Introduction

In high altitude a large number of casualties are caused by high altitude affects and due to extreme cold temperature.

Ø   Common problems of High Altitude.

(a)       Due to extreme cold (hypothermia, frost bite, trench foot, chill blains).
(b)       Effects due to low oxygen concentration (pulmonary edema, cerebral edema).
(c)        Due to extreme cold (hypothermia, frost bites, trench foot, chill blains).
(d)       Due to exposure to snow (snow blindness).
(e)       Due to solar radiation (sun burn).
(f)        Psychological problems.

Ø  Hypothermia. 

 It is generalized cooling of body caused by exposure to extreme cold. Body temperature can be below 350c (950 f).

(a)       Signs & symptoms.

(i)         Shivering. 
(ii)        Dizziness.
(iii)       Numbness. 
(iv)       Confusion. 
(v)        Weakness. 
(vi)       Impaired judgment.
(vii)      Impaired vision. 
(viii)     Drowsiness. 
(ix)       Slow breathing and pulse rate.
(x)        Shock.

(b)       First aid of hypothermia.

(i)         Get victim out of cold. 
(ii)        Give him dry and warm clothing.
(iii)       Warm body slowly.
(iv)       Give nothing orally unless he is fully conscious.
(v)        Treat shock.
(vi)       Give CPR if required.
(vii)      Seek professional medical attention immediately.

Ø   Frostbite.

Superficial frostbite is localized cooling of a body part. Tissue exposed to extreme cold can begin to freeze over time, often causing permanent damage.

(a)       Frost bite commonly effects.

(i)         Hands.
(ii)        Feet.
(iii)       Nose & Ears.

(b)       Signs and symptoms.

(i)         White, waxy skin colour. 
(ii)        Skin feels frozen to touch. 
(iii)       Mottled, blotchy skin (as frostbite progresses).

(c)        First aid of frostbite.

(i)         Handle affected area gently.
(ii)        Warm affected area slowly by applying heat to healthy parts of body.
(iii)       Avoid rubbing or putting pressure on site.
(iv)       Avoid applying direct heat. 
(v)        Seek professional medical attention immediately.
(vi)       Keep patient warm and at rest.

Ø  Chilblains.

               It is a cold injury which occurs due to excessive exposure of body parts extreme cold.

(a)       Signs and symptoms.

(i)         Redness of toes, fingers, tip of nose and ears.  
(ii)        Intense itching. 
(iii)       Cyanosis.
(iv)       Pain.
(v)        Blisters. 
(vi)       Ulcers.

(b)       First aid.

(i)         Re-warm   part carefully.
(ii)        Use of warm dry socks.
(iii)       Remove patient from site.
(iv)       Adequate nutrition to patient helps.

Ø  Snow Blindness.

Caused when eyes are exposed to glare produced by reflection of sun rays on snow for a long time.

(a)       Signs and symptoms.

(i)         Intense pain in affected eye. 
(ii)        Irritation in eye. 
(iii)       Redness. 
(iv)       Watering. 
(v)        Sensitivity to light. 
(vi)       Pain.

(b)       Treatment.

(i)         Wash eyes with cold water.
(ii)        Lightly dress eyes with eye pads or clean cloth.
(iii)       Shift to nearest medical aid.

Ø  Sunburn.

 It occurs due to overexposure to sunrays, Windy climate and ultraviolet rays over high mountains. Sun burn can be of two types i.e. Superficial and Deep.

(a)       Sign and symptoms.

(i)         Red, swollen & painful skin.
(ii)        Itching over burn, affected skin will become hot.

(b)       First aid.

(i)         Remove patient to cool place.
(ii)        Sponging with cold water.
(iii)       A soothing cream or lotion may be applied, don’t break blisters.
(iv)       Give sips of cold water frequently.
(v)        If required shift to hospital.

Ø  High Altitude Pulmonary Oedema.           High altitude pulmonary edema(HAPO)  is not a disease, it is an acute, dramatic and sometimes life-threatening condition seen in un-acclimatized persons. This sometimes happens suddenly and without warning to a person.

(a)       Signs & symptoms.

(i)         Symptoms often begin suddenly in middle of night and worsen rapidly.
(ii)        Extreme shortness of breathes, sometimes with wheezing.
(iii)       Restlessness and anxiety.
(iv)       Paleness.
(v)        Sweating.
(vi)       Bluish nails and lips.
(vii)      Low blood pressure-it may be high in initial stages. 
(viii)     Cough - this may be unproductive at first, but later it can produce frothy, bloodstained sputum.

(b)       Risk factors of HAPO.

(i)         Sudden induction of un-acclimatized persons to high altitude.
(ii)        Stress, inadequate rest.
(iii)       Recent heart attack.
(iv)       High blood pressure or any form of heart disease.
(v)        Obesity.
(vi)       Smoking.
(vii)      Fatigue or overwork.
(viii)     Diabetes.

(c)        First aid.

(i)         Position of patient should be semi recumbent with back rest and extra pillows.
(ii)        Loosen clothing.
(iii)       Give oxygen inhalation with help of face mask at rate of  6 liters/min.
(iv)       Remove secretions.
(v)        Bring patient to low altitude at earliest. 
(vi)       Give Injection Lasix 60 mg iv bolus. 
(vii)      Injection Morphine 4 mg iv stat (one fourth of ampoule) may help in relieving anxiety.

(d)       Prevention.

(i)         Follow regime of acclimatization. 
(ii)        Principle of work high and sleep low should be adhered strictly.
(iii)       Avoid alcohol and smoking.
(iv)       Take lots of fluids as tea, coffee & cocoa at frequent intervals.
(v)        Aspirin can be given to reduce headache and irritability.
(vi)       Patients of diabetes mellitus (high blood sugar), hypertension and heart diseases should avoid high altitude.
(vii)      Don’t take even minor ailments like cold, viral fever etc lightly.