High-Altitude Medical

HANDBOOK

Using a gas stove inside a tent is extremely dangerous and is not recommended by manufacturers of stoves or expedition tents.

The main risks include:

➤ carbon monoxide poisoning

➤ fire

However, in practice climbers often take this risk.

When strong wind and freezing temperatures make cooking outside impossible, there may be no alternative.

Without melting snow and preparing food, a climber cannot function in high mountains. Lack of food and water leads to:

➤ dehydration

➤ energy depletion

➤ hypothermia

➤ frostbite

Therefore, climbers often choose the lesser evil — cooking inside the tent.

EPIDEMIOLOGY

In the United States between 1999 and 2004, carbon monoxide poisoning caused approximately 16,000 deaths, of which 16% were unintentional and unrelated to fires.

PATHOPHYSIOLOGY

Carbon monoxide is a colorless and odorless gas with approximately 250 times greater affinity for hemoglobin than oxygen.

When it binds with hemoglobin it forms carboxyhemoglobin, which:

➤ impairs oxygen transport

➤ leads to tissue hypoxia

At high altitude the danger is even greater because lower atmospheric pressure reduces oxygen availability, causing symptoms of hypoxia to appear earlier.

SYMPTOMS

Symptoms of carbon monoxide poisoning are highly variable, which makes diagnosis difficult.

Possible symptoms include:

➤ headache

➤ fatigue

➤ exertional shortness of breath

➤ chest pain

➤ abdominal pain

➤ nausea and vomiting

➤ weakness

➤ confusion

➤ balance and memory disturbances

➤ drowsiness

➤ hallucinations

➤ anxiety

➤ visual disturbances

➤ fainting

➤ seizures

➤ urinary or fecal incontinence

➤ coma

Often also observed:

➤ increased heart rate

➤ increased breathing rate

Symptoms such as:

➤ headache

➤ balance disturbances

➤ altered consciousness

are identical to those seen in HACE.

Carbon monoxide poisoning should be strongly suspected when similar symptoms appear simultaneously in several people staying in the same enclosed space.

HACE rarely occurs simultaneously in multiple individuals.

Untreated carbon monoxide poisoning may lead to death.

TREATMENT

The most important step is immediate removal from exposure.

Actions should include:

➤ removing the source of carbon monoxide

➤ evacuating affected individuals from the enclosed space

➤ ventilating the tent or room

The half-life of carbon monoxide elimination:

➤ 3–4 hours when breathing normal air

➤ 30–90 minutes when breathing 100% oxygen

➤ 15–23 minutes in a hyperbaric chamber (2.5 atm)

LITERATURE

• Johnson C., Anderson S.R., Dallimore J. et al.: Oxford handbook of expedition and wilderness medicine. Oxford University Press, 2008

• Forgey W.W.: Wilderness Medical Society: Practice guidelines for wilderness emergency care. Falcon, 2006

• West J.B., Schoene R.B., Milledge J.S.: High altitude medicine and physiology. Hodder, 2007

• Traveling in High Mountains –www.medex.org.uk

• Hackett P.H., Roach R.C.: High altitude cerebral edema. High Alt. Med. Biol., 2004

• Shochat G.N., Lucchesi M.: Carbon Monoxide Toxicity in Emergency Medicine. Medscape

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WANT TO LEARN MORE?

If you want to better prepare your health for trekking or a high-altitude expeditions, check out the expanded guide in the ebook "High-Altitude Medicine for Trekkers and Climbers" >>

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Gain practical skills for handling emergencies in the mountains through our online training "High-Altitude First Aid" >> - prepared for those planning trips to high altitudes.

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 For a detailed list of what to include in your expedition medical kit and step-by-step instructions for assembling your personal first aid set, see the ebook "High-Altitude Expedition Medical Kit Guide" >>

PLANNING A TREK OR A HIGH-ALTITUDE EXPEDITION?

If you would like to check whether your health condition allows you to safely participate in a trek or high-altitude expedition, consider booking a medical consultation >> or using a telemedical expedition package >>

This allows you to assess potential health risks in advance, prepare properly fot altitude, and increase your safety during the expedition.

The company was established in 2004. The goal of MedEverest is education in the field of mountain medicine and the dangers of high altitudes. I deal with all medical aspects of staying at high altitude. I organize medical support for trekking and high-altitude expeditions.

Specialist Medical Practice Medeverest Robert Szymczak based in Gdańsk (80-360), at ul. Bolesława Krzywoustego 19F, NIP: 5841943576, REGON: 220148318.

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