What is mountain (altitude) sickness?
Mountain sickness is a special painful condition that occurs when climbing to high altitude areas with thin air. It can be observed in climbers, geologists when climbing mountains, when climbing mountains by vehicle, by cable car etc., as well as for persons arriving in high mountains to work before they have adapted to the altitude.
The painful condition that occurs under these conditions has been known to mankind for a very long time. The very name “mountain sickness” is usually attributed to Acosta (Acosta, 1590), who observed in himself and his companions sharp deterioration well-being when reaching an altitude of 4500 m above sea level while traveling in the Peruvian Andes. But systematic study of the effect of altitude on the body began only in the second half of the 19th century.
It was then established that the main etiological factor of mountain sickness is a decrease in the partial pressure of oxygen in the inhaled air as one rises to altitude. Other unfavorable factors specific to high mountain areas and contributing to the development of altitude sickness are enormous physical activity when climbing mountains on foot (climbers), low humidity and air temperature, strong winds, and increased ultraviolet radiation.
Along with the advent of the first aircraft, and then more advanced aircraft that made it possible to quickly reach great heights, new factors arose that negatively affected the body. These are, first of all, sharp changes in atmospheric pressure, high accelerations, noise, increased levels of carbon monoxide, gasoline vapors and other toxic impurities in the air of closed cabins, as well as significant stress on the nervous system.
Pathological condition, which occurs in pilots at altitude as a result of hypoxia, is commonly called altitude sickness.
The creation of jet and turbojet aircraft flying at speeds exceeding the speed of sound at an altitude of more than 20 km could not but lead to new requirements for ensuring human safety in flight. In conditions of reliable sealing of the cabin, the creation of special suits and equipment that ensures a sufficient supply of oxygen to the crew, the effect of hypoxia on the body is small. The main factors that negatively affect a person in high-altitude flight are sudden decompression, high accelerations as a result sudden changes flight speeds and directions, shock loads, vibration, breathing under pressure, toxic effects of harmful substances and significant psychomotor and emotional stress.
At the same time, the problem of hypoxia remains relevant for these flights, since emergency situations are always possible when oxygen-breathing equipment fails at high altitudes. The idea of mountain sickness as a type of altitude sickness can also be preserved to denote a painful condition that occurs in a person during a rapid ascent to an altitude of over 3500-4000 m on an airplane, helicopter, balloon and other transport that does not provide reliable sealing of the cabins and oxygen breathing with the help of special equipment.
Causes of air sickness
In its pathogenesis and clinical manifestation, mountain sickness is similar, but not identical to altitude sickness due to the fact that the effect of hypoxia in it is usually longer lasting. In addition, when climbing to a height, the pilot goes from normal atmospheric pressure to reduced pressure within a short period of time and, along with the cold, feels the influence of vibration, noise, acceleration and pressure changes in the rarefied atmosphere.
It is known that the properties of the atmosphere, the gas shell surrounding the earth, change with altitude. Currently, the atmosphere is usually divided into four main layers: the troposphere, stratosphere, ionosphere and exosphere. Altitude sickness occurs within the troposphere - the lower layer of the atmosphere in direct contact with the ground. The troposphere has different heights depending on geographical latitude area and time of year. On average, the height of the troposphere is 9-11 km. Above the equator, the boundary between the troposphere and the stratosphere lies at an altitude of 16-18 km above sea level, at the north pole - 7-10 km, at the south pole - 5-6 km. In summer, the troposphere ceiling is 1.5 times higher than in winter.
Atmospheric air near the ground consists of a physical mixture of gases in certain proportions. Dry atmospheric air contains: nitrogen 78.08%, oxygen 20.93%, argon 0.94%, carbon dioxide 0.03%, hydrogen, neon, helium, etc. about 0.01%.
It is important to emphasize that in different regions of the globe and at different altitudes, the percentage of oxygen - the most important component of the atmosphere for living organisms - remains almost unchanged up to an altitude of 19,000 m. However, air density is a variable value. If at the sea surface at a pressure of 760 mm Hg and a temperature of 0° the density of dry air is 1293 g per 1 m3, then at an altitude of 5000 m it decreases by almost 50%.
The atmosphere produces pressure on the surface of the earth, which at sea level averages 1033 kg per 1 cm2, which is equivalent to the weight of a column of mercury with a base area of 1 cm2 and a height of 760 mm at 0°. As altitude increases, atmospheric pressure decreases geometric progression, and the faster the higher the temperature. Up to an altitude of 1000 m, for every 10.5 m, atmospheric pressure decreases on average by 1 mm Hg.
Since atmospheric air at sea level under standard conditions exerts a pressure equal to 760 mm Hg, and the oxygen content in the air is 20.93%, then the partial pressure of oxygen at sea level is 760 x 0.2093, i.e. 159 mm mercury column.
According to Dalton's law, the partial pressure of any gas in a mixture is equal to the pressure that this gas would produce if it alone occupied the entire volume of the mixture of gases. When rising to a height of up to 19,000 m, the partial pressure of air gases, including oxygen, decreases in proportion to the decrease in atmospheric pressure, since the percentage composition of air remains constant. At a pressure of 0.5 atmospheres, i.e. at an altitude of approximately 5400 m, the partial pressure of oxygen will already be equal to 79.5 mmHg (380 x 0.2093). Therefore, the greater the distance from the ground, the lower the partial pressure of oxygen.
It is known that gas exchange in the lungs occurs due to the difference in the partial pressure of oxygen and carbon dioxide in the alveolar air and in the blood. In the alveolar air at sea level, the partial pressure of oxygen is on average 103 mmHg, and that of carbon dioxide is 39-40 mmHg. In the blood flowing to the lungs, the partial pressure of oxygen is usually 30-50 mmHg, and that of carbon dioxide is approximately 40-65 mmHg.
According to the law of diffusion, gases move from a medium with a higher partial pressure to a medium with a lower pressure. In this case, oxygen passes from pulmonary alveoli into the blood, and carbon dioxide, on the contrary, from the blood into the alveoli.
At normal atmospheric pressure of 760 mmHg in a healthy person, blood oxygen saturation in the lungs reaches 95-97%. Thus, for every 100 ml of blood there are 18.5 ml of chemically bound oxygen in the form of oxyhemoglobin and approximately 0.24 ml of oxygen is in the blood in a state of physical solution.
Directly in the tissues of the body between arterial blood and cells, the reverse process occurs. Oxygen from the blood diffuses into the cells, into an environment with a lower partial pressure, and carbon dioxide, on the contrary, from the tissue into the blood. At altitude, under conditions of lower partial pressure of oxygen in the atmosphere, and accordingly in the alveolar air, oxygen saturation of the blood decreases, which leads to tissue hypoxia with the subsequent development of a symptom complex called mountain sickness.
Classification of hypoxia
There are several classifications of hypoxia
One of the first to propose and become widespread was the Barcroft classification of hypoxia with the addition of Peters and van Slyke. According to this classification, four types of hypoxia are distinguished:
1) anoxic hypoxia (anoxemia), in which there is a low oxygen content in the arterial blood. This type of hypoxia occurs during ascent to altitude, when the partial pressure of oxygen in the atmosphere and alveolar air falls and normal saturation of blood hemoglobin with oxygen does not occur;
2) anemic hypoxia, in which the oxygen tension in the blood is normal, but there is not enough hemoglobin to bind the oxygen required for normal life;
3) stagnant hypoxia, when arterial blood contains a normal amount of oxygen, but due to stagnation, for example during cardiac decompensation, the delivery of oxygen to tissues per unit time is slowed down;
4) histotoxic anoxia (hypoxia), observed in poisoning and in all other cases when tissue cells lose the ability to utilize oxygen.
There is another classification:
1. Hypoxemic hypoxia:
a) from a decrease in the partial pressure of oxygen in the inhaled air; b) as a result of difficulty in the penetration of oxygen into the blood through the respiratory tract; c) due to respiratory distress.
2. Hemic hypoxia:
a) anemic type;
b) hypoxia during hemoglobin inactivation.
3. Circulatory type of hypoxia:
a) stagnant form;
b) ischemic form.
4. Tissue hypoxia.
The third, different classification aims to highlight the most common type of oxygen starvation, which combines some of the types of hypoxia given above:
1) oxygen starvation due to a decrease in the partial pressure of oxygen in the inhaled air;
2) oxygen starvation during pathological processes that disrupt the supply of oxygen to tissues at normal levels in the environment. These include the following types of oxygen starvation:
a) respiratory (pulmonary);
b) cardiovascular (circulatory);
c) blood;
d) fabric;
d) mixed.
Mountain sickness, which occurs when climbing to high altitudes, as well as during a long stay at relatively low altitudes (2000-3000 m), primarily due to a decrease in the partial pressure of oxygen in the inhaled air, is based on the development of hypoxemic hypoxia.
As mentioned above, at sea level the hemoglobin of arterial blood is 95-97% saturated with oxygen and, therefore, under these conditions the blood contains 18.5 vol.% oxygen (full, i.e. 100%, saturation would be equal to 20 vol. . %). When passing through the capillaries, about 5 vol. is removed from the blood. % oxygen, so mixed deoxygenated blood contains about 14 vol. % of it, in other words, her hemoglobin is only 70% saturated with oxygen.
Thus, during hypoxemic hypoxia, as a result of a decrease in the partial pressure of oxygen in the alveolar air and in the blood, the saturation of hemoglobin with oxygen decreases. Under these conditions, the supply of oxygen to the body's cells deteriorates, since the pressure gradient between capillaries and tissues also decreases. The speed also changes oxidative processes in tissues, which depends on the partial pressure of oxygen in the blood. This factor in the pathogenesis of hypoxia during mountain sickness is currently given, perhaps, greater importance than the decrease in the oxygen capacity of arterial blood.
A decrease in the partial pressure of oxygen in the inhaled air when ascending to a height in the initial stage, with moderate degrees of hypoxia, causes a number of physiological protective and adaptive reactions on the part of the body. The resulting increased breathing leads to the leaching of carbon dioxide from the lungs, as a result of which its partial pressure in the arterial blood decreases.
