ACCLIMATIZATION

Major Dr Inam Danish KhanMedical Officer

Nehru Institute of Mountaineering

PROLOGUE

Altitude acclimatizationHigh Altitude DiseasesCold AcclimatisationCold InjuriesHeat AcclimatisationHeat Illness

HIGH ALTITUDE

8850 m/ 29000 ft

5500 m/ 18000 ft

0 m

pA = 0.3

O2 - 21 %

pA = 0.5

pA = 0.75

pA = 1 atm

2700 m/ 9000 ft

ALTITUDE PRESSURE TEMP PO2 02 %

Feet Mtrs mmHg Cel mmHg equiv

0 0 760 15 160 21

5000 1525 632 5 132 17

10000 3050 523 -3 114 15

15000 4575 430 -15 91 12

20000 6100 350 -25 73 10

GUIDING PRINCIPLES1. Ascend gradually < 2000 ft in a day2. Work high, sleep low3. Take proper meals and plenty of fluids4. Take adequate sleep, do some exercise5. Abstain from tobacco and alcohol etc.6. Avoid physical exertion and cold exposure7. Avoid sleeping pills, tranquilizers etc.8. Don’t get overconfident, follow schedule9. Immediately report health problems10. If you feel unwell, it is high altitude illness

unless proven otherwise

ACCLIMATISATION SCHEDULESTAGE 1 (9000 ft – 12000 ft ) 6 DAYS

Day 1&2 - rest, short walk, no climb Day 3&4 - 1.5-3 km walk without load No steep climb Day 5&6 - 5 km walk with load/ 300 m climb with load

STAGE 2 (12000 ft – 15000ft ) 4 DAYSSTAGE 3 (15000 ft – 18000ft ) 4 DAYS

Day 1&2 - 1.5 km walk without load no steep climb. Day 3 - 3 km walk without load 300 m climb without load Day 4 - 3 km walk with load/ 300 m climb with load

ACCLIMATISATION SCHEDULE

< 10 Days - no re acclimatization 10-28 days - 4-4-4 > 28 Days - complete acclimatization

RE ENTRY

No acclimatization is possible

DETERIORATING ZONE 6000-8000 M

DEATH/LETHAL ZONE >8000 M

WHAT HAPPENS BEYOND 5500M/18000FT?

1. ACUTE MOUNTAIN SICKNESS (AMS) 2. HIGH ALTITUDE PULMONARY OEDEMA (HAPO) 3. HIGH ALTITUDE CEREBRAL OEDEMA (HACO)

HIGH ALTITUDE ILLNESSES

HIGH ALTITUDE

AMS

HAPO

HACO

ACUTE MOUNTAIN SICKNESSSYMPTOMS Occurs in everyone 6-24 hrs of ascent Headache Nausea / Vomiting Loss of sleep Loss of appetite Fever Weakness Dizziness Memory problem

CAUSES Improper acclimatisation Undue exertion Alcohol/Smoking on mtnTREATMENT Rest, Stop further ascent Plenty of fluids Paracetamol 500 mg X 3 Diamox 250 mg X 3 Avomine SOS Descent if severe

HIGH ALTITUDE PULMONARY OEDEMASYMPTOMS Young/fit mtneers 2nd night of ascent Symptoms of AMS Breathlessness Cough Blood in sputum Abnormal pulse, resp Cyanosis (Tongue?) Unconsciousness

CAUSES Rapid ascent Undue exertionTREATMENT Immediate Descent Dexamethasone 4 mg Diamox 250 mg X 3

(Acetazolamide) HAPO bag Inhaler puffs Oxygen 5 lit/min by mask

Non medical deviceCauses no harm at allLife saving deviceWorks in place of OxygenNot for evacuation9000 ft @ Mt Everest

HAPO BAG

DECOMPRESSION CHAMBER

SYMPTOMS Usually > 12000 ft Symptoms of AMS Altered walk Double vision Seizures/Fits Irritability Drowsiness Abnormal pulse, resp Coma Death frequent (60%)

HIGH ALTITUDE CEREBRAL OEDEMACAUSES Rapid ascent Neglecting AMSTREATMENT Immediate Descent Dexamethasone 4 mg Diamox 250 mg X 3

(Acetazolamide) HAPO bag Inhaler puffs Oxygen 5 lit/min by mask

SYMPTOMS Swelling of feet, hands and face Mostly seen in females in morningTREATMENT Disappears on its own Salt restriction Avoid tight fitting clothes Diamox 250 mg X 3

HIGH ALTITUDE SYSTEMIC OEDEMA

CAUSES More radiation at higher altitudes Snow reflects UV rays Can cause blindnessPREVENTION Good quality snow goggles Wear even in shade

SNOW BLINDNESS

25

30

26

27

28

29

31

32

33

34

35

36

37

38

39

40

41

42

43

24

77

78.8

80.6

82.4

75.2

84.2

86

87.8

95

93.2

91.4

89.6

104

102.2

100.4

98.6

96.8

109.4

107.6

105.8

0C0FUnconsciousness / fitting.Confused / restless.Headache, dizzy, uncomfortable.Strong bounding pulse.Flushed dry skin, hot to touch.Cramps in stomach / arms / legs.Pale sweaty skin.Nausea / loss of appetite.

