329.2 🩺 國考版

329.2.1 高頻考點

329.2.1.1 High Altitude Illness

  • AMS, HAPE, HACE

  • 2500m altitude

  • Acetazolamide for prevention + AMS treatment
  • Nifedipine + dexamethasone for HAPE / HACE
  • Descend is most important

329.2.1.2 AMS Diagnosis (Lake Louise)

  • Headache + 1 of (GI, fatigue, insomnia, dizziness)
  • Altitude > 2500m

329.2.1.3 HAPE Treatment

  • Descend
  • Oxygen
  • Nifedipine 30 mg ER BID (pulmonary vasodilator)
  • Sildenafil alternative
  • Portable hyperbaric chamber if descent delayed

329.2.1.4 HACE Treatment

  • Descend
  • Dexamethasone 4-8 mg q6h
  • Oxygen
  • Truncal ataxia is hallmark

329.2.1.5 Prevention

  • Gradual ascent 300-500 m/day
  • Acetazolamide 125-250 mg BID for prophylaxis
  • Dexamethasone for high-risk

329.2.1.6 Diving Emergencies

  • Decompression sickness: N2 bubble; 100% O2 + HBOT
  • Arterial gas embolism: pulmonary barotrauma; Trendelenburg + 100% O2 + HBOT
  • Pulmonary barotrauma: alveolar rupture; pneumothorax, pneumomediastinum

329.2.1.7 DCS vs AGE

  • DCS: minutes-hours, joint/neuro/pulmonary
  • AGE: minutes after surfacing, stroke-like, cardiac

329.2.1.8 Smoke Inhalation

  • CO: 100% O2 (half-life 320 → 60-80 min)
  • Cyanide: hydroxocobalamin
  • Thermal: early intubation
  • HBOT for severe CO (CO-Hb > 25%, neuro, pregnancy)

329.2.1.9 Chemical Inhalation

  • Chlorine: pulmonary edema, supportive
  • Ammonia: mucosal damage
  • NO2 silo filler: delayed bronchiolitis obliterans
  • Phosgene: delayed pulmonary edema 6-24 hr

329.2.1.10 Near-Drowning

  • ARDS
  • Lung-protective ventilation
  • No routine antibiotics
  • Steroids not beneficial

329.2.2 易混淆比范

Condition Onset Key Feature Treatment
AMS 6-24 hr HA + GI Acetazolamide
HAPE 2-4 days Dyspnea, frothy sputum Descend + nifedipine
HACE Late AMS Ataxia, altered MS Descend + dexamethasone
DCS Minutes-hours post-dive Joint pain, neuro 100% O2 + HBOT
AGE Minutes after surfacing Stroke-like Trendelenburg + HBOT
CO poisoning Variable Headache, confusion 100% O2; HBOT severe
Cyanide Acute Lactate ↑, cherry-red Hydroxocobalamin
Phosgene 6-24 hr delayed Pulmonary edema Supportive

329.2.3 Special Topics

329.2.3.1 Pre-Trip Considerations for High Altitude

  • Age, comorbidities
  • Smoking
  • Prior AMS
  • Acetazolamide prescription
  • Hydration + nutrition planning

329.2.3.2 Diving Medicine Consultations

  • Pre-dive medical evaluation
  • PFO closure consideration
  • HBO consultation post-incident

329.2.3.3 Smoke Inhalation Severity

  • Burn surface area
  • CO-Hb level
  • Cyanide level (lactate proxy)
  • Airway evaluation
  • ARDS development