Considering that in normal conditions A sufficient partial pressure of carbon dioxide in the blood is one of the important factors in the process of dissociation of oxyhemoglobin, then a decrease in this pressure makes it difficult for hemoglobin to release oxygen from the blood. Consequently, hyperventilation, which at first glance is an expedient compensatory reaction in response to a lack of oxygen in the inhaled air, in turn leads to excessive release of carbon dioxide by the lungs. It is known that, in addition to participating in the regulation of respiration and blood circulation, carbon dioxide is an important factor in maintaining acid-base balance. Therefore, during hypoxia, as a result of a violation of the acid-base balance, under-oxidized metabolic products accumulate in the blood.
Clinical picture and pathogenesis
Clinical manifestations of mountain sickness in the initial phase are caused mainly by acidosis, and later by alkalosis (autointoxication theory).
The pathogenesis of mountain sickness is quite complex.
Lack of oxygen at altitude (hypoxemic hypoxia) is accompanied by a number of changes in the ratio of blood gases like a “chain” reaction. As a result of this, firstly, the rate of oxidation in tissues decreases due to a decrease in the partial pressure of oxygen and a decrease in the oxygen capacity of arterial blood; secondly, increased and rapid breathing helps to wash out carbon dioxide from the lungs, reduce its partial pressure in the blood and leads to difficulty in dissociating oxyhemoglobin; thirdly, depletion of blood in carbon dioxide causes a shift in the acid-base balance towards alkalosis and the accumulation of under-oxidized metabolic products in the body.
Our country has many high mountainous regions where thousands of people live. Mountaineering has become widely developed. This dictates the need for even more persistent study of the condition physiological systems the body and its adaptive reactions when rising to altitude.
Currently, some new data have been obtained that shed light on other mechanisms involved in the occurrence and manifestation of mountain sickness. In particular, experimental studies It has been proven that dysfunction of individual organs and systems during oxygen starvation is of a reflex nature. Switching off the receptors of the sinocarotid zones in animals increases resistance to oxygen starvation.
Along with hypoxia, a number of internal and external environment body. Wind, dry mountain air, and the appearance of snow and ice in the mountains often contribute to an earlier onset of the disease. In different climatic conditions, mountain sickness occurs at different altitudes: in the Alps and the Caucasus - at an altitude of 3000 m, in the Andes -4000 m, and in the Himalayas - when climbing mountain ranges 5000 m high.
Along with this, the time of onset and severity clinical picture Mountain sickness is largely determined by age and health status. Pre-existing illnesses, poor nutrition, insufficient rest in the absence of acclimatization before ascending to altitude significantly reduce the body's stability. In these cases, the first manifestations of altitude sickness may develop already at an altitude of 2500-3000 m. Of course, the speed of ascent to altitude also matters.
Symptoms of altitude sickness
Symptoms of mountain sickness in different individuals can develop at different altitudes, depending on the individual characteristics of the body and its resistance to oxygen starvation, as well as the degree of fitness. Most people do not experience altitude sickness at altitudes of 2500-3000 m.
In older people, mild signs of altitude sickness in the form of drowsiness can occur already at an altitude of 1000 m. Starting from an altitude of 3000 m, especially during physical activity, most people experience the well-known symptoms of altitude sickness: shortness of breath, headache, etc., and with At altitudes of 4000 m, mountain sickness usually develops.
The painful condition can arise suddenly, in the midst of complete health, or develop gradually after barely noticeable precursors in the form of dizziness, increased fatigue and apathy. Subsequently, general weakness increases, a feeling of chilliness, a painful headache (mainly in the forehead) and vomiting appear. Sleep becomes restless, appetite disappears, and symptoms of disorders of the higher nervous activity, cyanosis appears. In severe cases, these symptoms may be followed by loss of consciousness.
The sequence of occurrence of functional and then organic changes in various organs and systems depends not only on the duration of hypoxia, but also on the sensitivity of tissues to oxygen starvation.
Changes in the nervous system
The higher parts of the central nervous system are most sensitive to oxygen deficiency. Along with general weakness, increased fatigue, lethargy, insomnia or, conversely, drowsiness and apathy, mental disorders are observed in a person. One of the first signs of altitude sickness may be an uncritical assessment of your condition. As mountain sickness develops, even slight mental stress causes headaches. The amount of memory and attention decreases sharply: simple mathematical calculations become difficult. One can often observe peculiar changes in character. For some, these changes are expressed in weakness, lethargy, indifference, and for others - in excitement (euphoria). In severe cases of hypoxia, a period of euphoria is replaced by a sharp depression of the psyche. At an altitude of 5000 m or more, general diffuse inhibition develops with the transition to sleep.
In rare cases, loss of consciousness occurs.
The initial changes in the central nervous system during mountain sickness, which in elderly people can occur already at an altitude of 2000-3000 m, are explained by disturbances in braking processes. In middle-aged people, internal inhibition mainly suffers, and only to a small extent changes in the irritable process are noted.
Physiological studies have established that even when staying at an altitude of 2000-4000 m for 40-50 minutes, disorders of reflex activity on the part of the central nervous system can be determined: “shortening of the latent period, increasing the magnitude of the conditioned motor reaction, and in some cases, disinhibition of differentiation” .
At altitudes of about 6000 m, a violation of internal inhibition is determined in the direction of weakening, reducing the closure function of the cerebral cortex.
The effect of air rarefaction on higher nervous activity depends both on irritation of the chemoreceptors of blood vessels and tissues as a result of a decrease in the partial pressure of oxygen, and on irritation of the mechanoreceptors of the gastrointestinal tract, middle ear, adnexal cavities when the gas they contain expands.
When rising to high altitudes, the flow of impulses into the cerebral cortex can exceed the limit of the working capacity of nerve cells and lead to the development of extreme inhibition, which widely irradiates throughout the cortex and extends to the subcortical nerve centers. Nervous processes become inert, phase states develop, especially ultraparadoxical and inhibitory reactions.
However, changes in the nervous system are not limited to disorders of higher nervous activity. Quite often, with mountain sickness, changes in the peripheral nervous system can be observed: decreased pain and tactile sensitivity, paresthesia various parts bodies.
On the part of the sensory organs, one can indicate a decrease in visual acuity, narrowing of visual fields, deterioration of night vision, weakening of accommodation, and prolongation of adaptation to darkness. Hearing can decrease at relatively high altitudes (5000-6000 m).
The sense of smell and tactile sensitivity decreases. Somewhat earlier, deterioration in coordination of movements occurs, manifested in awkwardness and clumsiness, and difficulties in performing usual work. Tremors of small muscles and even paralysis are often observed.
In non-acclimatized individuals, when ascending to a height, a reactive increase in gas exchange occurs, however, as observations of people living at high altitudes show, in well-acclimatized climbers there are no significant changes in basal metabolism and thermoregulation. Only with severe mountain sickness can the temperature drop. Muscular strength of the arms at an altitude of 2400 m decreases by 25%, and at an altitude of 3400 m - by 1/3 of the original figures at sea level.
Changes in the cardiovascular system
First of all, starting from an altitude of 2000 m, disorders of the cardiovascular system are manifested by increased heart rate and increased heart contractions. These violations, on the one hand, may be a consequence of changes in nervous regulation cardiac activity, and on the other hand, are caused by hypoxia of the heart muscle itself. An increase in the amount of circulating blood is also important. A sharp increase in heart rate when rising to altitude is a sign of poor endurance to the lack of oxygen.
Climbing uphill to an altitude of 1500-2000 m is usually accompanied by a moderate increase in blood pressure, primarily systolic. At an altitude of 2500-3000 m, an increase in diastolic pressure is also observed. At high altitudes, with the development of pronounced symptoms of mountain sickness due to weakening of cardiac activity, blood pressure drops and venous pressure rises.
With a long stay at an altitude of 2000-3000 m, blood pressure tends to normalize. The influence of acclimatization on the state of vascular tone is also proven by observations of people living in mountainous areas at an altitude of 3000-4000 m above sea level. Their blood pressure is not only not increased, but, on the contrary, slightly decreased.
In the mechanism of increased blood pressure during mountain sickness, the main importance is given to the influence of hypoxia on the central nervous system, as well as on the carotid and aortic receptor zones. Of no small importance is the effect of carbon dioxide directly on the vasomotor center, increasing the amount of circulating blood and systolic volume.
With a pronounced degree of mountain sickness, hyperemia of the mucous membranes, cyanosis, thickening of the fingertips, and dilation of the veins in the periphery are observed. Due to the overflow of blood vessels, nasal, pulmonary and gastric bleeding may occur.
Data on the effect of hypoxia during mountain sickness on the heart muscle are contradictory. Observations indicating an increase in heart size have not been confirmed in studies. Considering the changes in hemodynamics that occur during hypoxia at high altitudes (increased and intensified heart contractions, increased amount of circulating blood, increased blood pressure), it should be assumed that the observed increase in heart size in acute cases may be temporary due to stretching of the cavities, and in long-term hypoxia, it is natural to expect the development of hypertrophy of the heart muscle.
Electrocardiographic changes are characterized by prolongation P-Q interval, decrease, smoothing or two-phase T wave, decrease S-T interval. These electrocardiographic signs of myocardial hypoxia are often found in individuals who complain of a feeling of tightness and pressure behind the sternum.
In weakened individuals, with insufficient physical development and with certain diseases of the heart muscle, especially in old age, these changes in the cardiovascular system occur much earlier, are more pronounced and are accompanied by shortness of breath with minor physical exertion.
Changes in the external respiration system. Climbing even to a small height is always accompanied by natural changes in breathing. For different individuals, the height at which breathing disorders appear is different and its numbers vary widely.
All other things being equal, in non-acclimatized people, increased breathing occurs when rising to a height of 1000-2000 m, which approximately corresponds to a decrease in oxygen content in the blood by 5%.
Changes in the respiratory system
Minor physical exertion at altitude is accompanied by shortness of breath. Quite often, especially at high altitudes, so-called periodic breathing is observed, which is characterized by extended intervals after 3-4 normal breaths and resembles Cheyne-Stokes breathing. This kind of wrong breathing depends on oppression respiratory center and is a consequence of hypoxia.
Changes in the depth of breathing during oxygen starvation are more pronounced and are often the first manifestations of altitude sickness. Deep breathing and, at the same time, an increase in minute volume occur as a result of irritation of the respiratory center, the nerve cells of which are most sensitive to a lack of oxygen. Along with this, increased breathing and a simultaneous decrease in its depth are sometimes a sign of the occurrence of catarrhal phenomena in the respiratory tract and lungs.