Normal Body Temperature

ShiveringFatigue, Slurred speechConfusion, forgetfulnessShivering stops, muscle rigidityVery slow, very weak pulseNoticeable drowsinessSevere reduction in response levelsUnconsciousnessDilated pupilsPulse undetectableAppearance of death

Death

HeatStroke

HeatExhaustion

Mild Hypothermia

Severe Hypothermia

Normal

TEMPERATURE

TEMPERATURE

COLD ACCLIMATIZATION

GUIDING PRINCIPLES1. Monitor environment and assess risk 2. Drink plenty of fluids3. Wear multilayered clothing4. Protect from wind5. Exercise regularly6. Abstain from tobacco and alcohol etc.7. Avoid physical exertion and cold exposure8. Keep hands and feet clean9. Expose to 00 – 50 C X 3-4 hrs for 3 weeks

COLD INJURIES1. Chilblains2. Frost bite3. Trench foot4. Hypothermia5. Metal Bite

Fingers Toes Ear lobes Nose Cheeks Chin Foot Male genitalia Buttocks

COLD INJURY : FIRST AID1. Bring victim inside2. If hands, hold them in armpits3. Slow rewarming (37-420 C/101-103 F)4. Don’t use hot water, water bottle, heat lamp, electric blanket5. Don’t rub frostbitten area6. Let circulation reestablish naturally, exercise7. Give them something warm to drink8. Seek a doctor’s help

SYMPTOMS Red/pale colouration Itching Swelling Reduced sensation

TREATMENT Slow rewarming with tea

leaves/pieces of turnip Aloe Vera cream/ Cutfar cream Tab Disprin ½ tab daily

CHILBLAINS

FROST BITE20 frost bite 30-40 frost bite10 frost bite

10 : SYMPTOMS Symptoms of Chilblains Pain20 : SYMPTOMS Pink Blisters30 : SYMPTOMS Blue/black Blisters Permanent loss of skin40 : SYMPTOMS Entire area black & dead Auto amputation

FROST BITE10 : TREATMENT Same as Chilblains Painkillers20 : TREATMENT Inj Tetanus & Antibiotics30 : TREATMENT Surgery/grafting Physiotherapy40 : TREATMENT Amputation Artificial Limb

HYPOTHERMIA

HYPOTHERMIAProlonged exposure to coldeg Alcoholics, avalanche, drowning, snowstorm etcCLASSIFICATION : Core temperature Mild : 95 – 90 F Alert, shivering, memory lapse,

(350 – 320 C) Difficulty in speaking, swallowing Mod : 90 – 82 F Stiffness, shallow breathing,

(320 – 280 C) Confusion, Abnormal BP, pulse,

Severe : < 82 F < 280 C HAPO, Coma, Death Survival known to occur even at 200 C

TREATMENT Have a helping, caring and positive attitute Patient may appear dead --- Suspended animation Bring victim inside gently, don’t move too much Prevent further heat loss, protect from wind Remove wet clothes, use blankets, sleeping bags If conscious, sweet hot drinks – no alcohol/narcotics Warm dry sponging in armpits, groins Don’t let the patient sit/stand/move in severe cases Evacuate with care to hospital NO PATIENT IS DEAD UNTIL WARM AND DEAD

HYPOTHERMIA

HEAT ACCLIMATIZATION

HEAT ACCLIMATIZATION

GUIDING PRINCIPLES1. Monitor environment and assess risk 2. Drink lot of fluids frequently3. Wear light weight clothing and proper gear4. Take rest in shade5. Acclimatize properly6. Abstain from tobacco and alcohol etc.7. Avoid physical exertion and heat exposure

HEAT ILLNESSES1. Heat rash2. Heat syncope (fainting) 3. Heat cramps 4. Heat exhaustion 5. Heat stroke

HEAT EXHAUSTIONSIGNS Pale skin, sweating,

Rapid pulse, weakness, Headache, dizziness, nausea, Cramps in abdomen and limbs

FIRST AIDHave victim lie down, elevate feetMove victim to shade or cool placeGive victim diluted salt waterEvacuate to a medical facility

HEAT STROKESIGNS Flushed hot and dry skin,

No sweating rapid, weak pulse, Confusion, unconscious, seizures

FIRST AIDHave victim lie down, elevate feetMove victim to shade or cool placeGet medical help, patient can dieSpray water or Cold spongingGive liquids, but no alcohol

THANK YOU