Mountain Miseries

A Guide to the Effects of Cold and Altitude

Each year, several visitors to our mountains die needlessly. They fall victim to the problems discussed here because they didn’t know how to protect themselves from the mountain envir-. onment. The San Luis Valley Emergency Medical Services Council has prepared this pamphlet for free distribution–not to scare you, or to make your stay in the Rockies less enjoyable, but in the hope that by reading this, you will become better prepared to cope with some of the hazards of the mountains. We hope that your trip to Coforado has a happy ending, and if by means of this message to you, we prevent just one unhappy ending, we will consider our efforts well rewarded. Please read this-think about what we are saying-consider for a moment whether you are prepared to handle the situations we describe here…

Acclimatization

Acclimatization to high altitude involves complex changes in your body’s regulatory mechanisms. For example, breathing auto-matically becomes more rapid, and the blood increases its proportion of oxygen-carrying red blood cells. These changes enable the body to function properly even though the amount of available oxygen is much less at high altitude. Your body starts adapting to this lack of oxygen upon reaching altitude-about 90% of acclimatization occurs in 10 days, and about 98% occurs in 6 weeks.

You may notice any of the following symp-toms, which indicate that you are not yet completely adapted to high altitude: shortness of breath, general malaise (a “run-down” feeling), loss of appetite, nausea, vomiting, dizzi-ness, and headache.

Mountain Sickness

Rapid ascent by persons not used to altitude, as by automobile, to altitudes over 8000 feet usually results in what is known as “Mountain Sickness”. In addition to the symptoms listed above, you may experience drowsiness, yawn-ing, weakness, and chilliness. You may notice a whitish pallor of the face, and a bluish tinge of the lips and fingernails. Headache is frequent and may be severe. Even slight physical effort can produce troublesome shortness of breath. You may notice pounding or palpitations of the


heartbeat. Sleep can be difficult, and respira-tion may assume the pattern of several very deep, rapid breaths followed by a. period of shallow or even ab!ient breathing, then deep, rapid breaths again. This type of breathing is known as “Cheyde-Stokes” breathing, and is so common at high altitudes that it should not be considered abnormal. Dizziness, ringing in the ears, irritability, and memory defects may appear. Most of the symptoms of mountain sickness are due to the effect of oxygen lack in the body’s central nervous system and should disappear when you become better adapted to altitude. Most of them stop within 24 to 48 hours after arrival at altitude, although the shortness of breath, lack of appetite, and headache may persist.

Rest, or at most very light physical activity during the first 24 hours at altitude is helpful in preventing mountain sickness; more serious symptoms can often be alleviated by descent to a lower elevation for a day or two. Proper diet and fluid intake also are very important–the success of the 1973 American Everest Expedi-tion was attributed in large part to continuous, conscientious efforts to consume adequate amounts of food and liquids in spite of loss of appetite. At least two quarts of liquid should be drunk daily, and four quarts are preferable.

High Altitude Pulmonary Edema

Mountain sickness is caused by lack of oxygen and, although extremely disagreeable, is not life-threatening. A disorder called High Altitude Pulmonary Edema (HAPE) is also caused by oxygen lack, and although apparently rare is extremely dangerous-deaths have resulted in within 6 to 10 hours from the onset of symptoms. Although the set of conditions which result in HAPE are very complex and poorly understood, diagnosis is not difficult. The classic symptoms are rapidly increasing shortness of breath and a dry cough which later produces a white, frothy sputum which may be streaked with blood. The victim is usually cyanotic (that is, blueness of the lips and nails is present). Bubbling sounds may be heard, as if the victim is breathing through liquid-as indeed he is; pulmonary edema means that blood plasma has leaked into the air sacs of the lungs.


Adequate acclimatization seems to be the best protection against HAPE. Above 1 0,000 feet, at least one day should be allowed for each thousand feet of altitude gained. As with mountain sickness, adequate fluid intake is extremely important.

