, so a separate application is unnecessary. Page 4

5 Chapter 3 : The High Altitude Medicine Guide Medicine for Mountaineering & Other Wilderness Activities has 87 ratings and 7 reviews. Mike said: This *very dense* book tells of everything, and I mean. Treatment Early diagnosis is important. Acute mountain sickness is easier to treat in the early stages. The main treatment for all forms of mountain sickness is to climb down descend to a lower altitude as rapidly and safely as possible. You should not continue climbing if you develop symptoms. Extra oxygen should be given, if available. People with severe mountain sickness may need to be admitted to a hospital. A medicine called acetazolamide Diamox may be given to help you breathe better. It can help reduce symptoms. This medicine can make you urinate more often. Make sure you drink plenty of fluids and avoid alcohol when taking this drug. This medicine works best when taken before reaching a high altitude. If you have fluid in your lungs pulmonary edema, treatment may include: Oxygen A high blood pressure medicine called nifedipine Beta agonist inhalers to open the airways Breathing machine in severe cases Medicine to increase blood flow to the lungs called phosphodiesterase inhibitor such as sildenafil Dexamethasone Decadron may help reduce acute mountain sickness symptoms and swelling in the brain cerebral edema. Portable hyperbaric chambers allow hikers to simulate conditions at lower altitudes without actually moving from their location on the mountain. These devices are very helpful if bad weather or other factors make climbing down the mountain impossible. Outlook Prognosis Most cases are mild. Symptoms improve quickly when you climb down the mountain to a lower altitude. Severe cases may result in death due to lung problems or brain swelling, called cerebral edema. In remote locations, emergency evacuation may not be possible, or treatment may be delayed. The outlook depends on the rate of descent once symptoms begin. Possible Complications Coma unresponsiveness Fluid in the lungs pulmonary edema Swelling of the brain cerebral edema, which can lead to seizures, mental changes, or permanent damage to the nervous system Death When to Contact a Medical Professional Call your provider if you have or had symptoms of acute mountain sickness, even if you felt better when you returned to a lower altitude. Call or your local emergency number if you or another climber have any of the following symptoms: Page 5

6 Chapter 4 : Acute mountain sickness: MedlinePlus Medical Encyclopedia Sports Medicine Outdoor medical emergencies A classic since, this updated handbook covers mountaineering medical emergencies in the back country. 80 illustrations. Anti-inflammatory[ edit ] Dexamethasone is used to treat many inflammatory and autoimmune conditions, such as rheumatoid arthritis and bronchospasm. It is unclear whether dexamethasone in this condition is significantly better than other glucocorticoids. Dexamethasone is commonly given as a treatment for croup in children, as a single dose can reduce the swelling of the airway to improve breathing and reduce discomfort. It is useful to counteract allergic anaphylactic shock, if given in high doses. It is present in certain eye drops â particularly after eye surgery â and as a nasal spray trade name Dexacort, and certain ear drops Sofradex, when combined with an antibiotic and an antifungal. Dexamethasone intravitreal steroid implants trade name Ozurdex have been approved by the FDA to treat ocular conditions such as diabetic macular edema, central retinal vein occlusion, and uveitis. The steroid is released into the myocardium as soon as the screw is extended and can play a significant role in minimizing the acute pacing threshold due to the reduction of inflammatory response. The typical quantity present in a lead tip is less than 1. Dexamethasone may be administered before antibiotics in cases of bacterial meningitis. It acts to reduce the inflammatory response of the body to the bacteria killed by the antibiotics bacterial death releases proinflammatory mediators that can cause a response which is harmful, thus reducing hearing loss and neurological damage. Dexamethasone can increase the antiemetic effect of 5-HT3 receptor antagonists, such as ondansetron. It is also given in cord compression, where a tumor is compressing the spinal cord. Endocrine[ edit ] Dexamethasone is the treatment for the very rare disorder of glucocorticoid resistance. It can be used in congenital adrenal hyperplasia in older adolescents and adults to suppress ACTH production. It is typically given at night. This has been associated with low birth weight, although not with increased rates of neonatal death. CAH causes a variety of physical abnormalities, notably ambiguous genitalia. Early prenatal CAH treatment has been shown to reduce some CAH symptoms, but it does not treat the underlying congenital disorder. This use is controversial: It is commonly carried on mountain-climbing expeditions to help climbers deal with complications of altitude sickness. Page 6