The vital capacity of the lungs at altitude decreases not only as a result of these breathing disorders, but also due to the high position of the diaphragm when the volume of gases in the intestines expands.
In origin functional disorders On the part of the external respiration system, the drop in carbon dioxide tension in the alveolar air is of no small importance. Close connection and the interdependence between minute volume and carbon dioxide tension, which exists at normal atmospheric pressure, is violated in conditions of a rarefied atmosphere. It is known that during shortness of breath caused by oxygen starvation, there is an increased leaching of carbon dioxide from the lungs and a decrease in its tension in the alveolar air. This in turn leads to a decrease in the excitability of the respiratory center, a decrease in the dissociation of oxyhemoglobin and the development of alkalosis.
In severe cases of mountain sickness, when breathing becomes frequent and shallow, oxygen deprivation progressively increases. As a result of incomplete combustion of carbohydrates, lactic acid accumulates in the blood and tissues. Further depression of the respiratory center and decreased breathing, in turn, lead to the accumulation of carbon dioxide in the blood and also contribute to the development of acidosis.
Changes in the digestive system
It is known that prolonged stay at high altitudes is often accompanied by weight loss. Weight loss can be explained not only by the influence of hypoxia on appetite, which is significantly distorted and reduced (especially for fatty foods and meat), but also by insufficient absorption of water, sodium chloride and other nutrients. A decrease in the absorption of fats, carbohydrates and proteins occurs as a result of inhibition of secretion and acid-forming function of the stomach. This also explains the intestinal dysfunction. Experiments in a pressure chamber showed that hypoxia disrupts the function of all digestive glands.
The effect of hypoxia on gastric secretion was studied in detail by Piquet and van Leer. It turned out that in experiments on animals, when the partial pressure of oxygen is reduced to 117 mm Hg (this approximately corresponds to an altitude of 2500 m), a decrease in secretion is observed gastric juice. The authors found the most pronounced decrease in gastric secretion at a partial pressure of oxygen equal to 94 mmHg (4000-4500 m).
Of particular interest are experiments performed on dogs with Pavlovian and Heidenhain ventricles. It turned out that hypoxia causes depression of gastric secretion much earlier in dogs operated on according to Heidenhain with transection of the nerve branches of the small ventricle. In dogs operated on according to Pavlov, the decrease in secretion at the same degree of hypoxia was less significant.
Similar differences were obtained when studying acidity. If in animals with a Pavlovian ventricle the pH of the gastric juice does not change up to an altitude of 7000-7500 m (partial pressure of oxygen 63 mm Hg), then in dogs with a Heidenhain ventricle the decrease in acidity begins already from an altitude of about 5000-5200 m.
In addition, it turned out that in dogs with a Heidenhain ventricle there is a decrease in chlorides in the gastric juice, while in dogs with preserved innervation of the small ventricle the chloride content in the gastric juice does not change.
These data undoubtedly indicate the leading role of the nervous system in the regulation of gastric secretion and, in turn, once again testify in favor of the influence of hypoxia on higher nerve centers.
Hypoxia also has a significant effect on the motility of the gastrointestinal tract. Violation motor function The ventricle is characterized by spastic contractions, increased tone, and delayed emptying. With significant hypoxia at altitudes of 5000-6000 m or more, leading to severe mountain sickness, the tone of the pyloric sphincter, on the contrary, decreases.
Observations show that even with mild degree mountain sickness in conditions of moderate hypoxia, disturbances in the digestive system can manifest in a person with a feeling of fullness, distension in the epigastric region, nausea, vomiting, and diarrhea that cannot be treated with medication. Often this functional disorders preceded by changes in the central nervous system.
Changes in the genitourinary system
The effect of hypoxia on urine output has not been sufficiently studied. There are indications that at altitudes starting from 4200 m, oliguria is quite often observed. Decreased urine output is associated with vascular factor as a result of increased secretion of adrenaline.
This assumption is confirmed by observations indicating an increase in the function of the adrenal glands up to their complete depletion. With severe and prolonged hypoxia in rabbits under a pressure of 379 mm Hg (altitude 5400 m), hypertrophy was first noted, and then the development of degenerative changes in the adrenal glands.
Based on the data obtained, the authors are inclined to believe that symptoms of mountain sickness such as lethargy, fatigue, headache, nervous excitability and asthenia can be explained by insufficiency of adrenal gland function or an increased need for corticoadrenal hormones.
Changes in the blood system
Ascent to altitude is accompanied by a natural increase in the number of red blood cells in the peripheral blood. This increase is more significant the higher a person rises into the atmosphere. So, for example, at an altitude of 1500 m the number of red blood cells reaches 6,500,000, at an altitude of 4500-5000 m - 7,000,000 - 8,000,000 per 1 mm3 of blood. Along with this, an increase in hemoglobin content is observed. According to Fitzgerald's law, for every 200 m of mercury decrease in atmospheric pressure, hemoglobin increases by 10%. The color index does not change significantly.
Several theories have been proposed to explain polycythemia, which occurs in a rarefied atmosphere under conditions of decreased partial pressure of oxygen. Among them, the most substantiated are theories that explain the increase in the number of red blood cells by an increase in the mass of circulating blood as a result of contractions of the spleen, blood thickening, as well as the influence of solar radiation and, primarily, cosmic rays.
In light of the latest advances in physiology and clinical practice, decisive importance in the occurrence of polycythemia should be given to the effects of oxygen starvation on hematopoiesis. In experiments and as a result of observations in humans, it has been proven that during hypoxia, rapid regeneration of the red germ occurs in the bone marrow, and normoblasts can appear in the peripheral blood.
The stimulating effect of oxygen starvation on the bone marrow is also supported by the fact that at high altitudes, significant reticulocytosis is observed in the peripheral blood, 2-3 times higher than normal. Clarification of the specific mechanisms involved in the implementation of the pathogenic effect of hypoxia on hematopoiesis is the task of further observations. However, even now, based on research, it should be assumed that a significant role in increasing the functional activity of the bone marrow belongs to the central nervous system, which regulates the inclusion of compensatory reactions in response to hypoxia.
A natural reaction of the bone marrow when rising to altitude is an increase in the number of blood platelets. On the white blood side, moderate lymphocytosis is noted with normal quantity leukocytes. Severe hypoxia may be accompanied by moderate leukopenia.
The viscosity of blood at high altitudes increases slightly, but the same cannot be said about specific gravity. If normally it is 1056, then already at an altitude of 1800 m, due to an increase in the number of red blood cells and blood platelets, the specific gravity of blood is 1067, and at an altitude of 4000 m it is 1073. The osmotic resistance of red blood cells increases. Blood clotting time decreases.
An increase in the number of red blood cells in the peripheral blood at high altitudes is naturally accompanied by an increase in the oxygen content in the blood, but the saturation of hemoglobin with it is significantly reduced.
Changes in blood pH during hypoxia are initially characterized by alkalosis due to the leaching of carbon dioxide during hyperventilation, as well as as a result of a decrease in ammonia excretion by the kidneys. Subsequently, with an increase in oxygen starvation and disturbances in oxidative processes, in particular as a result of incomplete combustion of carbohydrates, lactic acid accumulates in the blood and acidosis develops.
Biochemical blood tests conducted in people under conditions of low barometric pressure at altitudes exceeding 4000-5000 m also indicate an increase in the content of sugar, bilirubin and cholesterol. The content of blood chlorides, as a rule, remains unchanged. With regard to calcium, there is evidence of some reduction, apparently due to increased adrenal function.
Prevention of altitude sickness
Observations of the functional state of physiological systems in residents of mountainous regions show that during a long stay at low altitudes, a number of changes occur in the human body that allow one to maintain normal life activity.
Climbers who climb mountains again, although they get tired, suffer from altitude sickness much less than those who climb for the first time.
The greatest importance in acclimatization to the action of rarefied air in mountainous areas is an increase in the volume of pulmonary ventilation, hypertrophy of the heart muscle, dilatation of the pulmonary capillaries and alveoli, an increase in the number of red blood cells and hemoglobin content, a change in the oxygen capacity of the blood and the form of dissociation, and an increase in blood alkalinity. An important role in this, undoubtedly, is played by the central nervous system and those compensatory metabolic mechanisms that increase the resistance of body tissues to oxygen starvation.
It is quite obvious that for every person, a certain height above sea level, adaptation to oxygen starvation will require varying amounts of time. Acclimatization occurs faster in young people (from 24 to 40 years old) physically healthy people. After just 8-10 days of staying at an altitude of 2000-3000 m, as a result of the action compensatory mechanisms the number of red blood cells and hemoglobin increases, the activity of the cardiovascular system and external respiration, as well as other physiological functions, increases.
The most important event To prevent mountain sickness in people participating in climbing to high altitudes, it is to strengthen their physical condition.
By existing instructions For climbers, in order to prevent altitude sickness, it is recommended to carry out two months of acclimatization by successive ascents with two breaks to descend to an altitude of 2000 m, as well as stay in a training camp at an altitude of 5000 m for 1.5 months.
However, as physiological studies have shown, the acclimatization period can be significantly shortened if you first systematically engage in sports throughout the year.
According to the observations of the authors who took part in the high-altitude expedition, year-round training can significantly increase the body's adaptive abilities to oxygen starvation. Even at an altitude of 7050 m for 14 days, climbers who did not use oxygen-breathing equipment remained wellness. Compensatory reactions from internal organs, manifested by increased heart rate, changes in blood pressure, and increased respiratory rate, were weakly expressed and unstable.
Essential for good tolerance of low partial pressure of oxygen in a rarefied atmosphere, along with pre-training, is the correct organization of nutrition and water-salt regime. In particular, taking a large amount of fluid (about 3 liters per day) has a beneficial effect, which is apparently associated with the acceleration of the excretion of more under-oxidized metabolic products by the kidneys.
Another method of preventing mountain sickness is systematic training in a pressure chamber before climbing using a special technique. Thus, a systematic climb of 2500 m in combination with five climbs to a height of 3000 to 4500 m increases the “ceiling” of endurance when climbing mountains.
An important means prevention of mountain sickness is regular inhalation of oxygen-depleted gas mixtures, as well as ultraviolet irradiation, before climbing.
Carrying out a set of preventive measures for acclimatization helps to increase endurance.
