ACCLIMATISATION, HA DISEASES, COLD INJURIES-Maj Dr ID Khan
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  • 1. ACCLIMATIZATION
    Major Dr Inam Danish Khan
    Medical Officer
    Nehru Institute of Mountaineering
  • 2.
  • 3. PROLOGUE
    Altitude acclimatization
    High Altitude Diseases
    Cold Acclimatisation
    Cold Injuries
    Heat Acclimatisation
    Heat Illness
  • 4. HIGH ALTITUDE
    O2 - 21 %
    8850 m/ 29000 ft
    pA = 0.3
    5500 m/ 18000 ft
    0 m
    pA = 0.5
    pA = 0.75
    2700 m/ 9000 ft
    pA = 1 atm
  • 5.
  • 6.
  • 7. GUIDING PRINCIPLES
    Ascend gradually < 2000 ft in a day
    Work high, sleep low
    Take proper meals and plenty of fluids
    Take adequate sleep, do some exercise
    Abstain from tobacco and alcohol etc.
    Avoid physical exertion and cold exposure
    Avoid sleeping pills, tranquilizers etc.
    Don’t get overconfident, follow schedule
    Immediately report health problems
    If you feel unwell, it is high altitude illness unless proven otherwise
  • 8. ACCLIMATISATION SCHEDULE
    STAGE 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
  • 9. ACCLIMATISATION SCHEDULE
    STAGE 2 (12000 ft – 15000ft ) 4 DAYS
    STAGE 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
  • 10.
  • 11. RE ENTRY
    < 10 Days - no re acclimatization
    10-28 days - 4-4-4
    > 28 Days - complete acclimatization
  • 12. WHAT HAPPENS BEYOND 5500M/18000FT?
    No acclimatization is possible
    DETERIORATING ZONE 6000-8000 M
    DEATH/LETHAL ZONE >8000 M
  • 13. HIGH ALTITUDE ILLNESSES
    1. ACUTE MOUNTAIN SICKNESS (AMS)
    2. HIGH ALTITUDE PULMONARY OEDEMA (HAPO)
    3. HIGH ALTITUDE CEREBRAL OEDEMA (HACO)
  • 14. ACUTE MOUNTAIN SICKNESS
    SYMPTOMS
    CAUSES
    • Improper acclimatisation
    • 24. Undue exertion
    • 25. Alcohol/Smoking on mtn
    TREATMENT
    • Rest, Stop further ascent
    • 26. Plenty of fluids
    • 27. Paracetamol 500 mg X 3
    • 28. Diamox 250 mg X 3
    • 29. Avomine SOS
    • 30. Descent if severe
  • HIGH ALTITUDE PULMONARY OEDEMA
    SYMPTOMS
    CAUSES
    • Rapid ascent
    • 39. Undue exertion
    TREATMENT
    • Immediate Descent
    • 40. Dexamethasone 4 mg
    • 41. Diamox 250 mg X 3 (Acetazolamide)
    • 42. HAPO bag
    • 43. Inhaler puffs
    • 44. Oxygen 5 lit/min by mask
  • HAPO BAG
    Non medical device
    Causes no harm at all
    Life saving device
    Works in place of Oxygen
    Not for evacuation
    9000 ft @ Mt Everest
  • 45. DECOMPRESSION CHAMBER
  • 46. HIGH ALTITUDE CEREBRAL OEDEMA
    SYMPTOMS
    CAUSES
    • Rapid ascent
    • 56. Neglecting AMS
    TREATMENT
    • Immediate Descent
    • 57. Dexamethasone 4 mg
    • 58. Diamox 250 mg X 3 (Acetazolamide)
