ACCLIMATIZATION<br />Major Dr Inam Danish Khan<br />Medical Officer<br />Nehru Institute of Mountaineering<br />
PROLOGUE<br />Altitude acclimatization<br />High Altitude Diseases<br />Cold Acclimatisation<br />Cold Injuries<br />Heat ...
HIGH ALTITUDE<br />O2 - 21 %<br /> 8850 m/ 29000 ft<br /> pA = 0.3<br /> 5500 m/ 18000 ft<br />0 m<br /> pA = 0.5<br /> pA...
GUIDING PRINCIPLES<br />    Ascend gradually	    < 2000 ft in a day<br />Work high, sleep low<br />Take proper meals and p...
ACCLIMATISATION SCHEDULE<br />STAGE 1 (9000 ft – 12000 ft ) 6 DAYS <br />    Day 1&2  -  rest, short walk, no climb<br /> ...
ACCLIMATISATION SCHEDULE<br />STAGE 2 (12000 ft – 15000ft ) 4 DAYS<br />STAGE 3 (15000 ft – 18000ft ) 4 DAYS<br />   Day 1...
RE ENTRY<br /> < 10 Days    -   no re acclimatization<br /> 10-28 days  -   4-4-4<br /> > 28 Days    -   complete acclimat...
WHAT HAPPENS BEYOND 5500M/18000FT?<br />No acclimatization is possible<br />DETERIORATING ZONE      6000-8000 M<br />DEATH...
HIGH ALTITUDE ILLNESSES<br /> 1. ACUTE MOUNTAIN SICKNESS (AMS)<br /> 2. HIGH ALTITUDE PULMONARY OEDEMA (HAPO)<br /> 3. HIG...
ACUTE MOUNTAIN SICKNESS<br />SYMPTOMS<br /><ul><li>Occurs in everyone
6-24 hrs of ascent
Headache
Nausea / Vomiting
Loss of sleep
Loss of appetite
Fever
Weakness
Dizziness
Memory problem</li></ul>CAUSES<br /><ul><li>Improper acclimatisation
Undue exertion
Alcohol/Smoking on mtn</li></ul>TREATMENT<br /><ul><li>Rest, Stop further ascent
Plenty of fluids
Paracetamol 500 mg X 3
Diamox 250 mg X 3
Avomine SOS
Descent if severe</li></li></ul><li>HIGH ALTITUDE PULMONARY OEDEMA<br />SYMPTOMS<br /><ul><li>Young/fit mtneers
2nd night of ascent
Symptoms of AMS
Breathlessness
Cough
Blood in sputum
Abnormal pulse, resp
Cyanosis (Tongue?)
Unconsciousness</li></ul>CAUSES<br /><ul><li>Rapid ascent
Undue exertion</li></ul>TREATMENT<br /><ul><li>Immediate Descent
Dexamethasone 4 mg
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ACCLIMATISATION, HA DISEASES, COLD INJURIES-Maj Dr ID Khan

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ACCLIMATISATION, HA DISEASES, COLD INJURIES-Maj Dr ID Khan

  1. 1. ACCLIMATIZATION<br />Major Dr Inam Danish Khan<br />Medical Officer<br />Nehru Institute of Mountaineering<br />
  2. 2.
  3. 3. PROLOGUE<br />Altitude acclimatization<br />High Altitude Diseases<br />Cold Acclimatisation<br />Cold Injuries<br />Heat Acclimatisation<br />Heat Illness<br />
  4. 4. HIGH ALTITUDE<br />O2 - 21 %<br /> 8850 m/ 29000 ft<br /> pA = 0.3<br /> 5500 m/ 18000 ft<br />0 m<br /> pA = 0.5<br /> pA = 0.75<br /> 2700 m/ 9000 ft<br /> pA = 1 atm<br />
  5. 5.
  6. 6.