Mountain sickness in acclimatized people can develop at significantly higher altitudes than in non-acclimatized people, even starting from 5500-6000 m with significant physical stress.
Chronic mountain sickness
In cases where acclimatization does not occur and the climber remains at the same altitude, subacute mountain sickness can become chronic.
There are two forms of chronic mountain sickness: emphysematous and erythraemic. The symptoms of chronic mountain sickness are the same as those of acute form, but they are more pronounced: sharp cyanosis up to a crimson color, hyperemia of the sclera and swelling of the eyelids, thickening of the fingertips, nosebleeds, hemoptysis. Quite often aphonia, dry skin, and paresthesia occur.
Along with signs of heart failure, pronounced mental changes are observed, up to nervous exhaustion and a complete personality change. Polycythemia and leukocytosis increase. Protein appears in the urine.
In the chronic form of mountain sickness, the utilization of oxygen by tissues is sharply impaired as a result of a decrease in oxygen saturation in arterial blood to 75%. The increase in the arteriovenous difference in oxygen consumption when descending to sea level cannot but indicate the participation in the genesis of mountain sickness not only of hypoxemic, but also histotoxic hypoxia.
Treatment of altitude sickness
The difficulties of climbing high mountain peaks in small groups require that climbers be familiar with the rules of self- and mutual aid. Each participant in a high-altitude expedition must clearly imagine the danger associated with the development of oxygen starvation, know the main symptoms of altitude sickness and take appropriate measures in a timely manner.
In cases where a large group of climbers is involved in climbing to a significant height, it is advisable to include a doctor in the expedition. Special medical care must also be provided for long-term work, even at low altitudes (2000-3000 m).
It is quite obvious that the organization and volume of therapeutic assistance for mountain sickness in each specific case will be determined not only by the severity of symptoms, but also by the conditions in which this assistance can be provided.
When the initial symptoms of mountain sickness develop, when headache, shortness of breath, palpitations, and fatigue occur in the midst of complete well-being, it is necessary to stop climbing. The sick person should be warmed up and given hot tea.
As mild stimulants of the central nervous system, caffeine with bromine, ginseng tincture) 15 drops per dose, Cola in tablets of 0.5 g or in solution (Extr. Colae fluidi) no 15 drops 2 times a day are indicated, and Chinese lemongrass in powder 0.5 g per dose (Pulv. Schizandrae chinensis). It should be taken into account that the use of Chinese Schisandra is contraindicated in case of increased blood pressure, nervous excitement and pronounced violations cardiac activity.
In the presence of persistent tachycardia, it is advisable to prescribe drugs that reduce and increase heart contractions. In mountainous conditions, tincture of lily of the valley or adonizide, 15 drops per dose, 2 times a day, can be used for this purpose.
Since enormous physical activity over a long period of time significantly increases the need for vitamins, when signs of mountain sickness appear, it is quite reasonable to prescribe them in therapeutic doses. Vitamins B1, B2, B6, C and A are especially indicated, which are part of the enzymes involved in the regulation of redox processes and are closely related to the metabolism of carbohydrates, proteins and fats.
It is advisable to use a multivitamin complex.
If, as a result of these measures, the patient’s condition does not improve, it is necessary to descend to a safe altitude (2000-2500 m). A special place in easing the tolerability of the difficulties of climbing and in eliminating the initial manifestations of mountain sickness is occupied by balanced diet and water and drinking regime.
Until recently, it was believed that climbers needed to limit their fluid intake to prevent heart failure. However, observations have shown that the tolerance of climbing is significantly easier if the daily regimen includes at least 3 liters of fluid. You should drink slowly and in small portions.
During high-altitude ascent, the following drinking regime is recommended. During breakfast before leaving the camp - complete satisfaction of the need for liquid (tea, coffee). When climbing - drink sweet acidified water in the amount of 0.75-1 liters in fractional portions. During an overnight stop, the need for fluid is again fully satisfied. Drinking hot tea, eating predominantly carbohydrate foods, and taking glucose tablets are especially recommended. Meat and fatty foods are better tolerated when hot. The daily caloric intake of climbers should not be less than 5000 large calories.
With the development of severe symptoms of mountain sickness, when severe weakness, chilliness, painful headache, significant shortness of breath, tachycardia, cyanosis and other signs appear without noticeable previous deterioration of the condition, the best treatment is to descend the victim to a safe altitude or give oxygen.
The best oxygen concentration for breathing is 40-60%.
If for some reason the descent is impossible for a long time and there is no oxygen-breathing equipment, then, except medicinal products listed above, stronger cardiac drugs are indicated in the form of corazol in tablets of 0.1 or cordiamine, 20 drops per dose.
If there is a doctor in the group climbing a mountain peak, it is good to use cardiac remedies as follows: 1 ml of cordiamin, 2 ml of camphor oil mixed with 1 ml of caffeine, it is better to inject it under the skin; in case of phenomena of sharply increasing weakness of cardiac activity - a solution of strophanthin 1:1000 or 0.06% korglykon 0.3-0.5 ml per 20 ml of 40% glucose is administered intravenously, and in case of respiratory depression - 1 ml of a solution of cititon or 1 ml 1 % lobeline - intramuscularly or intravenously.
Along with this, it is necessary to help reduce the need for oxygen by creating conditions for peace, eliminating not only physical, but also mental stress and anxiety. Since the central nervous system suffers first of all during mountain sickness, where necessary and possible, the use of sleeping pills is indicated in order to create extreme inhibition. Extreme inhibition significantly increases the body's adaptability to hypoxia. Sleeping pills protect brain cells from exhaustion and bring metabolism into line with the limited supply of oxygen.
The quality of treatment measures in the event of mountain sickness will ultimately be determined not so much by the choice of medicines, but by the degree of preparedness of the expedition (including acclimatization), the ability to determine the earliest signs of oxygen starvation and the search for all opportunities to provide the most effective assistance the victim in this particular situation.
Until recently, it was believed that heavier gases predominate in the atmosphere adjacent to the earth's surface, and lighter gases far from it.
Numerous studies conducted over last years, did not confirm this assumption. It was also not confirmed by analysis of air samples taken at an altitude of 70 kilometers using special rockets.
The results of the analysis of these samples and other studies have shown that the composition of air in layers of the atmosphere remote from the earth remains almost unchanged and the percentage of oxygen in it is the same as at the surface of the earth.
Since the barometric pressure of the air decreases as it moves away from the ground, the pressure of each component of the air separately decreases, that is, the partial pressure of oxygen, nitrogen and other gases that make up the air decreases.
The partial pressure of oxygen at an altitude of 10 kilometers is almost 4 times less than at the surface of the earth, and is only 45 millimeters of mercury instead of 150 at sea level.
Oxygen penetration rate blood vessels by diffusion is determined not by its percentage in the air, but by partial pressure. That is why, despite the fact that the oxygen content in the air at high altitudes is 21 percent, the amount of oxygen becomes less and less as we move away from the ground and people find it difficult to breathe. At an altitude of about 5 thousand meters, where the partial pressure of oxygen drops to 105 millimeters of mercury, a person already experiences heaviness in the head, drowsiness, nausea, and sometimes loss of consciousness. This condition is characteristic of oxygen starvation, which is caused by a low oxygen content in the air compared to its normal content at sea level.
A decrease in the partial pressure of oxygen to 50-70 millimeters of mercury causes death.
When flying at high altitude, the pilot wears an oxygen mask.
This is why without artificially adding oxygen to the air that pilots breathe during high-altitude flights, it would be impossible to reach the modern flight ceiling.
At an altitude of 4.5-5 thousand meters, pilots have to use breathing masks, into which a little oxygen is added from a can to the inhaled air. As the flight altitude increases, the amount of oxygen added to the mask increases. This ensures normal breathing for the aircraft crew.
Divers also use oxygen for breathing when working underwater. In an atmosphere of suffocating gases, firefighters use oxygen masks into which air environment It doesn't hit at all.
The main consumers of oxygen in nature are animals and vegetable world. But plants and animals consume oxygen only for breathing, while humans also use it to satisfy their domestic needs and in industry.
Mountain sickness (miner, acclimukha - slang) is a painful condition of the human body that has risen to a significant altitude above sea level, which occurs as a result of hypoxia (insufficient oxygen supply to tissues), hypocapnia (lack of carbon dioxide in tissues), manifested by significant changes in all organs and systems human body, which can quickly lead to the death of the patient in the absence proper treatment and tactics for evacuating a victim from a height down.
Since not every sports group has a professional physician present, in this article we will try to make the symptoms of mountain sickness “recognizable” and the treatment tactics understandable and reasonable.
Most processes in our body occur with the help of oxygen, which, when inhaled, enters the lungs, as a result of gas exchange in the lungs, enters the blood, and, passing through the heart, is sent to all organs and systems of the human body - to the brain, kidneys, liver, stomach , as well as to muscles and ligaments.
If the amount of oxygen in the surrounding air decreases, the amount of oxygen in the human blood decreases. This condition is called hypoxia. In the case of slight hypoxia, the body responds to a decrease in the level of oxygen in the tissues, first of all, by increasing heart rate (increasing heart rate), increasing blood pressure, and leaving the hematopoietic organs - depot (liver, spleen, bone marrow) of more young red blood cells, which capture additional amount of oxygen, normalizing gas exchange in the lungs.
In the case of high-altitude mountaineering, as a rule, other factors are added to the decrease in oxygen content in the air: physical fatigue, hypothermia, and dehydration of the body at altitude. If you do not influence the body correctly at this moment, physiological processes will go through a “vicious circle”, complications will arise, and the life of the climber-athlete will be under threat. The speed of such pathological processes is very high, for example, pulmonary or cerebral edema can cause the death of the victim within a few hours.
The main difficulty in diagnosing mountain sickness is associated, first of all, with the fact that most of its symptoms, with a few exceptions (for example, periodic intermittent breathing), are also found in other diseases: cough, difficulty breathing and shortness of breath in acute pneumonia, abdominal pain and digestive disorders in case of poisoning, disturbances of consciousness and orientation in case of traumatic brain injury.
But in the case of mountain sickness, all of these symptoms are observed in the victim either during a rapid rise to altitude, or during prolonged stay at altitude (for example, when waiting out bad weather). So at what altitudes should you expect mountain sickness to develop?