7 Chapter 5 : Mountain Medicine â UIAA Medicine for Mountaineering 6th Edition by James Wilkerson. The best-selling backcountry medical guide of its kind * Featuring new chapters on avalanche injuries, drowning, eye disorders, medical evacuations, and lightning. For example, you may experience confusion as a result of brain swelling. You may also suffer from shortness of breath due to fluid in the lungs. Symptoms of severe altitude sickness may include: The condition is much easier to treat if you address it before it progresses. Your risk of experiencing acute mountain sickness is greater if you live by or near the sea and are unaccustomed to higher altitudes. Other risk factors include: How is acute mountain sickness diagnosed? Your doctor will ask you to describe your symptoms, activities, and recent travels. During the exam, your doctor will most likely use a stethoscope to listen for fluid in your lungs. To pinpoint the severity of the condition, your doctor may also order a chest X-ray. How is acute mountain sickness treated? Treatment for acute mountain sickness varies depending on its severity. You might be able to avoid complications by simply returning to a lower altitude. Hospitalization is necessary if your doctor determines that you have brain swelling or fluid in your lungs. You may receive oxygen if you have breathing issues. Medications Medications for altitude sickness include: You can take some important preventive steps to reduce your chances of acute mountain sickness. Get a physical to make sure you have no serious health issues. Review the symptoms of mountain sickness so you can recognize and treat them quickly if they occur. Taking it the day before you climb and on the first day or two of your trip can lessen your symptoms. When climbing to higher altitudes, here are some tips that can help you avoid developing acute mountain sickness: Most people are able to recover from a mild case of acute mountain sickness quickly after returning to lower altitudes. Symptoms typically subside within hours, but may last up to two days. However, if your condition is severe and you have little access to treatment, complications can lead to swelling in the brain and lungs, resulting in coma or death. Page 7

8 Chapter 6 : Medicine for Mountaineering 6th edition Wilderness Medicine Outfitters Medicine for Mountaineering exemplifies a fine job of editing by Dr. Wilkerson, who has managed the offerings of numerous contributors on diverse subjects in a remarkably cohesive fashion. The book is divided into three sections, in addition to a very readable introduction and informative appendices. Edited by James A. The Mountaineers, Seattle, Washington, It is unusual for the layman to find books on how to recognize and manage medical problems, let alone books that instruct people about how to handle esoteric medical problems in a remote setting with little or no access to modern-day medical infrastructure. Medicine for Mountaineering exemplifies a fine job of editing by Dr. Wilkerson, who has managed the offerings of numerous contributors on diverse subjects in a remarkably cohesive fashion. The book is divided into three sections, in addition to a very readable introduction and informative appendices. The first section is devoted to the principles of medical diagnosis and management and serves as a well written primer for the uninitiated. It includes a detailed discussion on the all important aspects of sanitation and water purification. However, by suggesting that in underdeveloped countries, bottled, carbonated drinks are safe to drink, it fails to recognize a source of gastrointestinal misery for many a mountaineer: The second section is a short text upon the management of numerous traumatic and non-traumatic ailments. The line drawings accompanying the text are very useful. The authors have resisted the temptation of using medical jargon and instead they have painstakingly explained signs and symptoms with the layman in mind. This otherwise well-written section, however, did have its share of blemishes. It does not recognize that differences of opinion do exist about some of its statements and recommendations. Additionally, it was surprising that this section does not include guidelines to distinguish bacillary from amoebic dysentery, since these disorders are not uncommon in many mountainous regions of the world. The final section is one that the wilderness enthusiast and mountaineer will find especially interesting and pertinent. This section has been developed by top-notch contributors to the field and reading it before going off on an expedition should be de rigueur. The chapter on altitude sickness does a good job by including both the patho-physiological considerations of high altitude disorders and some case studies from lower elevations. This section is quite comprehensive and includes some recent advances in the management of altitude sickness such as Nifedipine and portable hyperbaric chambers. Hopefully the next edition will include a discussion of the recently described syndrome of subacute mountain sickness, which is a surprising omission. Taken together, this section should adequately drive home the need to acclimatize and thus avoid many of these problems. Tejvir Singh Khurana, M. Please contact us if you spot an error. Page 8

