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, 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:
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 (Symptom + Clinical):                              ____ ____ ____ ____

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.

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