Tibet, the city closest to heaven, gathers too many dreamers. After a long journey, not only for the sincere faith, but also for the vast shock and the frankness of the moment. There are no words to enter Tibet, and it is beautiful to be quiet.
However, entering Tibet is not an easy task.
High altitude, lack of oxygen, strong ultraviolet rays, large temperature differences, dietary discomfort, usually require good physical fitness. In addition, it is the high reaction that everyone is most worried about.
This is a big question to take seriously, what if it arises?
Image source: Stand Cool Helo
First, what is high reaction?
Altitude Sickness, also known as Altitude Sickness, is also known as Mountain Sickness. Since most hyperinflex occurs in tourist or other rapidly entering plateau populations, staying on the plateau for a short period of time (no more than 1 month), we all fall into the acute category of common hyper-reflex classification, so it is also called acute altitude sickness or acute altitude disease (Acute Mountain Sickness, AMS or Acute High Altitude Disease, AHAD).
Isn't it messy? Don't worry, this is because we found that the domestic and foreign statements are also inconsistent during the search process, so we listed them here so that everyone can quickly understand them the next time they encounter. Without doing detailed academic research, without considering translation habits, and simply focusing on tourism safety science, we can simply understand that there are many names of high reaction (altitude sickness, altitude sickness, altitude sickness, alpine disease, acute altitude sickness, acute altitude sickness, acute altitude sickness, acute mountain sickness), which is actually a problem.
Hyper-reaction refers to various pathological reactions that occur after entering the plateau area and exposing the human body to a hypoxic environment for a short period of time [1].
Second, what problems will occur with high reaction?
In most cases, hyperversion symptoms are mild.
Mild to moderate: dizziness or headache, insomnia, fatigue, loss of appetite, nausea or vomiting, tachycardia, shortness of effort, etc.; the most common of these is headache, especially a jumping pain in the forehead and temporal area.
Severe cyanosis (bluish-purple changes in the skin, etc.), chest tightness, coughing or even coughing up blood, drowsiness or decreased consciousness, inability to walk in a straight line or at all, at this time the obvious symptom is an increase in respiratory rate at rest, more than 25 breaths per minute (16-20 beats/minute in normal adults).
More severe cases can lead to high-altitude pulmonary edema and high-altitude cerebral edema, which are life-threatening.
High reaction occurs more often when entering the altitude of 3000 or more, the symptoms are most obvious on the 1st to 2nd day, and then gradually reduce, most of them basically disappear in 6-7 days, and a few can persist. The incidence is about 50% to 75%, with older adults occurring less frequently than among young people and women less than in men [2].
Third, why is there a high reaction?
The occurrence of high reaction is related to the speed of going up the mountain, altitude, living time and physique.
Under normal circumstances, due to the thin air in high altitude areas, the partial pressure of oxygen in the atmosphere is reduced, and the partial pressure of oxygen in the alveoli is also reduced, which directly affects the alveolar gas exchange, blood oxygen transport and the release rate of oxygenated hemoglobin in the tissue, resulting in insufficient oxygen supply and hypoxia.
In addition, the altitude rises too quickly, and the human body does not have enough time to adapt to changes in air pressure and oxygen content, which will obviously lead to low pressure and lack of oxygen, so that oxygen cannot be effectively transported to all parts of the body.
When the body is in a significantly hypoxic state, the body will automatically activate the circulatory system function to compensate for the supply of oxygen, such as mild to moderate hyperversion symptoms such as accelerated heart rate and accelerated breathing; when hypoxia affects most organs or the central nervous system, especially the brain, severe hyperversion [2][4].
In addition, the degree of activity after entering the plateau (excessive excitement at the time of tourism arrival), labor intensity, mental state (depressed mood), nutrition (dietary incompatibility), low humidity, infection, etc. are also factors that induce high reaction.
In short, in general, the higher the altitude, the faster the climb, the more exercise, the greater the likelihood of high reaction.
4. What should I do if I appear? How can it be prevented?
The main treatment for all forms of hyperreflexia is to return to a lower altitude as quickly and safely as possible[2][3][5].