9 Chapter 7 : Mountain Medicines - The Travel Doctor Medicine for Mountaineering & Other Wilderness Activities, 6th Edition picks up where other first aid manuals leave off. Written by a team of climber-physicians, this fully updated edition of a classic provides expert information as well as procedures on major and minor medical emergencies. Blister treatment for hikers is serious business. Your feet are your ticket onto the trail. Or hiking in a sub-optimal hobble. Read this for prevention strategies, which is the smartest approach to guarding your trail time. Instead, be the hiker who whips out a well stocked blister treatment kit. Blister treatment supplies to carry Your blister treatment supplies should be kept together in a water repellent, lightweight but durable bag. A blister kit also requires lightweight scissors and tweezers, although these might already be in your simple first aid kit. If not, stash them in this kit. Also in your bag should be some sort of material to prevent further friction, along with something to deal with discomfort. Note that moleskin provides a way to cut down on the rubbing from your boots, so take the time to carefully craft your custom shaped moleskin. To step things up a notch in terms of combating blister pain, try this system of GlacierGel dressings: And to combine the magic of Glacier Gel with the physical barrier of moleskin, get this kit. It includes alcohol prep pads and antiseptic towelettes to ward off infection from trail dirt stings like the dickens but cuts down on a chance of infection. These items should be in your kit, regardless of which approach you go with. To pop a blister, There are pros and cons to popping a blister. As you ponder whether or not to pop your hiking blister, consider: Will popping it increase the pain level? Wash or sanitize your hands, and the blistered area, before you begin. Put the blistered foot on a clean surface such as an unused hiking shirt. Use your alcohol wipes, or soap and water, to clean the area. Act quickly and methodically to decrease the amount of time the blister is exposed to the air which decreases the pain level. If your immune system is in question due to age, medical conditions, or prescription medications, consider applying a topical antibiotic. Trail dirt can have any number of microbes lurking within. Why a blister forms Just so you know, the devilish triad of blister formation is heat - friction - moisture. But whatever you do Why treat a blister when you can prevent it? A few trail tips: Stop immediately if you sense pressure, heat or discomfort anywhere on your feet. If your toes feel extremely hot, squashed or uncomfortable, try loosening your laces. Or consider a different boot lacing strategy. Or makes things worse. If your heel is developing a red, hot area, get moleskin or duct tape on it right away before it deepens. You do NOT want to hike back to the trail head in escalating pain, so take the time to do a good job preventing additional friction. Your blisters will slow down everyone sooner or later if they are not dealt with pro-actively and protectively. So step off the trail, get out your treatment kit, and take care of your precious feet. And use these hiking foot care tips to make sure your feet stay in top shape all season long. Page 9

