High-altitude medicine
ZONE OF KNOWLEDGE
THAWING
Exposed body parts are particularly vulnerable to low temperatures and strong winds. In high-altitude activities – apart from enjoying climbing and admiring the landscapes – it is essential to continuously care for the thermal comfort of the body.
The most at risk are:
➤ nose
➤ cheeks
➤ mouth
➤ ears
➤ fingers of the hands
➤ toes
The lack of oxygen and low temperatures promote the formation of frostbite. As Andrzej Zawada used to say: "An intelligent and thoughtful climber does not get frostbite."
PREVENTION
Before the trip, it is worth investing in high-quality equipment:
➤ well-fitting mountaineering boots with extra space for thick socks (usually +1.5 sizes larger than the everyday shoes worn)
➤ several pairs of gloves
➤ good technical socks or merino wool socks
In this case, quality really goes hand in hand with price.
During walking and climbing:
➤ regularly move your fingers of the hands and feet to monitor sensation
➤ do not wear tight shoes
➤ do not fasten crampons too tightly
➤ loosen your watch strap
➤ remove jewelry from fingers, wrists, ears, and nose
Also take care of:
➤ proper hydration – good blood circulation helps protect the limbs
➤ dry socks and gloves
FOOT PROTECTION SYSTEM (TESTED IN THE HIMALAYAS)
One of the foot protection systems used by polar explorers, which has also proven effective in high mountains, is a simple moisture insulation system.
It has proven effective during winter expeditions to Nanga Parbat and Broad Peak, as well as spring expeditions to Dhaulagiri and Mount Everest.
Layer scheme:
➤ very thin synthetic sock (e.g., like a thin stocking)
➤ strong plastic bag (about 35 l)
➤ thick merino wool sock
➤ inner boot and shell or mountaineering boot
Upon reaching the camp:
➤ the boot and thick sock remain dry
➤ the thin sock and bag are damp
The skin of the foot may be slightly macerated, but after drying, it quickly returns to normal.
The thin sock can be dried against the body, and the plastic bag in the sleeping bag. In the morning, the entire set is again dry and ready for use. The biggest advantage of this system is keeping the boots and thick socks dry, which significantly reduces the risk of frostbite.
SYMPTOMS OF FROSTBITE
Suspect frostbite if the skin:
➤ turns white
➤ feels hard
➤ loses sensation
In such a situation, it is necessary to immediately warm the affected area – e.g., putting a finger under your armpit. If, after about 15 minutes, sensation does not return, you should stop climbing and return to camp. After warming, the frostbitten area may be painful and swollen.
STAGES OF FROSTBITE
If the first symptoms are ignored, the damage may deepen.
The subsequent stages are:
➤ blisters resembling burn blisters
➤ blisters filled with clear or bloody fluid
➤ tissue necrosis
In extreme cases, there may be loss of toes, which may require amputation.
How to reduce the risk of frostbite
➤ Invest in good boots, mittens, and a balaclava – protect your head, face, and neck.
➤ Avoid skin contact with metal parts of equipment.
➤ Do not smoke and avoid alcohol and drugs.
➤ Limit exertion to reduce fatigue and sweating.
➤ Especially protect previously frostbitten areas.
➤ Do not wear tight shoes or too many pairs of socks.
➤ Drink plenty of fluids.
➤ Always wear dry clothing and gloves.
TREATMENT OF FROSTBITE
Pain relievers
You can use: Ibuprofen – 1 tablet (400mg) every 6 hours
Additionally, for stomach protection: Omeprazole – 1 tablet before breakfast
Management of frostbitten tissue
➤ Do not rub frostbitten tissues.
➤ Do not warm them with high temperatures (e.g., with a lighter flame).
➤ Do not puncture blisters unless they hinder evacuation (e.g., on feet).
➤ If they need to be punctured, do so with a sterile needle from the first aid kit.
DETHAWING
In the base or shelter, you should:
➤ immerse the frostbitten body part in water at a temperature of 38–40°C
➤ heat for about 30 minutes, monitoring the water temperature
Further management
➤ apply a sterile dressing made of gauze
➤ apply aloe vera ointment or antibacterial ointment (e.g., Argosulfan)
➤ change the dressing at least once a day
In case of frostbite on the hand, it is advisable to immobilize it in a sling (e.g., made from climbing tape).
RECOMMEND:
Wilderness Medical Society Clinical Practice Guidelines for the Prevention and Treatment of Frostbite: 2024 Update.
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DO YOU WANT TO LEARN MORE?
If you want to better prepare yourself health-wise for trekking or a high-altitude expedition, you can find the extended version of the guide in the ebook "High Altitude Medicine in Practice – A Guide for Trekking and Expeditions" >>
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You will also learn practical knowledge about how to act in emergencies in the mountains through the online training "High Altitude First Aid" >> - designed for those planning trips to high altitudes.
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You can find the detailed contents of a trekking first aid kit and a complete guide on how to prepare an expedition first aid kit and a personal rescue set in the ebook "Expedition First Aid Kit – A Complete Medical Guide" >>
ARE YOU PLANNING A TREKOR A HIGH-ALTITUDE EXPEDITION?
If you want to check if your health condition allows you to safely participate in trekking or a high-altitude expedition, it is advisable to use a medical consultation >> or a telemedicine expedition package >>
This way, you can assess the health risks in advance, prepare properly for the trip, and increase safety while at altitude.
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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