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at a rate of 4 6 L/min for 15 30 minutes Immediate descent (at least 610 meters [2000 feet]) is essential Recompression in a portable hyperbaric bag will temporarily reduce symptoms if rapid or immediate descent is not possible To conserve oxygen, lower flow rates (2 4 L/min) may be used until the victim recovers or can be evacuated to a lower altitude and SaO2 90% Treatment for acute respiratory distress syndrome (see 9) may be required for some patients who have a prolonged course of pulmonary edema Nifedipine, 10 mg initially followed by 30 mg slow-release tablets every 12 hours is recommended for symptomatic relief Dexamethasone, 4 mg every 6 hours, has been recommended if central nervous system symptoms are present Acetazolamide, 250 mg every 8 12 hours, should be administered if acute mountain sickness is suspected If bacterial pneumonia occurs, appropriate antibiotic therapy should be given Preventive measures include education of prospective mountaineers regarding the possibility of serious pulmonary edema, optimal physical conditioning before travel, gradual ascent to permit acclimatization, and a period of rest and inactivity for 1 2 days after arrival at high altitudes Salmeterol, 125 mcg by inhaler every 12 hours beginning 24 hours prior to ascent, has been shown to reduce the incidence of high-altitude pulmonary edema (HAPE) in susceptible patients Prompt medical attention with rest and high-flow oxygen if respiratory symptoms develop may prevent progression to frank pulmonary edema Persons with a history of HAPE should be hospitalized for further observation if possible Pulmonary embolism and high-altitude bronchitis can also occur Mountaineering parties at levels of 3000 meters (9840 feet) or higher should carry a supply of oxygen and equipment sufficient for several days Persons with symptomatic cardiac or pulmonary disease should avoid high altitudes

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This occurs most frequently in unacclimatized individuals and at altitudes above 4500 meters (14,764 feet) Symptoms dyspnea and cough are probably due to hypoxic pulmonary hypertension and secondary congestive heart failure There are additional problems of dehydration, skin dryness, and pruritus The hematocrit may be elevated, and there may be electrocardiographic and chest radiographic evidence of right ventricular hypertrophy Treatment consists of rest, oxygen administration, diuretics, and return to lower altitudes

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5 Chronic Mountain Sickness (Monge s Disease)

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Read or load a PDF file and extract its text content in C# and VB. NET application with GemBox.Document library.

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This uncommon condition, consisting of chronic hypoxia, polycythemia and, in some cases, pulmonary hypertension in residents of high-altitude communities who have lost their acclimatization to such an environment, is difficult to differentiate from chronic pulmonary disease The disorder is characterized by somnolence, mental depression, hypoxemia, cyanosis, clubbing of fingers, hemoglobin > 22 g/dL, polycythemia (hematocrit often > 75%), signs of right ventricular failure, electrocardiographic evidence of right axis deviation and right atrial and ventricular hypertrophy, and radiographic evidence of right heart enlargement and central pulmonary vessel prominence There is no radiographic evidence of structural pulmonary disease Pulmonary function tests usually disclose alveolar hypoventilation and elevated PaCO2 but fail to reveal defective oxygen transport There is a diminished respiratory response to CO2 Almost complete disappearance of all abnormalities eventually occurs when the patient returns to sea level Otherwise, phlebotomy, oxygen supplementation, respiratory training, medroxyprogesterone (20 60 mg/d orally for 10 weeks), acetazolamide (250 mg/d orally for 3 weeks) and enalapril (5 mg orally daily) have each been recommended for treatment

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Gallagher SA et al High-altitude illness Emerg Med Clin North Am 2004 May;22(2):329 55 [PMID: 15163571] Hackett PH et al High altitude cerebral edema High Alt Med Biol 2004 Summer;5(2):136 46 [PMID: 15265335] Leon-Velarde F et al Consensus statement on chronic and subacute high altitude diseases High Alt Med Biol 2005 Summer;6(2):147 57 [PMID: 16060849] Maloney JP et al Epidemiology, risk factors, and genetics of high-altitude-related pulmonary disease Clin Chest Med 2005 Sep;26(3):395 404, v [PMID: 16140134] Seto CK et al Environmental illness in athletes Clin Sports Med 2005 Jul;24(3):695 718, x [PMID: 16004926] Smith LO Alpine climbing: injuries and illness Phys Med Rehabil Clin N Am 2006 Aug;17(3):633 44 [PMID: 16952756]

how to read pdf file in asp.net using c#

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how to read pdf file in asp.net using c#

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