Wednesday, November 30, 2016

Altitude Sickness. How to Avoid it.

Some of the most beautiful places in the world are situated in mountainous regions of the world. Many of these places are very popular places for tourism. The majority of travelers are not used to high altitudes. The atmospheric pressure at 10000 feet above sea level (3050 meters above sea level) is two thirds that of the one at sea level. This means that when traveling to such altitudes it is like one third of the atmosphere (and oxygen) has been removed.

Altitude sickness is characterized by headache, nausea, shortness of breath on exertion, tachycardia and fatigue. In very rare circumstances, it can cause pulmonary edema or cerebral edema. 

In order to avoid or minimize the symptoms of altitude sickness, the traveler from sea level has to take it easy. Upon arrival to the high altitude location, rest, walk slowly, and take deep breaths. The tourist must eat lightly and allow one or two days for proper acclimatization (getting used to the new environment). True acclimatization does not complete until 2 or 3 weeks, however, there is never so much time during vacation. A strategy that some travelers employ is to travel to the desired destination in a stepwise fashion, stopping in intermediate altitude towns prior to the arrival to the high altitude place.

Finally, there are medications that physicians are familiar with and that may help. Travelers should contact their respective doctor for this purpose.

Marco A. Ramos MD

Wednesday, November 16, 2016

Documenting Obesity

Obesity is defined by having a body mass index (BMI) of 30 or more. For clinical purposes, the BMI is a screening tool, however, for the purposes of documenting in a patient’s chart it is very important  to make the difference between people who have obesity and people who do not. Continuing with definitions, morbid obesity is when someone has a BMI of 40 or more. 

Obesity is very common in our society. For this reason, it tends to be overlooked and not included in the patient’s chart when documenting. In addition, many physicians feel uncomfortable including  diagnosis that may make the patient not feel good about him or herself. Obesity and specially morbid obesity, are associated with increased morbidity and mortality by worsened outcomes and delayed recovery times. Hospitals use more resources when treating patients who are obese or morbidly obese.

In order to make sure obesity and morbid obesity are properly documented, providers have to develop the habit of including a BMI, close to the patient’s vitals. Moreover, providers should always allow in their templates a space for a nutritional diagnosis.

Finally, its is extremely important to include the diagnosis of obesity hypoventilation syndrome if the patient has a BMI greater than 30 and also has a diagnosis of obstructive sleep apnea (OSA) or a documented wake up arterial partial pressure of carbon dioxide greater than 45 mmHg with no other cause such as chronic obstructive pulmonary disease  (COPD), asthma, or hypoventilation from other causes.

Marco A. Ramos MD
Second Medical Opinions PLC

Physician Advisor in Clinical Documentation Improvement