The treatment of choice for HAPE is IMMEDIATE AND RAPID DESCENT! Instances have been reported where normal breathing was restored only 2000 feet lower than the altitude at which symptoms appeared. If oxygen is available, give it at 4 liters per minute while descending,

Hypothermia

Most deaths of victims lost in the mountains that are called “exposure” by the media are really due to a condition called hypothermia. Simply put, this is a loss of body heat faster than it is being produced, causing a drop in the body’s inner-core temperature. Usually, it results from a loss of the body’s store of nutrients in a situation where the victim is subjected to severe chilling. Hypothermia can occur well above freezing–deaths have been recorded when the temperature never dropped below 50 0 F.

When clothes become wet, they lose about 90 per cent of their insulating value. Wind drives cold air under and through clothing and refrig-erates wet clothing by evaporating moisture from the surface.

Cold affects the body slowly and subtly–it can produce lapses in memory, errors in judgment, clumsiness and loss of coordination. THE VICTIM IS UNAWARE THAT THESE MENTAL EFFECTS ARE HAPPENING!

There are signs and symptoms that indicate the victim is in the process of dying from hypother-mia-these can be divided into three consecutive

stagev

1. Uncontrollable shivering–which is an attempt by the body to generate heat and maintain a normal body tempera-


ture. This stage will last as long as the body has readily-available nutrients, for practical purposes, this consists of sugars and starches (fats and proteins cannot be used by the body fast enough to help).

II. Shivering stops-the body no longer has the fuel necessary to produce heat. The victim will be listless and indifferent. HE WILL NOT BE MOTIVATED TO SAVE HIMSELF. He will be clumsy, forgetful, and he cannot make the decisions neces-sary to save his life.

III. Unconsciousness, coma and death can follow Stage 11 in a matter of minutes.

A hypothermia victim, even in the first stages, will usually deny that he is in trouble.

BELIEVE THE SYMPTOMS, NOT THE VICTIM. You must act quickly and drastically to save his life! Get the victim out of the wind and rain and into the best shelter available. Remove his v4et clothing and replace it with dry, insulate him from the ground, and warm him the best way you can. If he is fully conscious, give him warm, sweetened liquids. Get him into a sleeping bag, if one is available, which has been pre-warmed by another member of the party. (Placing a hypothermia victim in a cold sleeping bag will do him no good–remem-ber, he cannot produce enough heat to keep his inner-core body temperature at a survival level.) Skin-to-skin contact is the most effective treat-ment, with the victim in a sleeping bag with another person. If the victim is able to eat, give him anything that is high in carbohy-drates–candy bars, hard candy, or dextrose tablets are easy to carry. Under no circum-stances should a hypothermia victim be given alcoholic beveragesl Alcohol dilates the blood vessels near the surface of the skin, and will in effect chill the blood, causing a further drop in inner-core body temperature. .

Fortunately, with a minimum of knowledge and preparedness, hypothermia can be prevented. Dress for WARMTH, WIND, and WET-the three W’s of hypothermia. Although clothing does lose much of its insulating value


when wet, wool retains more insulation value than any other fabric. Put on rain gear before you are wet; put on wool clothes and wind gear before you are shivering. Protect the insulating value of down clothes by keeping them dry–a wet down garment amounts to two layers of thin nylon.

Any time you or your party is exposed to wind, wet or cold, carefully watch for signs of hypothermia: uncontrollable shivering; slow, slurred speech; irrational actions; memory lapses; immobile, fumbling hands; frequent stumbling; apparent exhaustion; and drowsiness (to sleep is to die). Remember that a person can slip into hypothermia in a matter of minutes and can die in less than 2 hours after the first signs of hypothermia are detected.

Carry emergency food that is high in sugars and is used only for emergency, eat regularly, have rain and wind gear with you, and THINK!

Alcohol and Altitude

It is difficult to predict exactly, but one alcoholic drink at altitude, in an unacclimatized person, is at least the equivalent of two or three at sea level. The lack of oxygen at altitude strengthens the sedative and disorienting effects of alcohol-and also the effects of sedatives and tranquilizers. USE CAUTION with alcohol and with these drugs until you are acclimatized.

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