  7. 7. GUIDING PRINCIPLES<br /> Ascend gradually < 2000 ft in a day<br />Work high, sleep low<br />Take proper meals and plenty of fluids<br />Take adequate sleep, do some exercise<br />Abstain from tobacco and alcohol etc.<br />Avoid physical exertion and cold exposure<br />Avoid sleeping pills, tranquilizers etc.<br />Don’t get overconfident, follow schedule<br />Immediately report health problems<br />If you feel unwell, it is high altitude illness unless proven otherwise<br />
  8. 8. ACCLIMATISATION SCHEDULE<br />STAGE 1 (9000 ft – 12000 ft ) 6 DAYS <br /> Day 1&2 - rest, short walk, no climb<br /> Day 3&4 - 1.5-3 km walk without load<br /> No steep climb<br /> Day 5&6 - 5 km walk with load/<br /> 300 m climb with load<br />
  9. 9. ACCLIMATISATION SCHEDULE<br />STAGE 2 (12000 ft – 15000ft ) 4 DAYS<br />STAGE 3 (15000 ft – 18000ft ) 4 DAYS<br /> Day 1&2 - 1.5 km walk without load<br /> no steep climb.<br /> Day 3 - 3 km walk without load<br /> 300 m climb without load<br /> Day 4 - 3 km walk with load/<br /> 300 m climb with load<br />
  10. 10.
  11. 11. RE ENTRY<br /> < 10 Days - no re acclimatization<br /> 10-28 days - 4-4-4<br /> > 28 Days - complete acclimatization<br />
  12. 12. WHAT HAPPENS BEYOND 5500M/18000FT?<br />No acclimatization is possible<br />DETERIORATING ZONE 6000-8000 M<br />DEATH/LETHAL ZONE >8000 M<br />
  13. 13. HIGH ALTITUDE ILLNESSES<br /> 1. ACUTE MOUNTAIN SICKNESS (AMS)<br /> 2. HIGH ALTITUDE PULMONARY OEDEMA (HAPO)<br /> 3. HIGH ALTITUDE CEREBRAL OEDEMA (HACO)<br />
  14. 14. ACUTE MOUNTAIN SICKNESS<br />SYMPTOMS<br /><ul><li>Occurs in everyone
  15. 15. 6-24 hrs of ascent
  16. 16. Headache
  17. 17. Nausea / Vomiting
  18. 18. Loss of sleep
  19. 19. Loss of appetite
  20. 20. Fever
  21. 21. Weakness
  22. 22. Dizziness
  23. 23. Memory problem</li></ul>CAUSES<br /><ul><li>Improper acclimatisation
  24. 24. Undue exertion
  25. 25. Alcohol/Smoking on mtn</li></ul>TREATMENT<br /><ul><li>Rest, Stop further ascent
  26. 26. Plenty of fluids
  27. 27. Paracetamol 500 mg X 3
  28. 28. Diamox 250 mg X 3
  29. 29. Avomine SOS
  30. 30. Descent if severe</li></li></ul><li>HIGH ALTITUDE PULMONARY OEDEMA<br />SYMPTOMS<br /><ul><li>Young/fit mtneers
  31. 31. 2nd night of ascent
  32. 32. Symptoms of AMS
  33. 33. Breathlessness
  34. 34. Cough
  35. 35. Blood in sputum
  36. 36. Abnormal pulse, resp
  37. 37. Cyanosis (Tongue?)