At altitudes of 1500-2500 m above sea level, slight functional changes in well-being are possible in the form of fatigue, increased heart rate, small increase blood pressure. After 1-2 days (depending on the athlete’s training) these changes, as a rule, disappear. Blood oxygen saturation at this altitude is practically within normal limits.
With a rapid rise to an altitude of 2500-3500 m above sea level, the symptoms of hypoxia develop very quickly, and also depend on the preparedness and training of the athletes. In the case of very short deadlines for the acclimatization of the group (which is now far from uncommon), if after a training climb on the 3-4th day of ascent, sports group enters a technically difficult route, participants may experience symptoms from the nervous system - inhibition on the route, poor or slow execution of commands, sometimes euphoria develops. A calm and modest athlete suddenly begins to argue, shout, and behave rudely. In this case, it is very important to immediately check the indicators of the cardiovascular system - hypoxia will be manifested by an increase in heart rate (more than 180), an increase in blood pressure (this can be determined by the strength of the pulse wave on the wrists), an increase in shortness of breath (shortness of breath is considered an increase in the number of breaths more than 30 per day). 1 minute). If these symptoms are present, the diagnosis of mountain sickness can be made for sure.
At an altitude of 3500-5800 meters, blood oxygen saturation is much less than 90% (90% is considered normal), so manifestations of mountain sickness are common, as well as the development of its complications: cerebral edema, pulmonary edema. During sleep, the patient may experience pathological rare breathing (so-called “periodic” breathing due to a decrease in the level of carbon dioxide in the blood), mental disorders, and hallucinations. A decrease in carbon dioxide in the body leads to a decrease in the frequency of inhalations during sleep due to a decrease in the activity of the respiratory center of the brain (when a person is awake, the number of inhalations is regulated by consciousness), which further increases hypoxia. This usually manifests itself as attacks of suffocation during sleep.
In the case of intense physical activity, these changes may increase. However, a little physical activity will be useful, as it stimulates anaerobic metabolic processes in the body and neutralizes the increase in hypoxia in organs and tissues. Recommendations to move in order to survive were mentioned by many high-altitude athletes (Reinhold Messner, Vladimir Shataev, Eduard Myslovsky).
Extreme altitudes include levels above 5800 above sea level; prolonged stay at such altitudes is dangerous for humans. High level ultraviolet radiation, hurricane winds, and temperature changes quickly lead to dehydration and exhaustion of the body. Therefore, athletes who climb to such a height must be very hardy and trained to the effects of hypoxia, and must consume a sufficient amount of water and high-calorie, quickly digestible foods during the ascent.
At altitudes above 6000 m, complete acclimatization is very problematic; therefore, many high-altitude climbers noted numerous signs of altitude sickness (fatigue, sleep disturbances, slow reaction) while staying at high altitudes.
At altitudes above 8000 m (“Death Zone”), a person can remain without oxygen for no more than 1-2 days (primarily due to high fitness and internal reserves), but his health will not be good. Many conquerors of eight-thousanders noted drowsiness, lethargy, bad dream with symptoms of suffocation, and the state of health immediately improved with rapid loss height.
Also, the development of mountain sickness depends on individual resistance to hypoxia, gender (women tolerate hypoxia better), age (than younger man, the worse it tolerates hypoxia), physical and mental state, speed of ascent to altitude, as well as previous “high-altitude” experience.
General and colds, dehydration, insomnia, overwork, drinking alcohol or coffee contribute to the development of mountain sickness and worsen well-being at altitude.
It should be noted that tolerance to high altitudes is very individual: some athletes begin to feel a deterioration in their condition at 3000-4000 m, others feel great at much higher altitudes.
So how does an athlete’s body react to a significant decrease in oxygen content in the surrounding air? Pulmonary ventilation increases - breathing becomes more intense and deeper. The work of the heart increases - the minute volume of circulating blood increases, blood flow accelerates. Additional red blood cells are released from blood depots (liver, spleen, bone marrow), resulting in an increase in hemoglobin content in the blood.
At the tissue level, capillaries begin to work more intensively, the amount of myoglobin in the muscles increases, metabolic processes intensify, and new metabolic mechanisms are activated, for example, anaerobic oxidation.
If hypoxia continues to increase, the body begins to pathological disorders: insufficient supply of oxygen to the brain and lungs leads to the development severe complications. Initially, a decrease in oxygen levels in brain tissue leads to disturbances in behavior and consciousness, and subsequently contributes to the development of cerebral edema. Insufficient gas exchange in the lungs leads to reflex stagnation of blood in the pulmonary circulation and the development of pulmonary edema. A decrease in blood flow in the kidneys leads to a decrease in the excretory function of the kidneys - first a decrease, and then a complete absence of urine. This is very warning sign, because a decrease in excretory function leads to rapid poisoning of the body. A decrease in oxygen in the blood of the gastrointestinal tract may manifest itself complete absence loss of appetite, abdominal pain, nausea, vomiting.
In addition, when the level of oxygen in tissues decreases as a result of impaired water-salt metabolism, dehydration of the body progresses (fluid loss can reach 7-10 liters per day), arrhythmia begins, and heart failure develops. As a result of liver dysfunction, intoxication quickly develops, body temperature rises, and fever in conditions of lack of oxygen increases hypoxia (it has been established that at a temperature of 38°C the body's need for oxygen doubles, and at 39.5°C it increases 4 times).
The feeling of well-being and the effects of cold are aggravated: firstly, in the cold, inhalation is usually short, and this also increases hypoxia. Secondly, at low temperatures, other colds (sore throat, pneumonia) may be associated with pulmonary edema. Thirdly, in the cold, the permeability of cell walls is impaired, which leads to additional tissue swelling. Therefore, at low temperatures, pulmonary edema or cerebral edema occurs faster: at high altitudes and in extreme cold, this period can be only a few hours instead of the usual 8-12 hours. As a rule, all complications in the development of mountain sickness develop at night, during sleep, and by morning there is a significant deterioration in the condition. This is due to the horizontal position of the body, decreased respiratory activity, and increased tone of the parasympathetic nervous system. Therefore, it is necessary not to put a person suffering from altitude sickness to sleep at altitude, but to use every minute to transport the victim down. Fast attack lethal outcome is explained by the fact that processes develop according to the principle of a “vicious” circle, when subsequent changes aggravate the cause of the process, and vice versa.
The cause of death with cerebral edema is compression of the brain matter by the cranial vault, wedging of the cerebellum into the posterior cranial fossa. Therefore it is very important when the slightest symptoms brain damage, use both diuretics (reducing brain swelling) and sedatives (sleeping pills), because they reduce the brain's need for oxygen.
In pulmonary edema, the cause of death is respiratory failure, as well as obstruction of the airways (asphyxia) by foam formed during swelling of the lung tissue. As a rule, pulmonary edema during mountain sickness is accompanied by heart failure, as a result of overflow of the pulmonary circulation. Therefore, along with diuretics that reduce swelling, it is necessary to give cardiac drugs that increase cardiac output and corticosteroids that stimulate the heart and increase blood pressure levels.
In the functioning of the digestive system, when dehydrated, the secretion of gastric juice decreases, which leads to loss of appetite and disruption of the digestive processes. As a result, the athlete sharply loses weight and complains of discomfort in the stomach, nausea, diarrhea. It should be noted that digestive disorders during mountain sickness differ from the disease digestive tract, primarily because the rest of the group did not observe signs of poisoning (nausea, vomiting). Diseases of the abdominal organs such as perforated ulcers or acute appendicitis are always confirmed by the presence of symptoms of peritoneal irritation (pain appears when pressing on the abdomen with a hand or palm, and sharply intensifies when the hand is withdrawn).
In addition, as a result of impaired brain function, a decrease in visual acuity, a decrease in pain sensitivity, and mental disorders are possible.
According to the time of exposure to hypoxia on the body, acute and chronic forms of mountain sickness are distinguished. Acute mountain sickness usually occurs within a few hours, and its symptoms develop very quickly.
Chronic mountain sickness is observed in residents of high mountain areas (for example, the village of Kurush in Dagestan), who live much above the vegetation line. This form of mountain sickness is characterized by a decrease in physical and mental performance, is marked by an increase in the size of the right half of the heart and liver. The chest often increases in volume; sometimes in such patients one can observe thickening of the terminal phalanges of the fingers (“ Drumsticks"), pronounced blueness of the lips. Patients with chronic mountain sickness complain of cough, hemoptysis, shortness of breath, pain in the right hypochondrium, and they experience bleeding from the veins of the esophagus as a result of dilatation of the thoracic veins.
In addition, there is a subacute form of mountain sickness, which lasts up to 10 days. Clinical manifestations of acute and subacute forms mountain sicknesses often coincide and differ only in the time of development of complications. There are mild, moderate and severe degrees of mountain sickness.
Mild mountain sickness is characterized by the appearance of lethargy, malaise, rapid heartbeat, shortness of breath and dizziness in the first 6-10 hours after ascending to altitude. It is also characteristic that drowsiness and poor sleep are observed simultaneously. If the rise to altitude does not continue, these symptoms disappear after a couple of days. Any objective signs of light form no altitude sickness. If these symptoms appear within 3 days after rising to altitude, the presence of some other disease should be assumed.
Moderate mountain sickness is characterized by inadequacy and a state of euphoria, which is later replaced by loss of strength and apathy. Symptoms of hypoxia are already more pronounced: severe headache, dizziness. Sleep is disturbed: patients have trouble falling asleep, often wake up from suffocation, and are often tormented by nightmares. With exertion, the pulse increases sharply and shortness of breath appears. As a rule, appetite completely disappears, nausea appears, and sometimes vomiting.
In severe cases of mountain sickness, the symptoms of hypoxia affect all organs and systems: poor physical well-being, fast fatiguability, heaviness throughout the body prevents the athlete from moving forward. The headache increases, and with a sudden change in body position, dizziness and lightheadedness occur. Because of severe dehydration the body is disturbed by strong thirst, there is no appetite, and gastrointestinal disorders appear in the form of diarrhea. There may be bloating and pain. During night sleep, breathing is disrupted (intermittent breathing), and hemoptysis may occur. Hemoptysis differs from bleeding by the presence of foamy sputum, whereas stomach bleeding, as a rule, is never associated with a cough and the blood coming from the stomach has the appearance of “coffee grounds” due to the interaction with hydrochloric acid of the gastric juice. When examining the patient, the tongue is coated and dry, the lips are bluish, and the skin of the face has a grayish tint.