    • 59. HAPO bag
    • 60. Inhaler puffs
    • 61. Oxygen 5 lit/min by mask
  • HIGH ALTITUDE SYSTEMIC OEDEMA
    SYMPTOMS
    • Swelling of feet, hands and face
    • 62. Mostly seen in females in morning
    TREATMENT
    • Disappears on its own
    • 63. Salt restriction
    • 64. Avoid tight fitting clothes
    • 65. Diamox 250 mg X 3
  • SNOW BLINDNESS
    CAUSES
    • More radiation at higher altitudes
    • 66. Snow reflects UV rays
    • 67. Can cause blindness
    PREVENTION
    • Good quality snow goggles
    • 68. Wear even in shade
  • 69. TEMPERATURE
    TEMPERATURE
    Unconsciousness / 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
    Shivering
    Fatigue, Slurred speech
    Confusion, forgetfulness
    Shivering stops, muscle rigidity
    Very slow, very weak pulse
    Noticeable drowsiness
    Severe reduction in response levels
    Unconsciousness
    Dilated pupils
    Pulse undetectable
    Appearance of death
    Death
    Heat
    Stroke
    Heat
    Exhaustion
    Normal
    Mild Hypothermia
    Severe Hypothermia
    0F
    0C
    43
    109.4
    42
    107.6
    41
    105.8
    40
    104
    39
    102.2
    38
    100.4
    37
    98.6
    36
    96.8
    35
    95
    34
    93.2
    33
    91.4
    32
    89.6
    31
    87.8
    30
    86
    29
    84.2
    28
    82.4
    27
    80.6
    26
    78.8
    25
    77
    75.2
    24
  • 70. COLD ACCLIMATIZATION
  • 71. GUIDING PRINCIPLES
    Monitor environment and assess risk
    Drink plenty of fluids
    3. Wear multilayered clothing
    4. Protect from wind
    5. Exercise regularly
    6. Abstain from tobacco and alcohol etc.
    7. Avoid physical exertion and cold exposure
    8. Keep hands and feet clean
    9. Expose to 00 – 50 C X 3-4 hrs for 3 weeks
  • 72. COLD INJURIES
    1. Chilblains
    2. Frost bite
    3. Trench foot
    Hypothermia
    Metal Bite
  • COLD INJURY : FIRST AID
    Bring victim inside
    If hands, hold them in armpits
    Slow rewarming (37-420 C/101-103 F)
    Don’t use hot water, water bottle,
    heat lamp, electric blanket
    5. Don’t rub frostbitten area
    6. Let circulation reestablish naturally, exercise
    7. Give them something warm to drink
    8. Seek a doctor’s help
  • 81. CHILBLAINS
    SYMPTOMS
    TREATMENT
    • Slow rewarming with tea leaves/pieces of turnip
    • 85. Aloe Vera cream/ Cutfar cream
    • 86. Tab Disprin ½ tab daily
  • FROST BITE
    20 frost bite
    30-40 frost bite
    10 frost bite
  • 87. FROST BITE
    10 : SYMPTOMS
    • Symptoms of Chilblains
    • 88. Pain
    20 : SYMPTOMS
    • Pink Blisters
    30 : SYMPTOMS
    • Blue/black Blisters
    • 89. Permanent loss of skin
    40 : SYMPTOMS
    • Entire area black & dead
    • 90. Auto amputation
    10 : TREATMENT
    • Same as Chilblains
    • 91. Painkillers
    20 : TREATMENT
    • Inj Tetanus & Antibiotics
    30 : TREATMENT
    • Surgery/grafting
    • 92. Physiotherapy
    40 : TREATMENT
    • Amputation
    • 93. Artificial Limb
  • HYPOTHERMIA
  • 94. HYPOTHERMIA
    Prolonged exposure to cold
    eg Alcoholics, avalanche, drowning, snowstorm etc
    CLASSIFICATION : 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
    • 95. Survival known to occur even at 200 C
  • HYPOTHERMIA
    TREATMENT
    • Have a helping, caring and positive attitute
    • 96. Patient may appear dead --- Suspended animation
    • 97. Bring victim inside gently, don’t move too much
    • 98. Prevent further heat loss, protect from wind
    • 99. Remove wet clothes, use blankets, sleeping bags
    • 100. If conscious, sweet hot drinks – no alcohol/narcotics
    • 101. Warm dry sponging in armpits, groins
    • 102. Don’t let the patient sit/stand/move in severe cases
    • 103. Evacuate with care to hospital
    • 104. NO PATIENT IS DEAD UNTIL WARM AND DEAD
  • HEAT ACCLIMATIZATION
  • 105.
  • 106. HEAT ACCLIMATIZATION
  • 107. GUIDING PRINCIPLES
    Monitor environment and assess risk
    Drink lot of fluids frequently
    3. Wear light weight clothing and proper gear
    4. Take rest in shade
    5. Acclimatize properly
    6. Abstain from tobacco and alcohol etc.
    7. Avoid physical exertion and heat exposure
  • 108. HEAT ILLNESSES
    1. Heat rash
    2. Heat syncope (fainting)
    3. Heat cramps
    4. Heat exhaustion
    5. Heat stroke
  • 109. HEAT EXHAUSTION
    SIGNS Pale skin, sweating,
    Rapid pulse, weakness,
    Headache, dizziness, nausea,
    Cramps in abdomen and limbs
    FIRST AID
    Have victim lie down, elevate feet
    Move victim to shade or cool place
    Give victim diluted salt water
    Evacuate to a medical facility
  • 110. HEAT STROKE
    SIGNS Flushed hot and dry skin,
    No sweating
    rapid, weak pulse,
    Confusion, unconscious, seizures
    FIRST AID
    Have victim lie down, elevate feet
    Move victim to shade or cool place
    Get medical help, patient can die
    Spray water or Cold sponging
    Give liquids, but no alcohol
  • 111. THANK YOU