  38. 38. Unconsciousness</li></ul>CAUSES<br /><ul><li>Rapid ascent
  39. 39. Undue exertion</li></ul>TREATMENT<br /><ul><li>Immediate Descent
  40. 40. Dexamethasone 4 mg
  41. 41. Diamox 250 mg X 3 (Acetazolamide)
  42. 42. HAPO bag
  43. 43. Inhaler puffs
  44. 44. Oxygen 5 lit/min by mask</li></li></ul><li>HAPO BAG<br />Non medical device<br />Causes no harm at all<br />Life saving device<br />Works in place of Oxygen<br />Not for evacuation<br />9000 ft @ Mt Everest<br />
  45. 45. DECOMPRESSION CHAMBER<br />
  46. 46. HIGH ALTITUDE CEREBRAL OEDEMA<br />SYMPTOMS<br /><ul><li>Usually > 12000 ft
  47. 47. Symptoms of AMS
  48. 48. Altered walk
  49. 49. Double vision
  50. 50. Seizures/Fits
  51. 51. Irritability
  52. 52. Drowsiness
  53. 53. Abnormal pulse, resp
  54. 54. Coma
  55. 55. Death frequent (60%)</li></ul>CAUSES<br /><ul><li>Rapid ascent
  56. 56. Neglecting AMS</li></ul>TREATMENT<br /><ul><li>Immediate Descent
  57. 57. Dexamethasone 4 mg
  58. 58. Diamox 250 mg X 3 (Acetazolamide)
  59. 59. HAPO bag
  60. 60. Inhaler puffs
  61. 61. Oxygen 5 lit/min by mask</li></li></ul><li>HIGH ALTITUDE SYSTEMIC OEDEMA<br />SYMPTOMS<br /><ul><li>Swelling of feet, hands and face
  62. 62. Mostly seen in females in morning</li></ul>TREATMENT<br /><ul><li>Disappears on its own
  63. 63. Salt restriction
  64. 64. Avoid tight fitting clothes
  65. 65. Diamox 250 mg X 3</li></li></ul><li>SNOW BLINDNESS<br />CAUSES<br /><ul><li>More radiation at higher altitudes
  66. 66. Snow reflects UV rays
  67. 67. Can cause blindness</li></ul>PREVENTION<br /><ul><li>Good quality snow goggles
  68. 68. Wear even in shade</li></li></ul><li>
  69. 69. TEMPERATURE<br />TEMPERATURE<br />Unconsciousness / fitting.<br />Confused / restless.<br />Headache, dizzy, uncomfortable.<br />Strong bounding pulse.<br />Flushed dry skin, hot to touch.<br />Cramps in stomach / arms / legs.<br />Pale sweaty skin.<br />Nausea / loss of appetite.<br />Normal Body Temperature<br />Shivering<br />Fatigue, Slurred speech<br />Confusion, forgetfulness<br />Shivering stops, muscle rigidity<br />Very slow, very weak pulse<br />Noticeable drowsiness<br />Severe reduction in response levels<br />Unconsciousness<br />Dilated pupils<br />Pulse undetectable<br />Appearance of death<br />Death<br />Heat<br />Stroke<br />Heat<br />Exhaustion<br />Normal<br />Mild Hypothermia<br />Severe Hypothermia<br />0F<br />0C<br />43<br />109.4<br />42<br />107.6<br />41<br />105.8<br />40<br />104<br />39<br />102.2<br />38<br />100.4<br />37<br />98.6<br />36<br />96.8<br />35<br />95<br />34<br />93.2<br />33<br />91.4<br />32<br />89.6<br />31<br />87.8<br />30<br />86<br />29<br />84.2<br />28<br />82.4<br />27<br />80.6<br />26<br />78.8<br />25<br />77<br />75.2<br />24<br />
  70. 70. COLD ACCLIMATIZATION<br />
  71. 71. GUIDING PRINCIPLES<br /> Monitor environment and assess risk <br /> Drink plenty of fluids<br />3. Wear multilayered clothing<br />4. Protect from wind<br />5. Exercise regularly<br />6. Abstain from tobacco and alcohol etc.<br />7. Avoid physical exertion and cold exposure<br />8. Keep hands and feet clean<br />9. Expose to 00 – 50 C X 3-4 hrs for 3 weeks<br />
  72. 72. COLD INJURIES<br />1. Chilblains<br />2. Frost bite<br />3. Trench foot<br />Hypothermia<br />Metal Bite<br /><ul><li>Fingers
  73. 73. Toes
  74. 74. Ear lobes
  75. 75. Nose
  76. 76. Cheeks
  77. 77. Chin
  78. 78. Foot
  79. 79. Male genitalia
  80. 80. Buttocks</li></li></ul><li>COLD INJURY : FIRST AID<br /> Bring victim inside<br /> If hands, hold them in armpits<br /> Slow rewarming (37-420 C/101-103 F)<br /> Don’t use hot water, water bottle,<br /> heat lamp, electric blanket<br />5. Don’t rub frostbitten area<br />6. Let circulation reestablish naturally, exercise<br />7. Give them something warm to drink<br />8. Seek a doctor’s help<br />