In the absence of treatment and descent, mountain sickness leads to serious complications - edema of the lungs and brain.
With pulmonary edema in the chest, mainly behind the sternum, moist rales, gurgling, and bubbling appear. In severe cases, coughing may produce pink, frothy sputum from the mouth. The pressure drops, the pulse increases sharply. If treatment is not started immediately, the patient can die very quickly. It is imperative to give the sick person a semi-sitting position to relieve the heart and breathing, give oxygen, administer intramuscular diuretics (Diacarb) and corticosteroids (dexomethasone, Dexon, hydrocortisone). To facilitate the work of the heart, you can apply tourniquets to the upper third of the shoulders and hips for 15-20 minutes. If the treatment is carried out correctly, the condition should improve quickly, after which an immediate descent should begin. If treatment is not carried out, as a result of heart overload, heart failure quickly joins pulmonary edema: the skin turns blue, severe pain appears in the heart area, a sharp drop in blood pressure, and arrhythmia.
High altitude cerebral edema differs from traumatic brain injury, first of all, by the absence of asymmetry of the face, pupils and facial muscles, and is manifested by lethargy and confusion, up to its complete loss. At the very beginning of development, cerebral edema may manifest itself as inadequacy (anger or euphoria), as well as poor coordination of movements. Subsequently, the symptoms of brain damage may increase: the patient does not understand the simplest commands, cannot move, or fix his gaze. As a result of cerebral edema, difficulty breathing and cardiac activity may occur, but this occurs some time after loss of consciousness. Cerebral edema is relieved by fractional (repeated) administration of diuretics (diacarb), mandatory administration of sedatives or sleeping pills, which reduce the brain’s need for oxygen, and mandatory cooling of the victim’s head (a decrease in temperature by several degrees reduces brain swelling and prevents the development of complications).
Prevention of altitude sickness will be, first of all, in good and correctly carried out acclimatization, moderate alternation of descents and ascents to altitude with constant monitoring of the well-being of group members. For athletes planning to climb high altitudes, it is necessary to include anaerobic training in the training cycle (running uphill, running with breath holding). When climbing high altitudes, it is necessary to take multivitamins (preferably with a complex of microelements), antioxidants (tinctures of ginseng, golden root, Rhodiola rosea, ascorbic acid, riboxin). Taking drugs that affect the pulse rate (potassium orotate, asparkam) in the mountains is not advisable due to the occurrence of various forms cardiac arrhythmias. Be sure to take products to normalize the water-salt balance (rehydron) in your first aid kit, or drink slightly salted water. If, when climbing to a height, one of the group members feels unwell, he must be immediately brought down, since his condition can greatly worsen in a matter of hours and the descent will already become dangerous for both the victim and other group members. Treatment of mountain sickness thus begins with the immediate descent of the sick participant to a lower altitude. The best remedy from increasing hypoxia there will be an increase in the oxygen content in the air. Mandatory when transporting a patient with mountain sickness will be: drinking plenty of fluids, administration of diuretics, with a sharp drop in pressure or deterioration general condition– intramuscular injection of corticosteroids. Hormones of the adrenal cortex - corticosteroids have an adrenaline-like effect: they increase blood pressure, increase cardiac output, and increase the body's resistance to disease. Taking 1-2 aspirin tablets can give a slight effect during hypoxia - by reducing blood clotting, it promotes better oxygen delivery to the tissues, but aspirin can be taken only in the absence of bleeding or hemoptysis. Alcohol under conditions of hypoxia is contraindicated, as it depresses respiration, impairs interstitial fluid exchange, increases the load on the heart and increases oxygen starvation of brain cells.
Climbers and mountain tourists planning climbs and hikes at high altitudes (over 5500 m) should understand that good physical preparation, high-quality equipment, proper acclimatization and thoughtful climbing tactics reduce the likelihood of mountain sickness in participants. The following will help save the life of an athlete who has fallen ill with mountain sickness: firstly, correct and quick diagnosis of the symptoms of the disease, secondly, the use of modern medications to reduce hypoxia and prevent the development of severe complications, thirdly, the immediate descent of the sick climber to a safe altitude for health .
Mountains attract people with their beauty and grandeur. Ancient, like eternity itself, beautiful, mysterious, bewitching the mind and heart, they do not leave a single person indifferent. Breathtaking views of mountain peaks covered with never-melting snow, forested slopes, and alpine meadows attract everyone who has at least once spent a vacation in the mountains to return.
It has long been noted that people in the mountains live longer than on the plain. Many of them, living to a ripe old age, retain good spirits and clarity of mind. They get sick less and recover faster from illness. Women in the middle mountains retain the ability to bear children much longer than women in the lowlands.
Breathtaking views of the mountains are complemented by the purest air, which is so pleasant to breathe deeply. Mountain air clean and filled with aromas of medicinal herbs and flowers. There is no dust, industrial soot or exhaust gases. You can breathe easily and it seems like you can’t get enough of it.
Mountains attract people not only with their beauty and grandeur, but also with a lasting improvement in well-being, a noticeable increase in performance, and a surge of strength and energy. In the mountains the air pressure is less than in the plains. At an altitude of 4 kilometers the pressure is 460 mmHg, and at an altitude of 6 km - 350 mmHg. As altitude increases, the density of the air decreases, and the amount of oxygen in the inhaled volume decreases accordingly, but paradoxically, this has a positive effect on human health.
Oxygen oxidizes our body, contributes to aging and the occurrence of many diseases. At the same time, life is completely impossible without it. Therefore, if we want to significantly extend life, we need to reduce the flow of oxygen into the body, but not too little and not too much. In the first case, there will be no therapeutic effect, but in the second, you can harm yourself. This golden mean is the mountain air of mid-mountains: 1200 - 1500 meters above sea level, where the oxygen content is approximately 10%.
At present, it has already been absolutely clear that there is only one factor that prolongs a person’s life in the mountains - this is mountain air, the oxygen content of which is reduced and this has a negative impact on highest degree beneficial effects on the body.
Lack of oxygen causes a restructuring in the functioning of various body systems (cardiovascular, respiratory, nervous) and forces reserve forces to turn on. This, as it turns out, is a very effective, inexpensive, and most importantly accessible way to restore and improve health. When the amount of oxygen in the inhaled air decreases, a signal about this is transmitted through special receptors to the respiratory center of the medulla oblongata, and from there goes to the muscles. The work of the chest and lungs increases, the person begins to breathe more often, and accordingly the ventilation of the lungs and the delivery of oxygen to the blood improves. The heart rate increases, which increases blood circulation and oxygen reaches the tissues faster. This is also facilitated by the release of new red blood cells into the blood, and therefore the hemoglobin they contain.
This explains the beneficial effect of mountain air on a person’s vitality. Coming to mountain resorts, many notice that their mood improves and their vitality is activated.
But if you rise higher into the mountains, where the mountain air contains even less oxygen, the body will react to its lack in a completely different way. Hypoxia (lack of oxygen) will already be dangerous, and first of all the nervous system will suffer from it, and if there is not enough oxygen to maintain the functioning of the brain, a person may lose consciousness.
In the mountains, solar radiation is much stronger. This is due to the high transparency of the air, since its density and the content of dust and water vapor decrease with altitude. Solar radiation kills many harmful microorganisms that live in the air and decomposes organic matter. But most importantly, solar radiation ionizes mountain air, promoting the formation of ions, including negative ions of oxygen and ozone.
For the normal functioning of our body, both negatively and positively charged ions must be present in the air we breathe, and in a strictly defined ratio. Violation of this balance in any direction has a very adverse effect on our well-being and health. At the same time, negatively charged ions, according to modern scientific data, are necessary for humans just like vitamins in food.
In rural air, the concentration of ions of both charges on a sunny day reaches 800-1000 per 1 cubic cm. In some mountain resorts their concentration rises to several thousand. Therefore, mountain air has a healing effect on most living beings. Many of Russia's long-livers live in mountainous areas. Another effect of thin air is increasing the body’s resistance to the damaging effects of radiation. However, at high altitudes the proportion of ultraviolet radiation increases sharply. The impact of ultraviolet rays on the human body is very great. Possible skin burns. They have a harmful effect on the retina of the eyes, causing sharp pain and sometimes temporary blindness. To protect your eyes, you must use glasses with light-protective lenses, and to protect your face, wear a wide-brimmed hat.
IN Lately In medicine, techniques such as orotherapy (treatment with mountain air) or normobaric hypoxic therapy (treatment with rarefied air with a low oxygen content) are becoming widespread. It has been precisely established that with the help of mountain air the following diseases can be prevented and treated: occupational diseases associated with damage to the upper respiratory tract, various forms of allergic and immunodeficiency conditions, bronchial asthma, a wide group of diseases of the nervous system, diseases of the musculoskeletal system, diseases cardiovascular system, gastrointestinal diseases, skin diseases. Hypoxytherapy excludes side effects as without medicinal method treatment.
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Source: Adventure Team "AlpIndustry"Altitude sickness(miner, acclimukha - slang) - a painful condition of the human body that has risen to a significant altitude above sea level, which occurs as a result of hypoxia (insufficient oxygen supply to tissues), hypocapnia (lack of carbon dioxide in tissues) and is manifested by significant changes in all organs and systems of the human body. body.
At improper treatment or incorrect actions (delay in evacuation down), mountain sickness can even lead to the death of the sick person. Sometimes very quickly.
Since not every sports group has a medical professional, in this article we will try to make the symptoms of mountain sickness “recognizable” and the treatment tactics understandable and reasonable.
So at what altitudes should you expect mountain sickness to develop?
At altitudes of 1500-2500 m above sea level, slight functional changes in well-being are possible in the form of fatigue, increased heart rate, and a slight increase in blood pressure. After 1-2 days (depending on the athlete’s training) these changes, as a rule, disappear. Blood oxygen saturation at this altitude is practically within normal limits.
