1. ACCLIMATIZATION Major Dr Inam Danish Khan Medical Officer Nehru Institute of Mountaineering

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

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

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)

15. 6-24 hrs of ascent

16. Headache

17. Nausea / Vomiting

18. Loss of sleep

19. Loss of appetite

20. Fever

21. Weakness

22. Dizziness

24. Undue exertion

26. Plenty of fluids

27. Paracetamol 500 mg X 3

28. Diamox 250 mg X 3

29. Avomine SOS

31. 2nd night of ascent

32. Symptoms of AMS

33. Breathlessness

34. Cough

35. Blood in sputum

36. Abnormal pulse, resp

37. Cyanosis (Tongue?)

40. Dexamethasone 4 mg

41. Diamox 250 mg X 3 (Acetazolamide)

42. HAPO bag

43. Inhaler puffs

45. DECOMPRESSION CHAMBER

47. Symptoms of AMS

48. Altered walk

49. Double vision

50. Seizures/Fits

51. Irritability

52. Drowsiness

53. Abnormal pulse, resp

54. Coma

57. Dexamethasone 4 mg

58. Diamox 250 mg X 3 (Acetazolamide)

59. HAPO bag

60. Inhaler puffs

63. Salt restriction

64. Avoid tight fitting clothes

66. Snow reflects UV rays

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

73. Toes

74. Ear lobes

75. Nose

76. Cheeks

77. Chin

78. Foot

79. Male genitalia

82. Itching

83. Swelling

85. Aloe Vera cream/ Cutfar cream

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

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