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drowsiness, dizziness, chilliness, nausea and vomiting, facial pallor, dyspnea, and cyanosis Later, there is facial flushing, irritability, difficulty in concentrating, vertigo, tinnitus, visual disturbances, auditory disturbances, anorexia, insomnia, increased dyspnea and weakness on exertion, increased headaches (due to cerebral edema), palpitations, tachycardia, Cheyne-Stokes breathing, and weight loss More severe manifestations include pulmonary edema and encephalopathy (see below) Voluntary periodic hyperventilation may relieve symptoms In most individuals, symptoms clear within 24 48 hours, but in some instances, if the symptoms are sufficiently persistent or severe, the patient must be returned to lower altitudes Definitive treatment is immediate descent, which is essential if reduced consciousness, ataxia, or pulmonary edema occurs Administration of oxygen, 1 2 L/min, will often relieve acute symptoms If immediate descent is not possible, portable hyperbaric chambers can provide symptomatic relief depending on altitude and severity Acetazolamide, 250 mg orally every 8 12 hours, or dexamethasone, 8 mg orally initially followed by 4 mg every 6 hours, for as long as symptoms persist, is recommended therapy; they may be used together in severe cases Preventive measures include slow ascent 300 meters (984 feet) per day adequate rest and sleep the day before travel, reduced food intake, and avoidance of alcohol, tobacco, and unnecessary physical activity during travel Acetazolamide, 250 mg orally every 8 12 hours, beginning the day before ascent and continuing for 48 72 hours at altitude, may be used as prophylaxis Dexamethasone, 4 mg orally every 12 hours beginning on the day of ascent, continuing for 3 days at the higher altitude, and then tapering over 5 days, is an alternative

Five manifestations of altitude illness are (1) acute mountain sickness, (2) high-altitude pulmonary edema, (3) high-altitude encephalopathy, (4) subacute mountain sickness, and (5) chronic mountain sickness (Monge s disease)

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This serious complication usually occurs at levels above 3000 meters (9840 feet) Early symptoms may appear within 6 36 hours after arrival at a high-altitude area: incessant dry cough, shortness of breath disproportionate to exertion, headache, decreased exercise performance, fatigue, dyspnea at rest, and chest tightness Later, wheezing, orthopnea, and hemoptysis may occur Recognition of the early symptoms may enable the patient to descend before incapacitating pulmonary edema develops, but strenuous exertion should be avoided An early descent of even 500 or 1000 meters may result in improvement of symptoms Physical findings include tachycardia, mild fever, tachypnea, cyanosis, prolonged respiration, and rales and rhonchi The patient may become confused or comatose, and the clinical picture may resemble severe pneumonia The white count is often slightly elevated, but the erythrocyte sedimentation rate is usually normal Chest radiographic findings vary from irregular patchy infiltration in one lung to nodular densities bilaterally or with transient prominence of the central pulmonary arteries Transient nonspecific ECG changes, occasionally showing right ventricular strain, may occur Pulmonary arterial blood pressure is elevated, whereas wedge pressure is normal Treatment, which must often be given under field conditions, consists of rest in the semi-Fowler position (head raised) and administration of 100% oxygen by mask

The Call Stack window shows you the method that called your currently executing method, and the method that invoked that method, and so forth, so that you can see how you arrived at the currently executing method. We hope that at this point, you re comfortable enough with Visual Studio s various debugging tools that you ll have an increased sense of confidence as you approach the rest of the chapters in this book. The tools won t prevent you from making mistakes, because that is normal and is nothing to worry about. They will help you find those mistakes more quickly, and get you back on your way. Before we get back into the intensively object-oriented content, there s one more piece of the puzzle that you should know about. Up to this point, you ve written programs that dealt with just one object at a time. That s about to change. The next chapter deals with arrays, which are a way to handle a group of similar objects as though they were one object.

Lack of sufficient time for acclimatization, increased physical activity, and varying degrees of health may be responsible for the acute, subacute, and chronic disturbances that result from (hypobaric) hypoxia at altitudes greater than 2000 meters (6560 feet) Acclimatization to altitudes above 5500 m (18,045 ft) is incomplete or physiologically impossible, although individual differences in tolerance to hypoxia exist Altitude exacerbated conditions include cardiac and pulmonary dysfunction and disease, sickle cell, high-risk pregnancy, radial keratotomy, and others

The severity of acute mountain sickness (AMS) correlates with altitude and rate of ascent Initial manifestations include headache (most severe and persistent symptom), lassitude,

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