If symptoms are mild, self-healing can be adjusted with rest. If mild to moderate symptoms occur, headaches, gastrointestinal discomfort, etc. can be treated symptomatically, and care should not continue to climb or stay, if there is a serious high reaction, it may be necessary to call for help or hospitalization immediately.
Regarding prevention, there may be many opinions, we consult evidence-based information, can currently recommend to everyone, and scientific rigor is the following 4 common methods:
1. Conduct a comprehensive physical examination before entering the plateau area, and those without contraindications adopt the principle of step-by-step and gradient stationing, and those who have just entered the plateau should strengthen adaptive training [5][6].
2. Stay comfortable on the road [7]. After arriving, pay attention to eating and resting, do not be too excited and anxious to move, pay attention to keep warm, and avoid colds such as bathing.
3. It is recommended to prepare the drug.
Acetazolamide [8], prophylactic use reduces hyperversion and accelerates adaptation;
Dexamethasone [9], a glucocorticoid, helps reduce the possibility of brain swelling and improves the body's ability to resist hypoxia;
Furosemide [10], a diuretic, for the treatment of hyperreflective cerebral edema;
Ibuprofen [11], a nonsteroidal antipyretic analgesic and anti-inflammatory drug, has antipyretic, analgesic, and anti-inflammatory effects.
Compound salvia drop pills [12] are effective in preventing decreased oxygen saturation and accelerated altitude heart rate due to high altitude hypoxia.
In addition, Rhodiola Rosea [4][13], Chinese medicine, do not discuss much, the reminder is to take 15 days in advance.
4. Carry oxygen. Oxygen therapy when chest tightness and asthma are pronounced can significantly relieve hyperversion [2][5].
Finally, I wish you a happy and safe return.
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【2】 Imray C, Wright A, Subudhi A. Acute mountain sickness: pathophysiology, prevention, and treatment. Prog Cardiovasc Dis. 2010. 52(6): 467-484.
【3】Acute mountain sickness. U.S. National Library of Medicine. https://medlineplus.gov/ency/article/000133.htm.
[4] Yang Yan, Ma Huiping, Jia Zhengping. Research progress on the pathogenesis of acute altitude sickness. Medical Review. 2010. 17: 2561-2563.
[5] ZHANG Hongzeng. Diagnosis and treatment of acute altitude sickness. Chinese General Practice. 2005. 8(9): 761-762.
[6] Hong Li, Shen Baode, Yuan Hailong. Research advances in anti-altitude sickness drugs. Evaluation and Analysis of Drug Use in Chinese Hospitals. 2021. 1: 125-128.
[7] Gao Cunyou, Gan Jingli, Wang Lijie. Effects of psychobehavioral factors on acute altitude sickness status of emergency altitude relief officers. Chinese Journal of Behavioral Medicine and Brain Science. 2011. 7: 644-646.
【8】Pin-Hsi Hung, Fang-Chi Lin,Shi-Chuan Chang. The usefulness of prophylactic use of acetazolamide in subjects with acute mountain sickness. J Chin Med Assoc. 2019. 82(2): 126-132.
【9】NJ Johnson, AM Luks. High-Altitude Medicine. Medical Clinics of North America.2016. 100(2): 357-369.
【10】Laura Carone BMedSci, Stephen G.Oxberry, AndrewWilcockDM, FRC. Furosemide. Journal of Pain and Symptom Management. 2016. 52(1): 144-150.
【11】G Aksel, EK Orbacolu, C Zen . High-altitude illness: Management approach. Turkish Journal of Emergency Medicine. 2019. 19(4): 121-126．
[12] LIU Li, ZHANG Xian. Effects of compound salvia drop pills combined with trimetazide on blood oxygen saturation and heart rate of medical team members after entering the plateau. Northwest Journal of Defense Medicine. 2017. 38(4): 215-219.
[13] Wang Yongxin, Zhan Hao, Xin Yimei. Study on the anti-hypoxia effect of rhodiola complexa. Chinese Journal of Experimental Pharmacology. 2010. 15: 152-153.
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