Medical List and Altitude Sickness

Caused through the inability of the human body to adjust to a rapid gain in altitude, problems range from mild cases of AMS, experienced to some extent by most climbers, through its various forms to the often fatal Pulmonary and Cerebral Oedema’s, the latter being less common.

Oddly enough, young fit males seem to be the worst affected by altitude.

Symptoms of AMS include, (in the order usually experienced), headache, nausea, vomiting, anorexia, exhaustion, lassitude, muscle weakness, a rapid pulse even at rest (±120/min), insomnia, swelling of the hands and feet and a reduced urine output. Climbers with severe symptoms MUST stop ascending and seriously consider descending to a lower altitude. Use of the drug Diamox can help prevent or reduce the severity of AMS.

With Pulmonary Oedema, additional symptoms may be noticed – shortness of breath, even at rest, gurgling bubbly sounds in the chest and sometimes a watery blood-tinged sputum. The skin may be cold and clammy and the finger nails and lips bluish. With Cerebral Oedema, severe headache, hallucination and lack of co-ordination are additional symptoms. Treatment must be immediate. DESCEND! Even if it means walking down at night. The speed with which these two conditions kill is often as little as 12 hours from when the symptoms first become apparent. If bottled oxygen is available, it should be used.

Precautions that the visitor can take to help minimize the severity of mountain sickness include:

1. Staying a night at 3000m and an extra night at 3800m (Horombo / Shira / Barranco).
2. Maintain a slow steady pace whilst walking up. (There is little point in trying to outdistance everyone else, for even at a slow pace, the time between huts is seldom in excess of 6 hours on the Marangu Route and 7 hours on the camping routes).
3. Drink at least 4-6 litres of fluids each day. Dehydration, even mild, leads to a thickening of the blood with increased possibility of pulmonary embolism or a thrombosis. Urine colour should be pale and the output copious. The mantra “Copious and clear“ should be remembered.

Prevention is the best course of action. Use appropriate equipment. Do not allow yourself or your clothing to become wet – either from rain or perspiration.

When at rest, keep out of the wind. Treatment is simple and needs to be carried out as quickly as possible. If a hut or natural shelter is not close by, a tent, bivi bag or similar protection should be arranged to keep the victim dry.

REMOVE wet clothing and place the victim in a sleeping bag (or two or three), if possible, another person should be placed in the bag as well. Direct skin-to-skin contact is best. Once the victim is conscious, hot drinks will go a long way to boost morale.

Frostbite, though unlikely to kill, can result in later loss, through amputation, of the body’s extremities such as fingers and toes.

Equipment in the form of good mittens, good footwear and keeping dry is 90% of the way towards preventing the problem.

Warning signs are severe pains in the affected area followed by a complete loss of feeling there. Colour of the affected area will be almost white.

As about 50% of the earth’s protective atmosphere is below an altitude of 5000m, far less of the harmful low frequency ultra violet light is filtered out, and the suns rays are much more powerful.

This can result in very rapid burning of exposed skin.

A preparation of 5% PABA in zinc oxide cream, or a factor 35+ sun cream is recommended protection.

Dark glasses with side panels, ‘wraparounds’, or proper snow goggles, are best worn at all times above 4 000m, especially when the sun is out, and are essential when crossing snow or ice, even in cloudy conditions. Snow blindness is a very painful experience.

Eye drops may help though the only real cure is to keep the eyes bandaged up for 24 hrs or more.

Blisters are usually a result of poor fitting, new or little used boots. As soon as a ‘hot spot’ is felt, stop, remove the boot and cover the area in a zinc oxide tape, moleskin or gel tape.

If boots are even slightly too small, the toes will hit against the front of the boots and be badly bruised, particularly when descending.

Toenails should be kept as short as possible.

Stop bleeding with direct pressure to the wound. If an artery has been cut, a tourniquet should, if direct pressure is ineffective, be applied above the cut. Note that the tourniquet should not be so tight as to cut off circulation to the part.

Clean wounds and the surrounding area with water and soap, preferably antibacterial. Usually it is best not to cover abrasions and small cuts, but rather let them dry out.

The below chart of fairly common symptoms will allow you an idea of how badly the mountain sickness if affecting you and the suggested treatment. This is a personal guide…your mountain guide and your own feelings will determine the rest. Take note of the symptoms of HAPE (High Altitude Pulmonary Edema) HACE (High Altitude Cerebral Edema).