  81. 81. CHILBLAINS<br />SYMPTOMS<br /><ul><li>Red/pale colouration
  82. 82. Itching
  83. 83. Swelling
  84. 84. Reduced sensation</li></ul>TREATMENT<br /><ul><li>Slow rewarming with tea leaves/pieces of turnip
  85. 85. Aloe Vera cream/ Cutfar cream
  86. 86. Tab Disprin ½ tab daily</li></li></ul><li>FROST BITE<br />20 frost bite<br />30-40 frost bite<br />10 frost bite<br />
  87. 87. FROST BITE<br />10 : SYMPTOMS<br /><ul><li>Symptoms of Chilblains
  88. 88. Pain</li></ul>20 : SYMPTOMS<br /><ul><li>Pink Blisters</li></ul>30 : SYMPTOMS<br /><ul><li>Blue/black Blisters
  89. 89. Permanent loss of skin</li></ul>40 : SYMPTOMS<br /><ul><li>Entire area black & dead
  90. 90. Auto amputation</li></ul>10 : TREATMENT<br /><ul><li>Same as Chilblains
  91. 91. Painkillers</li></ul>20 : TREATMENT<br /><ul><li>Inj Tetanus & Antibiotics</li></ul>30 : TREATMENT<br /><ul><li>Surgery/grafting
  92. 92. Physiotherapy</li></ul>40 : TREATMENT<br /><ul><li>Amputation
  93. 93. Artificial Limb</li></li></ul><li>HYPOTHERMIA<br />
  94. 94. HYPOTHERMIA<br />Prolonged exposure to cold<br />eg Alcoholics, avalanche, drowning, snowstorm etc<br />CLASSIFICATION : Core temperature<br /><ul><li>Mild : 95 – 90 F Alert, shivering, memory lapse, </li></ul> (350 – 320 C) Difficulty in speaking, swallowing<br /><ul><li>Mod : 90 – 82 F Stiffness, shallow breathing, </li></ul> (320 – 280 C) Confusion, Abnormal BP, pulse, <br /><ul><li>Severe : < 82 F < 280 C HAPO, Coma, Death
  95. 95. Survival known to occur even at 200 C</li></li></ul><li>HYPOTHERMIA<br />TREATMENT<br /><ul><li>Have a helping, caring and positive attitute
  96. 96. Patient may appear dead --- Suspended animation
  97. 97. Bring victim inside gently, don’t move too much
  98. 98. Prevent further heat loss, protect from wind
  99. 99. Remove wet clothes, use blankets, sleeping bags
  100. 100. If conscious, sweet hot drinks – no alcohol/narcotics
  101. 101. Warm dry sponging in armpits, groins
  102. 102. Don’t let the patient sit/stand/move in severe cases
  103. 103. Evacuate with care to hospital
  104. 104. NO PATIENT IS DEAD UNTIL WARM AND DEAD</li></li></ul><li>HEAT ACCLIMATIZATION<br />
  105. 105.
  106. 106. HEAT ACCLIMATIZATION<br />
  107. 107. GUIDING PRINCIPLES<br /> Monitor environment and assess risk <br /> Drink lot of fluids frequently<br />3. Wear light weight clothing and proper gear<br />4. Take rest in shade<br />5. Acclimatize properly<br />6. Abstain from tobacco and alcohol etc.<br />7. Avoid physical exertion and heat exposure<br />
  108. 108. HEAT ILLNESSES<br />1. Heat rash<br />2. Heat syncope (fainting) <br />3. Heat cramps <br />4. Heat exhaustion <br />5. Heat stroke<br />
  109. 109. HEAT EXHAUSTION<br />SIGNS Pale skin, sweating,<br /> Rapid pulse, weakness, <br /> Headache, dizziness, nausea, <br /> Cramps in abdomen and limbs<br />FIRST AID<br /> Have victim lie down, elevate feet<br /> Move victim to shade or cool place<br /> Give victim diluted salt water<br /> Evacuate to a medical facility<br />
  110. 110. HEAT STROKE<br />SIGNS Flushed hot and dry skin,<br /> No sweating<br /> rapid, weak pulse,<br /> Confusion, unconscious, seizures<br />FIRST AID<br />Have victim lie down, elevate feet<br /> Move victim to shade or cool place<br /> Get medical help, patient can die<br /> Spray water or Cold sponging<br /> Give liquids, but no alcohol<br />
  111. 111. THANK YOU<br />

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