When climbing quickly to an altitude of 2500-3500 m above sea level, the symptoms of hypoxia develop very quickly and also depend on the training of the athletes. When planning a very short period of time for acclimatization of a group, which is now far from uncommon, if after a training climb on the 3-4th day of ascent, a sports group already enters a technically difficult route, the participants may experience symptoms from the nervous system - inhibition on the route, poor or slow execution of commands, sometimes euphoria develops. A calm and modest athlete suddenly begins to argue, shout, and behave rudely. In this case, it is very important to immediately check the indicators of the cardiovascular system - hypoxia will be manifested by an increase in heart rate (more than 180), an increase in blood pressure (this can be determined by the strength of the pulse wave on the wrists), an increase in shortness of breath (shortness of breath is considered an increase in the number of breaths more than 30 for 1 minute). If these symptoms are present, the diagnosis of mountain sickness can be made for sure.
At an altitude of 3500-5800 meters blood oxygen saturation will be much less than 90% (and 90% is considered normal), so manifestations of mountain sickness are more common, and the development of its complications is also often observed: cerebral edema, pulmonary edema.
During sleep, the patient may experience pathological rare breathing (so-called “periodic” breathing, caused by a decrease in the level of carbon dioxide in the blood), mental disorders, and hallucinations. A decrease in carbon dioxide in the body leads to a decrease in the frequency of inhalations during sleep due to a decrease in the activity of the respiratory center of the brain (when a person is awake, the number of inhalations is regulated by consciousness), which further increases hypoxia. This usually manifests itself in the form of attacks of suffocation or even temporary cessation of breathing during sleep.
During intense physical activity, symptoms of altitude sickness may worsen. However, a little physical activity is useful, as it stimulates anaerobic metabolic processes in the body and neutralizes the increase in hypoxia in organs and tissues. The need to move in order to overcome it was mentioned by many high-altitude athletes (Reinhold Messner, Vladimir Shataev, Eduard Myslovsky).
Extreme heights include the level above 5800 m above sea level, prolonged stay at such an altitude is dangerous for humans. High levels of ultraviolet radiation, strong, sometimes hurricane-force winds, and temperature changes quickly lead to dehydration and exhaustion of the body. Therefore, those who climb to such a height must be very hardy and trained to the effects of hypoxia, and must consume a sufficient amount of water and high-calorie, quickly digestible foods during the ascent.
At altitudes above 6000 m complete acclimatization is even more difficult, in connection with this, even many trained high-altitude climbers noted numerous signs of mountain sickness during their stay at high altitudes (fatigue, sleep disturbances, slow reaction, headache, impaired taste, etc.).
At altitudes above 8000 m a non-acclimatized person can be without oxygen for no more than 1-2 days (and then only in the presence of general high fitness and internal reserves). The term “death zone” (lethal zone) is known - a high-altitude zone in which the body, to ensure its own vital functions, spends more energy than it can receive from external sources (nutrition, breathing, etc.). An extreme confirmation of the lethality of altitude is information from aviation medicine - at altitudes of about 10,000 m, a sudden depressurization of the aircraft cabin leads to death if oxygen is not immediately connected.
How does mountain sickness develop?
Most processes in our body occur with the help of oxygen, which, when inhaled, enters the lungs, then, as a result of gas exchange in the lungs, penetrates the blood, and, passing through the heart, is sent to all organs and systems of the human body - to the brain, kidneys, liver, stomach, as well as muscles and ligaments.
As altitude increases, the amount of oxygen in the surrounding air decreases and its amount in the human blood decreases. This condition is called hypoxia. In the case of slight hypoxia, the body responds to a decrease in oxygen levels in tissues, first of all, by increasing heart rate (increasing pulse), increasing blood pressure, and releasing more young red blood cells from the hematopoietic organs - depot (liver, spleen, bone marrow), which capture additional oxygen, normalizing gas exchange in the lungs.
In the mountains, especially high ones, other factors are added to the decrease in oxygen content in the air: physical fatigue, hypothermia, and dehydration at altitude. And in case of accidents, there are also injuries. And if in such a situation you do not influence the body correctly, physiological processes will take place in a “vicious circle”, complications will arise, and the life of the climber may be in danger. At altitude, the speed of pathological processes is very high; for example, the development of pulmonary or cerebral edema can cause the death of the victim within a few hours.
The main difficulty in diagnosing mountain sickness is due, first of all, to the fact that most of its symptoms, with a few exceptions (for example, periodic intermittent breathing), are also found in other diseases: cough, difficulty breathing and shortness of breath - in acute pneumonia, abdominal pain and digestive disorders - in case of poisoning, disturbances of consciousness and orientation - in case of traumatic brain injury. But in the case of mountain sickness, all of these symptoms are observed in the victim either during a rapid rise to altitude, or during prolonged stay at altitude (for example, when waiting out bad weather).
Many conquerors of eight-thousanders noted drowsiness, lethargy, poor sleep with symptoms of suffocation, and their health immediately improved with a rapid loss of altitude.
Common colds, dehydration, insomnia, overwork, and drinking alcohol or coffee also contribute to the development of altitude sickness and worsen well-being at altitude.
And simply the tolerance to high altitudes is very individual: some athletes begin to feel a deterioration in their condition at 3000-4000 m, others feel great at a much higher altitude.
That is, the development of mountain sickness depends on individual resistance to hypoxia, in particular on:
- gender (women tolerate hypoxia better),
- age (the younger the person, the worse he tolerates hypoxia),
- general physical fitness and mental state,
- speed of rise to altitude,
- as well as from past “high-altitude” experience.
The geography of location also influences (for example, 7000 m in the Himalayas is easier to endure than 5000 m on Elbrus).
So how does an athlete’s body react to a significant decrease in oxygen content in the surrounding air?
Pulmonary ventilation increases - breathing becomes more intense and deeper. The work of the heart increases - the minute volume of circulating blood increases, blood flow accelerates. Additional red blood cells are released from blood depots (liver, spleen, bone marrow), resulting in an increase in hemoglobin content in the blood. At the tissue level, capillaries begin to work more intensively, the amount of myoglobin in the muscles increases, metabolic processes intensify, and new metabolic mechanisms are activated, for example, anaerobic oxidation. If hypoxia continues to increase, pathological disorders begin in the body: insufficient oxygen supply to the brain and lungs leads to the development of severe complications. A decrease in oxygen levels in brain tissue first leads to disturbances in behavior and consciousness, and subsequently contributes to the development of cerebral edema. Insufficient gas exchange in the lungs leads to reflex stagnation of blood in the pulmonary circulation and the development of pulmonary edema.
A decrease in blood flow in the kidneys leads to a decrease in the excretory function of the kidneys - first a decrease, and then a complete absence of urine. This is a very alarming sign, because a decrease in excretory function leads to rapid poisoning of the body. A decrease in oxygen in the blood of the gastrointestinal tract can manifest itself as a complete lack of appetite, abdominal pain, nausea, and vomiting. In addition, when the level of oxygen in tissues decreases as a result of impaired water-salt metabolism, dehydration of the body progresses (fluid loss can reach 7-10 liters per day), arrhythmia begins, and heart failure develops. As a result of liver dysfunction, intoxication quickly develops, body temperature rises, and fever in conditions of lack of oxygen increases hypoxia (it has been established that at a temperature of 38°C the body's need for oxygen doubles, and at 39.5°C it increases 4 times).
Attention! If the temperature is high, the patient must be brought down immediately! A “miner” can add a catastrophic “minus” to any pathology!
Worsening the state of health and the effects of cold:
- Firstly, in the cold, inhalation is usually short, and this also increases hypoxia.
- Secondly, at low temperatures, other colds (sore throat, pneumonia) may be associated with pulmonary edema.
- Thirdly, in the cold, the permeability of cell walls is impaired, which leads to additional tissue swelling.
Therefore, at low temperatures, pulmonary edema or cerebral edema occurs and develops faster: at high altitudes and in extreme cold, this period, even death, can be only a few hours instead of the usual 8-12 hours.
The rapid onset of death is explained by the fact that processes develop according to the principle of a “vicious” circle, when subsequent changes aggravate the cause of the process, and vice versa.
As a rule, all complications in the development of mountain sickness develop at night, during sleep, and by morning there is a significant deterioration in the condition. This is due to the horizontal position of the body, decreased respiratory activity, and increased tone of the parasympathetic nervous system. Therefore, if possible, it is extremely important not to put a person suffering from altitude sickness to sleep at altitude, but use every minute to transport the victim down.
The cause of death with cerebral edema is compression of the brain matter by the cranial vault, wedging of the cerebellum into the posterior cranial fossa. Therefore, it is very important to use both diuretics (reducing brain swelling) and sedatives (sleeping pills) at the slightest symptoms of brain damage, because the latter reduce the brain’s need for oxygen.
In pulmonary edema, the cause of death is respiratory failure, as well as obstruction of the airways (asphyxia) by foam formed during swelling of the lung tissue. In addition to this, pulmonary edema during mountain sickness is usually accompanied by heart failure due to overflow of the pulmonary circulation. Therefore, along with diuretics that reduce swelling, it is necessary to give cardiac drugs that increase cardiac output and corticosteroids that stimulate the heart and increase blood pressure levels.
In the functioning of the digestive system, when dehydrated, the secretion of gastric juice decreases, which leads to loss of appetite and disruption of the digestive processes. As a result, the athlete sharply loses weight and complains of discomfort in the abdomen, nausea, and diarrhea. It should be noted that digestive disorders during mountain sickness differ from diseases of the digestive tract, primarily in that the other participants in the group do not observe signs of poisoning (nausea, vomiting). Diseases of the abdominal organs such as perforation of an ulcer or acute appendicitis are always confirmed by the presence of symptoms of peritoneal irritation (pain appears when pressing on the abdomen with a hand or palm, and sharply intensifies when the hand is withdrawn).
In addition, as a result of impaired brain function, a decrease in visual acuity, a decrease in pain sensitivity, and mental disorders are possible.
Symptoms
According to the time of exposure to hypoxia on the body, there are acute And chronic forms of mountain sickness.
Chronic mountain sickness observed in residents of high mountain areas (for example, the village of Kurush in Dagestan, 4000 m), but this is already the sphere of activity of local doctors.
Acute mountain sickness occurs, as a rule, within a few hours, its symptoms develop very quickly.
In addition, they distinguish subacute form of mountain sickness, which lasts up to 10 days. Clinical manifestations of acute and subacute forms of mountain sickness often coincide and differ only in the time of development of complications.
Distinguish light, average And heavy degree of mountain sickness.
