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High-altitude encephalopathy appears to be an extension of the central nervous system symptoms of AMS and results from cerebral vasogenic edema It usually occurs at elevations above 2500 meters (8250 feet) and is more common in unacclimatized individuals Clinical findings are due largely to hypoxemia and cerebral edema Hallmarks are altered consciousness and ataxic gait; the patient appears mildly drunk Severe headaches, confusion, truncal ataxia, urinary retention or incontinence, focal deficits, papilledema, nausea, vomiting, and seizures may also occur and progress to obtundation and coma Highaltitude retinopathy is a separate but related effect of altitude It can include dilated vessels, retinal hemorrhage, vitreous hemorrhage, and papilledema Treatment is immediate descent for at least 610 meters (2000 feet), continuing until symptoms improve One-hundred percent oxygen (2 4 L/min) should be administered by mask Dexamethasone, 4 8 mg orally every 6 hours, is recommended thereafter If immediate descent is impossible, a portable hyperbaric chamber should be used until symptomatic improvement occurs

The medical safety of air travel depends not only on the nature and severity of the traveler s illness but also on such

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factors as the duration of flight, pressurization, the availability of supplementary oxygen and other medical supplies, the presence of health care professionals, and other special considerations Airline policies, charges, and other details regarding on-board oxygen and medical supplies must be checked with each carrier The medical hazard most likely to be realized is hypoxia The most common in-flight emergencies are cardiovascular, respiratory, syncopal, neuropsychiatric, metabolic, and substance related The Air Transport Association of America defines an incapacitated passenger as one who is suffering from a physical or mental disability and who, because of such disability or the effect of the flight on the disability, is incapable of self-care; would endanger the health or safety of such person or other passengers or airline employees; or would cause discomfort or annoyance of other passengers Pretravel clinician evaluation is advisable for patients with hospitalization, surgery, chronic disease, emergency care, or substantive medication change within the past 4 weeks Patients subject to motion sickness can be given sedatives or antihistamines (eg, dimenhydrinate, 50 mg orally every 4 6 hours; promethazine, 25 mg orally every 6 hours; or meclizine, 25 50 mg orally every 24 hours) before and during the flight Small meals of easily digested food before and during the flight may reduce the tendency to nausea and vomiting Table 37 1 lists the more common contraindications to air travel

Exercise 9-1. You ll use the following program for this exercise. Either type it into Visual Studio, or copy it from this book s website. Note that this is spaghetti code you d never write method calls like this, but that s why this is the debugging chapter.

Congestive heart failure1 Uncomplicated myocardial infarction within 3 weeks; complicated myocardial infarction within 6 weeks Post CABG within 2 weeks CVA within 2 weeks Uncontrolled hypertension Uncontrolled ventricular or supraventricular tachycardia Severe symptomatic valvular heart disease New or unstable angina Deep venous thrombosis unless the person is stable, receiving anticoagulant therapy, and has no pulmonary complications2 Nasal congestion unresponsive to therapy Pulmonary cysts Pneumothorax Active communicable tuberculosis or other communicable virulent infection (eg, measles, chickenpox) Breathlessness or hypoxemia Anemia (hemoglobin < 85 g/dL), sickle cell disease Postsurgery (eye, thorax, abdomen) within 2 3 weeks unless surgeon approves Emotionally unstable, agitated, or psychotic Pregnancy unless low risk, without complications, and less than 8 months

Pregnant women may be permitted to fly during the first 8 months of pregnancy unless there is a history of complications of pregnancy or premature birth During the ninth month of pregnancy, air travel is not recommended; if travel is essential, a physician s authorization is required Infants less than 1 week old should not be flown at high altitudes or for long distances

DeHart RL Health issues of air travel Annu Rev Public Health 2003;24:133 51 [PMID: 12428033]

using using using using System; System.Collections.Generic; System.Linq; System.Text;

Oxygen should be made available for persons with cardiovascular, respiratory, or hematologic illness 2 Susceptible patients should wear support hose, perform leg exercises, and walk during flight Preflight low-molecular-weight heparin may also be indicated CABG, coronary artery bypass grafting; CVA, cerebrovascular accident

Gallus AS Travel, venous thromboembolism, and thrombophilia Semin Thromb Hemost 2005 Feb;31(1):90 6 [PMID: 15706480] Hovens MM et al Aspirin in the prevention and treatment of venous thromboembolism J Thromb Haemost 2006 Jul;4 (7):1470 5 [PMID: 16839339] Low JA et al Air travel in older people Age Ageing 2002 Jan;31 (1):17 22 [PMID: 11850303]

Clean Active Target (Shift-Command-K) Invokes the clean command, deleting any intermediate files from the project folder (including object and executable files). This command is like the UNIX make clean command.

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