High-Altitude and Wilderness Medicine
At Dr Sood’s clinic a detailed pre-travel health assessment is made to ensure that there are no known contra-indications to the travel vaccinations. This also helps to determine any other travel health risks which may be associated with the client’s travel itinerary, and countries visited, and may be necessary to administer anti-malarial treatment.
Altitude sickness-also known as acute mountain sickness, -is a pathological effect of high altitude on humans, caused by acute exposure to low partial pressure of oxygen at high altitude. It commonly occurs above 2,400 metres.
Acute mountain sickness, high altitude pulmonary oedema and high altitude cerebral oedema are the most important and most common altitude related diseases. Primary prevention is considered the gold standard to avoid altitude illness.
Adequate caloric and fluid intake are rated as high as that of oxygen.
Expedition and wilderness medicine is also concerned with the physical and psychological wellbeing of people in austere environments where access to medical services is difficult or impossible.
The vast majority of medical conditions during remote travel are non-urgent, for example travellers’ diarrhoea, ear ache or skin infections. Some cases that may appear at first to be non-urgent may become urgent if not managed or identified correctly at an early stage, for example a traveller developing a fever in Kenya may be suffering a self-limiting flu-like illness, or may be in the early stages of life-threatening malaria.
Symptoms at high altitude are:
- Hyperventilation/dyspnoea on exertion
- Increased urination
- Awaken many times at night
- Periodic breathing at night
Dehydration in Acute Mountain Sickness
Performance will be increasingly affected by increasing levels of dehydration. Any level of physical activity will be compromised in a dehydrated state, so ensure you are well hydrated before setting off.
There are special medical problems associated with hypoxia at higher altitudes. There are freezing temperatures, and there is potential for trauma due to avalanches, falls, crevasses on glaciers and other terrain hazards. Animal bites are fortunately uncommon occurrences on expedition; wild animals rarely have contact with humans. Dogs inflict the most common animal bites
There are some fundamental problems associated with animal bites Infection
- Wound closure
- Rabies and Wound infection
Tetanus should be adequately covered before going on an expedition. The incubation period for tetanus is 7-10 days, but this is variable. The time period between the first symptom, which is normally stiffness of the masseters, and spasms of other muscle groups, can be as short as 1 day. Spasm of opposing muscles results in rigidity and can lead to ineffective breathing, and laryngeal spasm leading to death.
Anaphylaxis is an extreme and severe allergic reaction. The whole body is affected, often within minutes of exposure to the substance which causes the allergic reaction but can sometimes occur after hours of exposure. Being aware of anaphylaxis and how to administer adrenaline via the Epipen device is very important.
The symptoms of a severe allergic reaction
- generalised flushing of the skin
- nettle rash (hives) anywhere on the body
- swelling of throat and mouth
- difficulty in swallowing or speaking
- alterations in heart rate
- severe asthma
- abdominal pain, nausea and vomiting
- sudden feeling of weakness (drop in blood pressure)
- collapse and unconsciousness
Hypothermia in Acute Mountain Sickness
Hypothermia occurs when a person’s heat loss exceeds their heat generation. To avoid hypothermia, use a two-pronged approach by dressing appropriately and avoiding exhaustion.
The symptoms of hypothermia start with feeling cold, apathy, clumsiness and stumbling followed by shivering. More severe hypothermia is recognised by confusion, lack of shivering, an inability to walk and finally coma. In the early stages, increased insulation, warm drinks and ‘carbs’ should allow a retreat to safety by walking.
Established, severe hypothermia is more difficult to manage as sudden movements of the casualty can precipitate a cardiac arrest