For mild mountain sickness characterized by the appearance of lethargy, malaise, rapid heartbeat, shortness of breath and dizziness in the first 6-10 hours after rising to altitude. It is also characteristic that drowsiness and poor sleep are observed simultaneously. If the rise to altitude does not continue, these symptoms disappear after a couple of days as a result of the body’s adaptation to the altitude (acclimatization). There are no objective signs of a mild form of mountain sickness. If these symptoms appear within 3 days after rising to altitude, the presence of some other disease should be assumed.
At moderate mountain sickness characterized by inadequacy and a state of euphoria, which are subsequently replaced by loss of strength and apathy. Symptoms of hypoxia are already more pronounced: severe headache, dizziness. Sleep is disturbed: those who are sick have difficulty falling asleep and often wake up from suffocation, they are often tormented by nightmares. With exertion, the pulse increases sharply and shortness of breath appears. As a rule, appetite completely disappears, nausea appears, and sometimes vomiting. In the mental sphere, there is inhibition on the route, poor or slow execution of commands, and sometimes euphoria develops.
With a rapid loss of altitude, your health immediately improves before your eyes.
At severe mountain sickness symptoms of hypoxia already affect all organs and systems of the body. The result is poor physical well-being, rapid fatigue, heaviness throughout the body, which prevents the athlete from moving forward.
The headache increases, and with a sudden change in body position, dizziness and lightheadedness occur. Due to severe dehydration of the body, severe thirst worries, there is no appetite, and gastrointestinal disorders appear in the form of diarrhea. Possible bloating and pain.
During night sleep, breathing is disturbed (intermittent breathing), hemoptysis may occur (hemoptysis differs from bleeding in the presence of foamy sputum; gastric bleeding, as a rule, is never associated with a cough, and the blood coming from the stomach has the appearance of “coffee grounds” due to for interactions with hydrochloric acid of gastric juice).
When examining the patient: the tongue is coated, dry, lips are bluish, the skin of the face has a grayish tint.
In the absence of treatment and descent, mountain sickness leads to serious complications - pulmonary and cerebral edema.
With pulmonary edema in the chest, mainly behind the sternum, moist rales, gurgling, and bubbling appear. In severe cases, coughing may produce pink, frothy sputum from the mouth. The pressure drops, the pulse increases sharply. If treatment is not started immediately, the patient can die very quickly. Be sure to give the sick person a semi-sitting position to relieve the heart and breathing, give oxygen, and administer intramuscular diuretics (diacarb, furosemide) and corticosteroids (dexomethasone, dexon, hydrocortisone). To facilitate the work of the heart, you can apply tourniquets to the upper third of the shoulders and hips for 15-20 minutes. If the treatment is carried out correctly, the condition should improve quickly, after which an immediate descent should begin. If treatment is not carried out, as a result of heart overload, heart failure quickly joins pulmonary edema: the skin turns blue, severe pain appears in the heart area, a sharp drop in blood pressure, and arrhythmia.
High altitude cerebral edema differs from traumatic brain injury, first of all, by the absence of asymmetry of the face, pupils and facial muscles and is manifested by lethargy and confusion, up to its complete loss. At the very beginning of development, cerebral edema may manifest itself as inappropriate behavior (anger or euphoria), as well as poor coordination of movements. Subsequently, the symptoms of brain damage may increase: the patient does not understand the simplest commands, cannot move, or fix his gaze. As a result of cerebral edema, difficulty breathing and cardiac activity may occur, but this occurs some time after loss of consciousness. Brain edema is relieved by fractional (repeated) administration of diuretics (diacarb, furosemide), mandatory administration of sedatives or hypnotics that reduce the brain's need for oxygen, and mandatory cooling of the victim's head (lowering the temperature by several degrees reduces cerebral edema and prevents the development of complications!) .
Prevention of altitude sickness
Climbers and mountain tourists planning climbs and hikes in the mountains should understand that the likelihood of mountain sickness in participants is reduced by:
- good informational and psychological preparation,
- good physical fitness,
- quality equipment,
- correct acclimatization and well-thought-out climbing tactics.
This is especially important for high altitudes (over 5000 m)!
- Good informational and psychological preparation
Be boring yourself in a good way this word. Find out thoroughly why mountains are dangerous, why heights are dangerous. Nowadays there is no problem finding any information on the Internet. And if you need individual consultation with a specialist - then AlpIndustry employees are at your service.
- Good general physical preparation (GPP)
Prevention of mountain sickness consists, first of all, in the advance creation of a good sports form of the athlete during the preparation phase for events in the mountains. With good general physical fitness, the athlete is less tired, better able to withstand the effects of cold, all his organs are prepared for high loads, including in the presence of oxygen deficiency. In particular, for athletes planning to climb high altitudes, it is necessary to include anaerobic training in the training cycle (running uphill, running with breath holding).
Victor Yanchenko, guide and head of our office in the Elbrus region, on the top of Elbrus.
One of the most experienced guides on Elbrus. More than 200 ascents to Elbrus.
- High-quality equipment
“The right” clothes, purchased in stores focused on mountain sports (“AlpIndustry”), bivouac equipment, equipment to ensure movement in the mountains - all these are factors that will save you from the cold (or heat, which can sometimes “ reach" in the sun with no wind), will allow you to move quickly and economically, will provide a reliable and protected bivouac and hot food. And these are factors to counteract altitude sickness.
Planning should also be included in the “equipment” section. correct selection products: light, easily digestible, high in calories, with good taste. By the way, when choosing products, it is advisable to take into account the taste preferences of each group member.
When climbing at high altitudes, it is necessary to take multivitamins (preferably with a complex of microelements), antioxidants: tinctures of ginseng, golden root, Rhodiola rosea, ascorbic acid, riboxin (it is advisable to carry out additional fortification of the body in advance, 1-2 weeks before leaving for the mountains ). Taking drugs that affect the pulse rate (potassium orotate, asparkam) in the mountains is not advisable due to the occurrence of various forms of cardiac arrhythmias. Be sure to take products to normalize the water-salt balance (rehydron) in your first aid kit or drink slightly salted water.
Well, and about others medications You shouldn’t forget to have anything in your first aid kit, just as you shouldn’t forget to consult with your doctor about its composition.
- Correct acclimatization and well-thought-out climbing tactics
Directly in the mountains, it is important to have good and properly carried out acclimatization, moderate alternation of ascents to heights and descents to the overnight location with constant monitoring of the well-being of group members. In this case, you should gradually increase both the height of the base camp and the height of the “peak” ascent points.
You can encounter a situation where an “athlete”, tired of the office, finally escaped into nature - to the mountains, to in this case- and decides to relax and “to sleep better” to take a dose of alcohol.
So here it is:
The tragic consequences of such “relaxation” in history, even not so long ago, are known: this does not contribute to acclimatization at all, but on the contrary.
Alcohol, even in small doses, is strictly contraindicated in conditions of hypoxia, as it depresses respiration, impairs interstitial fluid exchange, increases the load on the heart and increases oxygen starvation of brain cells.
If the disease does occur...
If, when climbing to a height, one of the group members feels unwell, then in the case of mild to moderate illness, it can be overcome by a smoother acclimatization, without forcing it. That is, go down - come to your senses - go up higher, look at how you are feeling, maybe even spend the night - go down. And so on.
But the main thing is not to miss the symptoms of another disease (see above).
If the disease is severe, the victim must be immediately taken down, as the condition can worsen greatly in a matter of hours, and the descent can become dangerous not only for the victim, but also for other members of the group. Maybe even at night...
Treatment of acute mountain sickness, therefore, begins with the immediate descent of the sick participant to a lower altitude. The best remedy for increasing hypoxia is to increase the oxygen content in the air along with medications.
The following are required when transporting a patient with mountain sickness:
- drinking plenty of water,
- administration of diuretics,
- in case of a sharp drop in pressure or deterioration of the general condition - intramuscular injection of corticosteroids.
(Adrenal cortex hormones - corticosteroids - have an adrenaline-like effect: they increase blood pressure, increase cardiac output, and increase the body’s resistance to disease).
Taking 1-2 aspirin tablets can have some effect during hypoxia - by reducing blood clotting, it promotes better oxygen delivery to the tissues, but aspirin can be taken only in the absence of bleeding or hemoptysis.
Alcohol under conditions of hypoxia is strictly contraindicated - we have already talked about this, but in case of illness - we emphasize: CATEGORICALLY!
Thus, the following will help save the life of a person suffering from mountain sickness:
- firstly, correct and quick diagnosis of the symptoms of the disease,
- secondly, the use of modern medications to reduce hypoxia and prevent the development of severe complications,
- thirdly, the immediate descent of the sick participant in the ascent to a safe height for health.
Attention! The group leader is obliged be well aware of the use of medications in the group first aid kit and their contraindications! Consultation with a doctor is required when purchasing!
Attention! Group members must have an appropriate level of health (approved by a doctor) and notify the manager in case of chronic diseases and allergies!
Attention! We must not forget about one more important point. It may turn out that the strength and skills of your comrades will not be enough to evacuate you safely and quickly. And so that your loved ones and friends do not have to raise funds for a helicopter or the work of professional rescuers, DON'T FORGET ABOUT THE CORRECT INSURANCE POLICY!
Remember that when preparing to climb, Special attention you need to pay attention to the person with whom you are going to the mountain.
This could be a private guide, working illegally or semi-legally, who will offer a “sweet” price for his services. And in this case, if something goes wrong on the climb, then who will be responsible for your life, safety and resolution of conflict situations?
Prices for active tours from officially operating tour operators are not much higher than from clubs and private guides. And by choosing a company that operates legally on the market, you get a number of advantages:
- Routes and programs carefully worked out by professional guides.
- The guarantor of fulfillment of obligations to you is not an individual, but a company that values its reputation and has financial and legal responsibility to its clients.
- Official payments; a complete package of documents and instructions allowing you to cooperate on equal terms and in legal security.
- Guides and experts are strictly selected for vocational training and ability to work with clients. By the way, AlpIndustry, together with the FAR (Russian Mountaineering Federation), is the organizer of the international school of mountain guides in Russia. Education at the School is conducted according to International standard IFMGA/UIAGM/IVBV. Our country is supervised by the Association of Canadian Mountain Guides (ACMG). And school graduates work in the AlpIndustry Adventure Team.
In any case, the choice is yours.
Have a good and safe climb!
Adventure Team "AlpIndustry" on Mera Peak
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