10 Chapter 8 : MEDICINE FOR MOUNTAINEERING Wilkerson New edition (Wilkerson, Dr. J.) :: Chessler Boo Note: Citations are based on reference standards. However, formatting rules can vary widely between applications and fields of interest or study. The specific requirements or preferences of your reviewing publisher, classroom teacher, institution or organization should be applied. Acute mountain sickness is caused by a lack of oxygen in the body of individuals exposed to higher elevations. This usually occurs when they travel to an altitude over 10, feet 3, metres without proper acclimatisation before engaging in physical activities. Mountain climbers, trekkers, skiers, and travellers to the Andes or Himalayas etc. While individual tolerance varies, symptoms usually appear within several hours of ascending, with those in poor physical condition being most susceptible. Headache, fatigue, shortness of breath, nausea, and poor appetite occur initially. Inability to sleep is also frequently reported. In more severe cases thinking and judgement may become impaired. Once the symptoms begin to occur, they usually subside over several days without treatment provided there has been adequate time for acclimatisation. However, if they worsen, they can be relieved with the administration of oxygen or descent to a lower altitude. This is the most tried and tested drug for altitude sickness prevention and treatment. Unlike dexamethasone below this drug does not mask the symptoms but actually treats the problem. It works by increasing the amount of alkali bicarbonate excreted in the urine, making the blood more acidic. Acidifying the blood drives the ventilation process, which is the cornerstone of acclimatization. For prevention, one mg tablet should be taken daily starting one or two days before and continuing for three days once the highest altitude is reached. Blood concentrations of acetazolamide peak between one to four hours after administration of the tablets. It may therefore, be better to take mg half a tablet twice daily. Gradual ascent is always desirable to try to avoid acute mountain sickness even when acetazolamide is being taken. Pulmonary function is greater both in subjects with mild AMS and asymptomatic subjects. The treated climbers also had less difficulty in sleeping. However, gradual ascent is always desirable to try to avoid acute mountain sickness but if rapid ascent is undertaken and actazolamide is used, it should be noted that such use does not obviate the need for a prompt descent if severe forms of high altitude sickness occur, i. Side effects of acetazolamide include: On most treks, gradual ascent is possible and prophylaxis tends to be discouraged. Certainly if trekkers do develop headache and nausea or the other symptoms of AMS, then treatment with acetazolamide is fine. The treatment dosage is mg twice a day for about three days. The dosage is 4 mg three times per day, and obvious improvement usually occurs within about six hours. It can be a good "emergency drug" since it "buys time" especially at night when it may be problematic to descend. Descent should be carried out as soon as possible the next day. It is unwise to ascend while taking dexamethasone: Dexamethasone can be highly effective: Many pilgrims at the annual festival at Gosainkunda lake in Nepal suffer from HACO following a rapid rate of ascent, and respond remarkably well to dexamethasone. Mountain climbers also sometimes carry this drug to prevent or treat AMS. However, it needs to be used cautiously. It has been known to cause stomach irritation, euphoria or depression. It may be a good idea to pack this drug for a high altitude trek for emergency usage in the event of HACO. In people allergic to and therefore unable to take acteazolamide, dexamethasone can also be used for prevention: A new study shows that Ibuprofen alleviates altitude sickness: A study published in in the Annals of Emergency Medicine by Dr. Grant Lipan, a professor of emergency medicine at Stanford University School of Medicine and a climber, recommends that taking a few ibuprofen tablets can prevent and alleviate the symptoms of AMS. Prior to the study, recommended medications for acute mountain sickness AMS included dexamethasone and acetazolamide or Diamox, a prescription-only drug. Now add ibuprofen to the list of altitude cures. Ibuprofen has lots of plusses; it is fast-acting, cheap, readily available, and quickly absorbed by the body. Ibuprofen Decreases Brain Swelling: As we ascend to higher altitudes, our bodies adjust to decreased oxygen in the air and reduction in air pressure, which leads to a swelling of the brain in some climbers. This allows fluid to build up in the brain, putting pressure on cranial nerves and causing headaches, dizziness, and the other symptoms of altitude sickness. Ibuprofen, an anti-flammatory drug, decreases the swelling, lowering the risk of headaches and helping the body to adjust to an oxygen-deprived environment. Page 10

11 Take Ibuprofen before climbing high: Lipman recommends taking mg as three mg ibuprofen tablets, several hours before climbing to a higher elevation. He notes that climbers should then take 24 hours off the drug to allow the body to adjust and acclimatize to the new higher altitude. Ibuprofen allows climbers and other altitude junkies to get past the initial period that causes AMS and helps the body to adjust to decrease the symptoms. This drug is normally used to treat high blood pressure and angina, but also seems able to decrease the narrowing in the pulmonary artery pulmonary vasodilation resolving the pulmonary hypertension responsible for the high pressure leak in the lungs caused by low oxygen levels, thereby improving oxygen transfer. Oxygen saturations gusually improve slightly after administration of nifedipine. The dosage is 20 mg of long acting nifedipine, six hourly. Nifedipine can cause postural hypotension; a sudden lowering of blood pressure so the patient has to be warned to get up slowly from a sitting or reclining position. It has also been used in the same dosage to prevent HAPO in people with a past history of this disease. However, Frusemide can also lead to collapse from low volume shock if the victim is already dehydrated. Usage of frusemide without medical supervision is not routinely recommended. The treatment dosage is mg daily. Obtain Diamox Acetazolamide for altitude sickness, forced acclimatisation and altitude sleep disturbance - Medicine on an NHS prescription from a pharmacy. Chapter 9 : Medicine for Mountaineering & Other Wilderness Activities by James A. Wilkerson I was an EMT until recently and a mountaineer going on 30 years. I was asked to do some research on first aid and wilderness medicine. Of the ten or so books I reviewed this one was the most authoritative and most complete. Page 11