AMS Worksheet in Nepali

Based on the Lake Louise AMS Questionnaire

Name______________________________    Age ____   Sex____  Date _____________

Prev Hx AMS/HAPE/HACE?
Meds:

Ascent Profile:
Treatment:

                                                     Time   ____  ____  ____
                                                 Altitude   ____  ____  ____
Symptoms:
1.Headache: (Kapal Dukcha)
                                 No headache (Dukdaina) 0   ____  ____  ____
                         Mild headache (Ali Ali Dukcha) 1   ____  ____  ____
                      Moderate headache (Thikai Dukcha) 2   ____  ____  ____
                  Severe, incapacitating (Ekdam Dukcha) 3   ____  ____  ____
2.GI: (Pet Ko Bare Lachyanharu)
          No GI symptoms (Wak-Wak Chhaina, Bhok Lagcha) 0   ____  ____  ____
  Poor appetite or nausea (Wak-Wak Lagcha, Bok Chhaina) 1   ____  ____  ____
 Moderate nausea or vomiting (Wak-Wak Ra Ali-Ali Banta) 2   ____  ____  ____
              Severe N&V, incapacitating (Dherai Banta) 3   ____  ____  ____
3.Fatigue/weakness: (Thakai Lagne)
                      Not tired or weak (Thakai Chaina) 0   ____  ____  ____
                 Mild fatigue/weakness (Alikati Thakai) 1   ____  ____  ____
       Moderate fatigue/weakness (Thikai-Thikai Thakai) 2   ____  ____  ____
             Severe F/W, incapacitating (Dherai Thakai) 3   ____  ____  ____
4.Dizzy/lightheaded: (Ringata Lagne)
                             Not dizzy (Ringata Chaina) 0   ____  ____  ____
                       Mild dizziness (Alikati Ringata) 1   ____  ____  ____
             Moderate dizziness (Thikai-Thikai Ringata) 2   ____  ____  ____
                Severe, incapacitating (Dherai Ringata) 3   ____  ____  ____
5.Difficulty sleeping: (Sutna Garo)
                     Slept well as usual (Ramrai Steko) 0   ____  ____  ____
       Did not sleep as well as usual (Ramrai Nasuteko) 1   ____  ____  ____
                  Woke many times (Dherai Choti Utheko) 2   ____  ____  ____
               Could not sleep at all (Sutdai Nasuteko) 3   ____  ____  ____
Symptom Score:
                                                            ____  ____  ____

Clinical Assessment:
6.Change in mental status:
                                              No change 0   ____  ____  ____
                                     Lethargy/lassitude 1   ____  ____  ____
                                   Disoriented/confused 2   ____  ____  ____
                               Stupor/semiconsciousness 3   ____  ____  ____
7.Ataxia(heel to toe walking):
                                              No ataxia 0   ____  ____  ____
                          Maneuvers to maintain balance 1   ____  ____  ____
                                         Steps off line 2   ____  ____  ____
                                             Falls down 3   ____  ____  ____
                                            Can't stand 4   ____  ____  ____
8.Peripheral edema:
                                               No edema 0   ____  ____  ____
                                           One location 1   ____  ____  ____
                                  Two or more locations 2   ____  ____  ____
Clinical Assessment Score:
                                                            ____  ____  ____
Total Score:
                                                            ____  ____  ____


Using the worksheet

Patients are assigned a single score for each numbered group. For visual ease, we have designed the worksheet so that this score is entered next to the corresponding symptom severity level.

For example, a person with moderate AMS might get 2 points for moderate headache, 1 point for poor appetite, and 1 point for mild fatigue, for a total symptom score of 4. In addition, this person might get 1 point for facial edema, for a clinical assessment score of 1 and a total AMS score of 5.

Serial evaluations several hours apart give a good measure of whether a patient is responding to treatment or deteriorating.

Notes on Nepali: the words are given in a standard phonetic transliteration.
"Th" is a hard T with slightly more air after it, NOT like "the" in English.
"e" is usually pronounced as a long "a" sound, like "say" in English.

Thanks to Dr. Buddha Basnyat of the
Himalayan Rescue Association Nepal for the Nepali translations.

(This page looks best printed in a fixed-width font)


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Copyright© Thomas E. Dietz, MD
Emergency & Wilderness Medicine

This Page URL: http://www.high-altitude-medicine.com/AMS-worksheet-Nepali.html
Last modified 8-May-2000