Travel Reference
In-Depth Information
Increasing evidence suggests that even a mild upper respiratory infection increases the
risk of HAPE.
Pleurisy
Pleurisy is pain that is worsened by inspiration and is caused by inflammation of the
thin membranes that cover the lungs and the inner surface of the chest wall. Pleurisy may
occur with pneumonia, injury to the chest wall, collapse of the lung (pneumothorax), or
pulmonary embolism. The principal symptom is pain with respiration. The pain usually is
sharp and stabbing and limited to an area on one side of the chest. Deep inspiration may
elicit a particularly severe twinge. Pleurisy may be particularly uncomfortable and painful
at altitude where respirations are more rapid and deeper than at sea level.
Physical signs are mild or absent. Motion of the affected side may be limited, and a few
wheezes or crackles may be heard over the involved area. Sometimes a leathery, rough,
rubbing sound can be heard over the area where pain is worst. This “friction rub” is dia-
gnostic of pleurisy but does not indicate its cause. The person may be more comfortable
when lying on the affected side, limiting the motion of that part of the chest.
The treatment of pleurisy is dictated by the underlying cause. If the fever is high, the
pulse rapid, or the person seems quite sick, pneumonia or embolism should be suspected.
Pneumonia requires antibiotic treatment, and both pneumonia and pulmonary embolism
dictate evacuation to a lower altitude. Recent trauma to the chest might suggest pneumo-
thorax or blood in the space between the chest wall and lung (hemothorax) as a cause of
pleurisy. Persistent pleuritic chest pain at extreme altitude can be caused by rib cartilages
torn by persistent coughing and can be disabling. Pleurisy caused by moderate trauma to
the chest wall, such as bruised or broken ribs without pneumothorax or hemothorax, may
be treated with analgesics. Taping or splinting the chest increases the risk of pneumonia or
collapse of part of the lung and is not recommended.
Pneumonia
Pneumoniaisaninfectionofthelungtissueinvolvingthealveoliandismostcommonly
caused by bacteria. Persons weakened by fatigue, exposure, or disease elsewhere in the
body are particularly susceptible. Infected fluid accumulates in the alveoli, and the ex-
change of carbon dioxide and oxygen is impaired. If a large amount of lung is involved,
low blood oxygen (hypoxia), combined with effects of toxic substances released from the
bacteria, may cause death. Pneumonia should always be taken seriously.
Anyonewithanytypeofpneumoniaisoxygendeficientabove8000feet(2400m).Sup-
plemental oxygenshouldbeadministered ifavailable, andindividuals shouldbeevacuated
to lower altitude as soon as possible.
The symptoms of pneumonia vary with the causative organisms and the severity of the
infection. Pneumonia usually causes fever with an oral temperature of more than 102°F
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