​Kembara Xtra - Medicine - Motion Sickness

​Kembara Xtra - Medicine - Motion Sickness 
Motion sickness is a physiological reaction in those who experience it to a circumstance in which there is sensory conflict regarding body motion between the ocular, vestibular, and bodily proprioceptors.
Frequently brought about when motion patterns are different from what was previously observed or anticipated  Distinct from "cybersickness" or "virtual reality sickness," which are symptoms, including dizziness, brought on by exposure to computer-based stimuli, in that motion sickness is typically diagnosed only after some kind of actual movement. Nervous and gastrointestinal systems are impacted. Synonym(s): kinetosis, physiological vertigo, seasickness, airsickness, and space sickness
 
​Incidence
Female is more prevalent than male.
Prevalence
The estimation is difficult to make; 25% of cases are brought on by air travel, 29% by sea travel, and 41% by road trip. Vomiting is estimated to occur 0.5% by air, 7% by sea, and 2% by road.

Pathophysiology and Etiology 
Unknown precise cause; believed to result from an imbalance between vestibular and visual senses Compared to linear, horizontal, and high-frequency motions, rotary, vertical, and low-frequency motions cause greater symptoms.
Dopamine and acetylcholine levels are elevated, which stimulates the vomiting center and chemoreceptor trigger zone in the central nervous system, causing nausea and vomiting.
Histamine, norepinephrine, and -aminobutyric acid are other signals that may play a role in this procedure (1).
Estimates of genetic heritability range from 55% to 75%.

Risk factors include motion (such as in a car, plane, boat, or on an amusement ride), visual stimuli (such as a moving horizon), poor ventilation (such as fumes, smoke, or carbon monoxide), emotions (such as fear or anxiety), zero gravity, menstruation, use of an oral contraceptive, and a history of migraines, particularly vestibular migraine.

 Pediatric Precautions General Information Rare in children under 2 years of age Peak incidence occurs between 6 and 12 years of age Children may get excitable when using antihistamines.

Aspects of Geriatrics
Age confers some resilience to motion sickness, and elderly people are more likely to have adverse treatment effects that are anticholinergic.

pregnant women's issues

 Treatment with drugs is regarded to be safe during morning sickness (examples include meclizine and dimenhydrinate). Pregnant people are more prone to experience motion sickness.
 Meclizine, promethazine, diphenhydramine, and scopolamine are typically regarded as safe during breastfeeding. 

Vestibular syndromes and migraines are related conditions.


History 

when a typical stimulus is present together with the aforementioned indications and symptoms: Anxiety, panic Malaise/fatigue/lethargy Weakness Confusion Dizziness Nausea Vomiting Stomach awareness (feeling of fullness in epigastrium) Diaphoresis Facial and perioral pallor Hypersalivation Yawning, hyperventilation 

clinical assessment 
No particular findings

Differential diagnosis: Toxin exposure, gastroenteritis, metabolic problems, concussion, hypoglycemia, and central and peripheral vestibular dysfunction.

Laboratory Results 

None are often present; a pregnancy test or a fingerstick glucose test can be used to rule out hypoglycemia. Tests in the Future & Special Considerations
Patients can identify their vulnerability to motion sickness and the circumstances that are most likely to trigger symptoms by filling out one of the many online questionnaires available (like the Motion Sickness vulnerability Questionnaire).

Management 
Follow the instructions under "General Measures" to avoid motion sickness.
 Take antidopaminergic, anticholinergic, or antihistamine medications before to travel: - For prolonged travel, think about using a scopolamine transdermal patch.
Benzodiazepines block the vestibular nuclei, but their potential for drowsiness and addiction prevents them from being used as a first-line treatment.
Rizatriptan, a serotonin receptor agonist, might help migraineurs who also have motion nausea.


General Actions 
Steer clear of unpleasant motions; bad weather while traveling may make symptoms worse.
Enhance ventilation and stay away from unpleasant stimuli.
Eat something light, soft, bland, low-fat, and low-acid before you travel; stay away from alcohol; don't go on an empty stomach.
Boost the airflow around your face.
Use supine or semi-recumbent seating.
Fix your gaze on the horizon, stay away from fast-moving objects, and maintain focus on far-off items that are still.
Avoid reading while you're actually moving.
 Habituation: repeated and gradual exposure to stimuli that cause nausea • Offer patient advice on how to reduce motion (in an airplane, sit over the wing; in a car, sit in the front passenger seat, facing forward; in a boat, sit facing the waves, away from the rocking bow; in a bus, sit near the front, at the lowest level; in a train, sit at the lowest level, facing forward).

First Line of Medicine
Apply a 2.5-cm2 (4 mg) scopolamine transdermal patch (Transderm Scop) behind the ear over the mastoid at least 4 hours (ideally 6 to 12 hours) before travel, and change it every 3 days.
Take Promethazine (Phenergan) 30 to 60 minutes prior to departure.
- Adults: 25 mg every 12 hours; if motion sickness is already severe, 25 to 50 mg intravenously. - Children and adolescents: 0.5 mg/kg q12h, maximum 25 mg BID; warning: this age group is more susceptible to a dystonic response. Take dimenhydrinate (Dramamine) 30 to 60 minutes prior to departure.
- For adults and adolescents, take 50 to 100 mg every four to six hours with a daily maximum of 400 mg. - Children 6 to 12 years old: 25 to 50 mg every 6 to 8 hours, with a daily maximum of 150 mg. - Children 2 to 5 years old: 12.5 to 25.0 mg every 6 to 8 hours, up to 75 mg per day. Take Meclizine (Travel Ease) 60 minutes prior to departure.
- Children 12 years of age: not advised - Adults and adolescents >12 years of age: 25 to 50 mg q24h
Take diphenhydramine (Benadryl) 30 minutes prior to departure.
Children aged 6 to 12 years: 5 mg/kg or 12.5 to 25.0 mg every four hours, with a daily limit of 150 mg for adults and adolescents and 25 to 50 mg every six to eight hours for children. Patients at risk for acute angle-closure glaucoma are contraindicated.
- Small children
- Seniors
Adverse effects: - Pregnancy - Urinary blockage - Pyloric duodenal obstruction - Eye and mouth dryness - Blurred vision
- Delirium/confusion - Headache
- Constipation - Urinary retention
Important potential interactions - Sedatives, including alcohol, antidepressants, and antihistamines - Anticholinergics (alkaloids from belladonna)
Next Line
Benzodiazepines: Take one to two hours prior to departure.
Lorazepam 1 to 2 mg PO every eight hours, and Diazepam 2 to 10 mg PO every six to twelve hours. - Serious liver or respiratory issues Warnings:
Alcohol and drug abuse
- Seniors
Addiction is a possibility - Sedation.

Alternative Therapies 

It has been demonstrated that acupressure on point PC6 (Neiguan on the pericardium meridian) will lessen nausea and vomiting during surgery, during chemotherapy for cancer, and during pregnancy. Point PC6: 2 cm proximal of the transverse crease of the palmar side of the wrist between tendons of the palmaris longus and the flexor carpi radialis. Ginger: 1.0 to 1.5 g per 24 hours (250 mg 4 times a day); take 4 hours prior to travel; studies have shown ginger to be an effective treatment for nausea and vomiting.


Continuous Care: Eat before you travel, avoid going on an empty stomach, and choose bland, low-fat, low-acid foods that are light and soft.
Beware of alcohol.

The symptoms should go away after the motion exposure is over, and resistance to motion sickness seems to get stronger with age.


Complications include syncope, depression, anxiety, hypotension, dehydration, and panic.