Mountain Medicine Society of Nepal scoring Page 1
Assesment of Altitude Illness
AMS Worksheet in Nepali
Based on the Lake Louise AMS Questionnaire
Name______________________________________
Age ____ Sex____ Date ____________
Previous History of 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, Bhok 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 Chhaina ) 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 Chhaina ) 0 ____ ____ ____ ____
Mild dizziness ( Alikati Ringata ) 1 ____ ____ ____ ____
Moderate dizziness ( Thikai-Thikai Rignata ) 2 ____ ____ ____ ____
Severe, incapacitating ( Dherai Ringata ) 3 ____ ____ ____ ____
5.Difficulty sleeping: (Sutna Garo)
Slept as well as usual (
Ramrai Suteko
) 0 ____ ____ ____ ____
Did not sleep as well as usual (
Ramrai Nasuteko
) 1 ____ ____ ____ ____
Woke many times, poor night's sleep (
Dherai Choti Utheko
) 2 ____ ____ ____
____
Could not sleep at all (
Sutdai Nasuteko
) 3 ____ ____ ____ ____
Symptom Score:
____ ____ ____ ____
Clinical Assessment:
