Causes and signs of altitude sickness in humans - treatment and prevention. Occupational health

The Earth's air envelope, which is a mixture of various gases, exerts pressure on the earth's surface and all objects located on it. At sea level, every 1 cm 2 of any surface experiences a pressure of the vertical column of the atmosphere equal to 1.033 kg. Normal pressure is considered to be 760 mm Hg. Art. at sea level at 0°. The value of atmospheric pressure is also determined in bars. One normal atmosphere is equal to 1.01325 bar. One millibar is equal to 0.7501 mm Hg. Art. To the surface human body presses a weight of approximately 15-18 tons, but a person does not feel it, since the pressure inside the body is balanced by atmospheric pressure. Normal daily and annual fluctuations in air pressure are 20-30 mmHg. Art., do not have a noticeable effect on well-being healthy people.

However, in elderly people, as well as in patients with rheumatism, neuralgia, hypertension before sharp deterioration weather, poor health, general malaise, and exacerbation of chronic diseases are often observed. These painful phenomena appear to occur as a result of the decrease in atmospheric pressure and other changes in meteorological factors that accompany bad weather.

As you rise in altitude, atmospheric pressure decreases; the partial pressure of oxygen in the air contained in the alveoli (i.e. that part total pressure air in the alveoli, which is due to oxygen). These data are illustrated in Table 6.

From Table 6 it can be seen that as atmospheric pressure decreases with height, the value of the partial pressure of oxygen in the alveolar air also decreases, which at an altitude of about 15 km is practically equal to zero. But already at an altitude of 3000-4000 m above sea level, a decrease in the partial pressure of oxygen leads to an insufficient supply of oxygen to the body (acute hypoxia) and the occurrence of a number of functional disorders. Headaches, shortness of breath, drowsiness, tinnitus, a feeling of pulsation of the vessels of the temporal region, impaired coordination of movements, pallor of the skin and mucous membranes, etc. appear. Disorders of the central nervous system are expressed in a significant predominance of excitation processes over inhibition processes; there is a deterioration in the sense of smell, a decrease in auditory and tactile sensitivity, a decrease visual functions. This entire symptom complex is usually called altitude sickness, and if it occurs when climbing mountains - mountain sickness(Table 6).

There are five height tolerance zones:
1) safe, or indifferent (up to a height of 1.5-2 km);
2) a zone of full compensation (from 2 to 4 km), where some functional changes in the body are quickly eliminated due to the mobilization of the body’s reserve forces;
3) zone of incomplete compensation (4-5 km);
4) a critical zone (from 6 to 8 km), where the above violations intensify, and death may occur in the least trained people;
5) a lethal zone (above 8 km), where a person can exist for no more than 3 minutes.

If the pressure changes quickly, then functional disorders occur in the ear cavities (pain, tingling, etc.), which can result in rupture eardrum. To eliminate oxygen? fasting uses special equipment that adds oxygen to the inhaled air and protects the body from possible disorders caused by hypoxia. At altitudes above 12 km, only a pressurized cabin or a special spacesuit can provide sufficient partial pressure of oxygen.

It is known, however, that people living in mountain villages at high altitudes, employees of high-mountain stations, as well as trained climbers who rise to an altitude of 7000 m above sea level and more, and pilots who have undergone special training, experience an addiction to others atmospheric conditions; their impact is balanced by compensatory functional changes in the body’s reactivity, which primarily include adaptation of the central nervous system. Phenomena from the hematopoietic, cardiovascular and respiratory systems also play a significant role (an increase in the number of red blood cells and hemoglobin, which are oxygen carriers, an increase in the frequency and depth of breathing, and blood flow speed).

Increased pressure does not occur under normal conditions; it is observed mainly when performing production processes at great depths under water (diving and so-called caisson work). For every 10.3 m of immersion, the pressure increases by one atmosphere. When working at high blood pressure, a decrease in pulse rate and pulmonary ventilation, decreased hearing, pale skin, dry mucous membranes of the nasal and oral cavities, abdominal depression, etc. are observed.

All these phenomena are significantly weakened and ultimately disappear completely with a slow transition to normal atmospheric pressure. However, if this transition occurs quickly, a severe pathological condition called decompression sickness may occur. Its origin is explained by the fact that when staying in conditions high pressure(starting from about 90 m) a large amount of dissolved gases (mainly nitrogen) accumulate in the blood and other body fluids, which, when quickly leaving the high pressure zone to normal, are released in the form of bubbles and clog the lumen of small blood vessels. As a result of the resulting gas embolism, a number of disorders are observed in the form of itching of the skin, damage to joints, bones, muscles, changes in the heart, pulmonary edema, various types of paralysis, etc. In rare cases, death is observed. To prevent decompression sickness, it is necessary, first of all, to organize the work of caisson workers and divers in such a way that the exit to the surface is carried out slowly and gradually to remove excess gases from the blood without the formation of bubbles. In addition, the time spent by divers and caisson workers on the ground must be strictly regulated.

To begin with, let's remember the high school physics course, which explains why and how atmospheric pressure changes depending on altitude. The higher the area is above sea level, the lower the pressure there. It is very simple to explain: atmospheric pressure indicates the force with which a column of air presses on everything that is on the surface of the Earth. Naturally, the higher you rise, the lower the height of the air column, its mass and the pressure exerted will be.

In addition, at altitude the air is rarefied, it contains a much smaller number of gas molecules, which also immediately affects the mass. And we must not forget that with increasing altitude, the air is cleared of toxic impurities, exhaust gases and other “delights”, as a result of which its density decreases and atmospheric pressure drops.

Studies have shown that the dependence of atmospheric pressure on altitude differs as follows: an increase of ten meters causes a decrease in the parameter by one unit. As long as the altitude of the area does not exceed five hundred meters above sea level, changes in the pressure of the air column are practically not felt, but if you rise five kilometers, the values ​​​​will be half the optimal ones. The strength of the pressure exerted by the air also depends on the temperature, which decreases greatly when rising to a higher altitude.

For the level of blood pressure and the general condition of the human body, the value of not only atmospheric pressure, but also partial pressure, which depends on the concentration of oxygen in the air, is very important. In proportion to the decrease in air pressure, the partial pressure of oxygen also decreases, which leads to an insufficient supply of this essential element to the cells and tissues of the body and the development of hypoxia. This is explained by the fact that the diffusion of oxygen into the blood and its subsequent transportation to the internal organs occurs due to the difference in the partial pressure of the blood and the pulmonary alveoli, and when rising to a high altitude, the difference in these readings becomes significantly smaller.

How does altitude affect a person's well-being?

The main negative factor affecting the human body at altitude is the lack of oxygen. It is as a result of hypoxia that acute disorders of the heart and blood vessels develop, increased blood pressure, digestive disorders and a number of other pathologies.

Hypertensive patients and people prone to pressure surges should not climb high into the mountains and it is advisable not to take long flights. They will also have to forget about professional mountaineering and mountain tourism.

The severity of the changes occurring in the body made it possible to distinguish several altitude zones:

• Up to one and a half to two kilometers above sea level is a relatively safe zone in which no special changes are observed in the functioning of the body and the state of vital systems. Deterioration in well-being, decreased activity and endurance are observed very rarely.
• From two to four kilometers - the body tries to cope with the oxygen deficiency on its own, thanks to increased breathing and taking deep breaths. Heavy physical work, which requires the consumption of large amounts of oxygen, is difficult to perform, but light exercise is well tolerated for several hours.
• From four to five and a half kilometers - the state of health noticeably worsens, performing physical work is difficult. Psycho-emotional disorders appear in the form of high spirits, euphoria, and inappropriate actions. When staying at such a height for a long time, headaches, a feeling of heaviness in the head, problems with concentration, and lethargy occur.
• From five and a half to eight kilometers - exercise physical work impossible, the condition worsens sharply, the percentage of loss of consciousness is high.
• Above eight kilometers - at this altitude a person is able to maintain consciousness for a maximum of several minutes, after which deep fainting and death follows.

For metabolic processes to occur in the body, oxygen is necessary, the deficiency of which at altitude leads to the development of altitude sickness. The main symptoms of the disorder are:

• Headache.
• Increased breathing, shortness of breath, lack of air.
• Nose bleed.
• Nausea, attacks of vomiting.
• Joint and muscle pain.
• Sleep disorders.
• Psycho-emotional disorders.

At high altitudes, the body begins to experience a lack of oxygen, as a result of which the functioning of the heart and blood vessels is disrupted, arterial and intracranial pressure increases, and vital internal organs fail. To successfully overcome hypoxia, you need to include nuts, bananas, chocolate, cereals, and fruit juices in your diet.

Effect of altitude on blood pressure levels

When rising to a high altitude, thin air causes an increase in heart rate and an increase in blood pressure. However, with a further increase in altitude, blood pressure levels begin to decrease. A decrease in the oxygen content in the air to critical values ​​causes depression of cardiac activity and a noticeable decrease in pressure in the arteries, while in the venous vessels the levels increase. As a result, a person develops arrhythmia and cyanosis.

Not long ago, a group of Italian researchers decided for the first time to study in detail how altitude affects blood pressure levels. To conduct research, an expedition to Everest was organized, during which the participants’ pressure levels were determined every twenty minutes. During the hike, an increase in blood pressure during ascent was confirmed: the results showed that the systolic value increased by fifteen, and the diastolic value by ten units. It was noted that the maximum blood pressure values ​​were determined at night. The effect of antihypertensive drugs at different altitudes was also studied. It turned out that the drug under study effectively helped at an altitude of up to three and a half kilometers, and when rising above five and a half it became absolutely useless.

According to the degree of influence of climatic and geographical factors on humans, the existing classification subdivides (conditionally) mountain levels into:

Low mountains - up to 1000 m. Here a person does not experience (compared to areas located at sea level) the negative effects of a lack of oxygen, even during hard work;

Middle Mountains - ranging from 1000 to 3000 m. Here, under conditions of rest and moderate activity, no significant changes occur in the body of a healthy person, since the body easily compensates for the lack of oxygen;

Highlands - over 3000 m. What is characteristic of these altitudes is that even under conditions of rest, a complex of changes caused by oxygen deficiency is detected in the body of a healthy person.

If at medium altitudes the human body is affected by the entire complex of climatic and geographical factors, then at high altitudes the lack of oxygen in the tissues of the body - the so-called hypoxia - becomes decisive.

The highlands, in turn, can also be conditionally divided (Fig. 1) into the following zones (according to E. Gippenreiter):

a) Full acclimatization zone - up to 5200-5300 m. In this zone, thanks to the mobilization of all adaptive reactions, the body successfully copes with oxygen deficiency and the manifestation of other negative factors of the influence of altitude. Therefore, it is still possible to locate long-term posts, stations, etc. here, that is, live and work permanently.

b) Zone of incomplete acclimatization - up to 6000 m. Here, despite the activation of all compensatory and adaptive reactions, the human body can no longer fully counteract the influence of height. With a long (several months) stay in this zone, fatigue develops, a person weakens, loses weight, atrophy of muscle tissue is observed, activity sharply decreases, and so-called high-altitude deterioration develops - a progressive deterioration in a person’s general condition during prolonged stay at high altitudes.

c) Adaptation zone - up to 7000 m. The body's adaptation to altitude here is short-lived and temporary. Already with a relatively short (about two to three weeks) stay at such altitudes, the adaptation reactions become exhausted. In this regard, clear signs of hypoxia appear in the body.

d) Partial adaptation zone - up to 8000 m. When staying in this zone for 6-7 days, the body cannot provide the necessary amount of oxygen to even the most important organs and systems. Therefore, their activity is partially disrupted. Thus, the reduced performance of systems and organs responsible for replenishing energy costs does not ensure restoration of strength, and human activity largely occurs at the expense of reserves. At such altitudes, severe dehydration of the body occurs, which also worsens its general condition.

e) Limit (lethal) zone - over 8000 m. Gradually losing resistance to the effects of heights, a person can stay at these heights using internal reserves only for an extremely limited time, about 2 - 3 days.

The given values ​​of the altitudinal boundaries of the zones have, of course, average values. Individual tolerance, as well as a number of factors outlined below, can change the indicated values ​​for each climber by 500 - 1000 m.

The body's adaptation to altitude depends on age, gender, physical and mental state, degree of training, degree and duration of oxygen starvation, intensity of muscle effort, and the presence of high-altitude experience. The individual resistance of the body to oxygen starvation also plays an important role. Previous illnesses, poor nutrition, insufficient rest, lack of acclimatization significantly reduce the body's resistance to mountain sickness - a special condition of the body that occurs when inhaling rarefied air. Great importance has a rapid climb rate. These conditions explain the fact that some people feel some signs of mountain sickness already at relatively low altitudes - 2100 - 2400 m, others are resistant to them up to 4200 - 4500 m, but when climbing to altitudes of 5800 - 6000 m signs of mountain sickness, expressed in varying degrees, appear in almost all people.

The development of altitude sickness is also influenced by some climatic and geographical factors: increased solar radiation, low air humidity, prolonged low temperatures and their sharp difference between night and day, strong winds, and the degree of electrification of the atmosphere. Since these factors depend, in turn, on the latitude of the area, distance from water areas, and so on similar reasons, then the same altitude in different mountainous regions of the country has a different effect on the same person. For example, in the Caucasus, signs of mountain sickness may appear already at altitudes of 3000-3500 m, in Altai, Fan Mountains and Pamir-Alai - 3700 - 4000 m, Tien Shan - 3800-4200 m and Pamir - 4500-5000 m.

Signs and nature of the effects of mountain sickness

Mountain sickness can manifest itself suddenly, especially in cases where a person has significantly exceeded the limits of his individual tolerance in a short period of time, or has experienced excessive overexertion in conditions of oxygen starvation. However, most often, mountain sickness develops gradually. Its first signs are general fatigue, regardless of the amount of work performed, apathy, muscle weakness, drowsiness, malaise, and dizziness. If a person continues to remain at altitude, then the symptoms of the disease increase: digestion is disturbed, frequent nausea and even vomiting are possible, respiratory rhythm disorder, chills and fever appear. The healing process is quite slow.

In the early stages of the disease, no special treatment measures are required. Most often, after active work and proper rest, the symptoms of the disease disappear - this indicates the onset of acclimatization. Sometimes the disease continues to progress, moving into the second stage - chronic. Its symptoms are the same, but expressed to a much stronger degree: headache can be extremely acute, drowsiness is more pronounced, the vessels of the hands are overflowing with blood, nosebleeds are possible, shortness of breath is pronounced, the chest becomes wide, barrel-shaped, observed increased irritability, loss of consciousness is possible. These signs indicate serious illness and the need to urgently transport the patient down. Sometimes the listed manifestations of the disease are preceded by a stage of excitement (euphoria), very reminiscent of alcohol intoxication.

The mechanism of development of mountain sickness is associated with insufficient oxygen saturation of the blood, which affects the functions of many internal organs and systems. Of all the body tissues, the nervous tissue is the most sensitive to oxygen deficiency. In a person who gets to a height of 4000 - 4500 m and prone to mountain sickness, as a result of hypoxia, excitement first arises, expressed in the appearance of a feeling of complacency and own strength. He becomes cheerful and talkative, but at the same time loses control over his actions and cannot really assess the situation. After some time, a period of depression sets in. Cheerfulness is replaced by gloominess, grumpiness, even pugnacity, and even more dangerous attacks of irritability. Many of these people do not rest in their sleep: sleep is restless, accompanied by fantastic dreams that have the nature of forebodings.

At higher altitudes, hypoxia has a more serious impact on functional state higher nerve centers, causing dulling of sensitivity, impaired judgment, loss of self-criticism, interest and initiative, and sometimes memory loss. The speed and accuracy of the reaction noticeably decreases; as a result of the weakening of internal inhibition processes, movement coordination is disrupted. Mental and physical depression, expressed in slowness of thinking and action, a noticeable loss of intuition and the ability to think logically, change conditioned reflexes. However, at the same time, a person believes that his consciousness is not only clear, but also unusually sharp. He continues to do what he was doing before he was seriously affected by hypoxia, despite the sometimes dangerous consequences of his actions.

The sick person may develop obsession, a feeling of the absolute correctness of one’s actions, intolerance to critical remarks, and this, if the group leader, a person responsible for the lives of other people, finds himself in such a state, becomes especially dangerous. It has been noticed that under the influence of hypoxia, people often make no attempts to get out of an obviously dangerous situation.

It is important to know what the most common changes in human behavior occur at altitude under the influence of hypoxia. Based on the frequency of occurrence, these changes are arranged in the following sequence:

Disproportionately great effort when completing a task;

A more critical attitude towards other travel participants;

Reluctance to do mental work;

Increased irritability of the senses;

Touchiness;

Irritability when receiving comments about work;

Difficulty concentrating;

Slowness of thinking;

Frequent, obsessive return to the same topic;

Difficulty remembering.

As a result of hypoxia, thermoregulation can also be disrupted, which is why, in some cases, at low temperatures, the body’s heat production decreases, and at the same time, its loss through the skin increases. Under these conditions, a person suffering from altitude sickness is more susceptible to chilling than other participants in the trip. In other cases, chills and an increase in body temperature by 1-1.5 ° C may occur.

Hypoxia also affects many other organs and systems of the body.

Respiratory system.

If at rest a person at altitude does not experience shortness of breath, lack of air or difficulty breathing, then during physical activity at high altitudes all these phenomena begin to be noticeably felt. For example, one of the participants in climbing Everest took 7-10 steps for each step at an altitude of 8200 meters. full breaths and exhalations. But even at such a slow pace of movement, he rested for up to two minutes every 20-25 meters of the way. Another participant in the climb, in one hour of movement and being at an altitude of 8500 meters, climbed a fairly easy section to a height of only about 30 meters.

Performance.

It is well known that any muscular activity, and especially intense activity, is accompanied by an increase in blood supply to the working muscles. However, if in plain conditions the body can provide the required amount of oxygen relatively easily, then with an ascent to a high altitude, even with the maximum use of all adaptive reactions, the supply of oxygen to the muscles is disproportionate to the degree of muscle activity. As a result of this discrepancy, oxygen starvation, and underoxidized metabolic products accumulate in the body in excess quantities. Therefore, a person’s performance decreases sharply with increasing altitude. So (according to E. Gippenreiter) at an altitude of 3000 m it is 90% at an altitude of 4000 m. -80%, 5500 m- 50%, 6200 m- 33% and 8000 m- 15-16% of the maximum level of work performed at sea level.

Even after the end of work, despite the cessation of muscle activity, the body continues to be under tension, consuming an increased amount of oxygen for some time in order to eliminate the oxygen debt. It should be noted that the time during which this debt is eliminated depends not only on the intensity and duration of muscle work, but also on the degree of training of the person.

The second, although less important, reason for the decrease in the body's performance is overload of the respiratory system. It is the respiratory system, by increasing its activity up to a certain time, that can compensate for the sharply increasing oxygen demand of the body in a rarefied air environment.

Table 1

Height in meters	Increase in pulmonary ventilation in % (with the same work)

However, the capabilities of pulmonary ventilation have their own limit, which the body reaches before the maximum performance of the heart occurs, which reduces the required amount of oxygen consumed to a minimum. Such restrictions are explained by the fact that a decrease in the partial pressure of oxygen leads to increased pulmonary ventilation, and consequently to increased “washing out” of CO 2 from the body. But a decrease in the partial pressure of CO 2 reduces the activity of the respiratory center and thereby limits the volume of pulmonary ventilation.

At altitude, pulmonary ventilation reaches maximum values ​​even when performing an average load for normal conditions. Therefore, the maximum amount of intensive work in a certain time that a tourist can perform in high altitude conditions is less, and the recovery period after work in the mountains is longer than at sea level. However, with a long stay at the same altitude (up to 5000-5300 m) Due to acclimatization of the body, the level of performance increases.

Digestive system.

At altitude, appetite changes significantly, absorption of water and nutrients decreases, and excretion gastric juice, the functions of the digestive glands change, which leads to disruption of the processes of digestion and absorption of food, especially fats. As a result, the person suddenly loses weight. Thus, during one of the expeditions to Everest, climbers who lived at an altitude of more than 6000 m within 6-7 weeks, lost weight from 13.6 to 22.7 kg. At altitude, a person may feel an imaginary feeling of fullness in the stomach, distension in the epigastric region, nausea, and diarrhea that cannot be treated with medication.

Vision.

At altitudes of about 4500 m normal visual acuity is possible only at a brightness 2.5 times higher than normal for plain conditions. At these altitudes, there is a narrowing of the peripheral field of vision and a noticeable “fogging” of vision as a whole. At high altitudes, the accuracy of gaze fixation and the correctness of determining distance also decreases. Even in mid-altitude conditions, vision weakens at night, and the period of adaptation to darkness lengthens.

Pain sensitivity

as hypoxia increases, it decreases until it is completely lost.

Dehydration of the body.

The excretion of water from the body, as is known, is carried out mainly by the kidneys (1.5 liters of water per day), skin (1 liter), lungs (about 0.4 k) and intestines (0.2-0.3 l). It has been established that the total water consumption in the body, even in a state of complete rest, is 50-60 G at one o'clock. With average physical activity in normal climatic conditions at sea level, water consumption increases to 40-50 grams per day for every kilogram of a person’s weight. In total, on average, under normal conditions, about 3 are released per day. l water. With increased muscle activity, especially in hot conditions, the release of water through the skin increases sharply (sometimes up to 4-5 liters). But intense muscular work performed in high altitude conditions, due to a lack of oxygen and dry air, sharply increases pulmonary ventilation and thereby increases the amount of water released through the lungs. All this leads to the fact that the total loss of water among participants in difficult high-altitude trips can reach 7-10 l per day.

Statistics show that in high altitude conditions it more than doubles respiratory morbidity. Inflammation of the lungs often takes on a lobar form, is much more severe, and the resorption of inflammatory foci is much slower than in plain conditions.

Pneumonia begins after physical fatigue and hypothermia. IN initial stage there is poor health, some shortness of breath, rapid pulse, and cough. But after about 10 hours, the patient’s condition worsens sharply: the respiratory rate is over 50, the pulse is 120 per minute. Despite taking sulfonamides, pulmonary edema develops within 18-20 hours, which in high altitude conditions great danger. The first signs of acute pulmonary edema: dry cough, complaints of compression slightly below the sternum, shortness of breath, weakness during physical activity. In serious cases, hemoptysis, suffocation, severe disorder consciousness, after which death occurs. The course of the disease often does not exceed one day.

The formation of pulmonary edema at altitude is usually based on the phenomenon of increased permeability of the walls of the pulmonary capillaries and alveoli, as a result of which foreign substances (protein masses, blood elements and microbes) penetrate into the alveoli of the lungs. Therefore, the useful capacity of the lungs is sharply reduced within a short time. Hemoglobin arterial blood, washing the outer surface of the alveoli, filled not with air, but with protein masses and blood elements, cannot be adequately saturated with oxygen. As a result, a person quickly dies from insufficient (below the permissible norm) oxygen supply to the body’s tissues.

Therefore, even in the case of the slightest suspicion of a respiratory disease, the group must immediately take measures to bring the sick person down as quickly as possible, preferably to altitudes of about 2000-2500 meters.

Mechanism of development of mountain sickness

Dry atmospheric air contains: nitrogen 78.08%, oxygen 20.94%, carbon dioxide 0.03%, argon 0.94% and other gases 0.01%. When rising to a height, this percentage does not change, but the density of the air changes, and, consequently, the values ​​of the partial pressures of these gases.

According to the law of diffusion, gases move from a medium with a higher partial pressure to a medium with a lower pressure. Gas exchange, both in the lungs and in the human blood, occurs due to the existing difference in these pressures.

At normal atmospheric pressure 760 mmp t. Art. The partial pressure of oxygen is:

760x0.2094=159 mmHg Art., where 0.2094 is the percentage of oxygen in the atmosphere equal to 20.94%.

Under these conditions, the partial pressure of oxygen in the alveolar air (inhaled with air and entering the alveoli of the lungs) is about 100 mmHg Art. Oxygen is poorly soluble in the blood, but it is bound by the hemoglobin protein found in red blood globules- red blood cells. Under normal conditions, due to the high partial pressure of oxygen in the lungs, hemoglobin in arterial blood is saturated with oxygen up to 95%.

When passing through tissue capillaries, blood hemoglobin loses about 25% of oxygen. Therefore, venous blood carries up to 70% oxygen, the partial pressure of which, as can be easily seen from the graph (Fig. 2), amounts to

0 10 20 30 40 50 60 70 80 90 100

Oxygen partial pressure mm.pm.cm.

Rice. 2.

at the moment of flow venous blood to the lungs at the end of the circulatory cycle only 40 mmHg Art. Thus, between venous and arterial blood there is a significant pressure difference equal to 100-40 = 60 mmHg Art.

Between carbon dioxide inhaled with air (partial pressure 40 mmHg Art.), and carbon dioxide flowing with venous blood to the lungs at the end of the circulatory cycle (partial pressure 47-50 mmHg.), pressure drop is 7-10 mmHg Art.

As a result of the existing pressure difference, oxygen passes from the pulmonary alveoli into the blood, and directly in the tissues of the body, this oxygen from the blood diffuses into the cells (into an environment with an even lower partial pressure). Carbon dioxide, on the contrary, first passes from the tissues into the blood, and then, when venous blood approaches the lungs, from the blood into the alveoli of the lung, from where it is exhaled into the surrounding air (Fig. 3).

Rice. 3.

With increasing altitude, the partial pressures of gases decrease. So, at an altitude of 5550 m(which corresponds to atmospheric pressure 380 mmHg Art.) for oxygen it is equal to:

380x0.2094=80 mmHg Art.,

that is, it is reduced by half. At the same time, naturally, the partial pressure of oxygen in arterial blood also decreases, as a result of which not only the saturation of hemoglobin in the blood with oxygen decreases, but also due to the sharp reduction in the pressure difference between arterial and venous blood, the transfer of oxygen from the blood to the tissues significantly worsens. This is how oxygen deficiency occurs—hypoxia, which can lead to mountain sickness in a person.

Naturally, a number of protective compensatory and adaptive reactions occur in the human body. So, first of all, lack of oxygen leads to excitation of chemoreceptors - nerve cells, very sensitive to a decrease in oxygen partial pressure. Their excitement serves as a signal for deepening and then increased breathing. The expansion of the lungs that occurs in this case increases their alveolar surface and thereby contributes to a more rapid saturation of hemoglobin with oxygen. Thanks to this, as well as a number of other reactions, a large amount of oxygen enters the body.

However, with increased breathing, ventilation of the lungs increases, during which increased removal (“washing out”) of carbon dioxide from the body occurs. This phenomenon is especially intensified with intensification of work in high altitude conditions. So, if on the plain at rest within one minute approximately 0.2 l CO 2, and during hard work - 1.5-1.7 l, then in high altitude conditions, on average per minute the body loses about 0.3-0.35 l CO 2 at rest and up to 2.5 l during intense muscular work. As a result, a lack of CO 2 occurs in the body - the so-called hypocapnia, characterized by a decrease in the partial pressure of carbon dioxide in the arterial blood. But carbon dioxide plays an important role in regulating the processes of respiration, blood circulation and oxidation. A serious lack of CO 2 can lead to paralysis of the respiratory center, a sharp fall blood pressure, deterioration of heart function, disruption nervous activity. Thus, a decrease in blood pressure CO 2 by an amount from 45 to 26 mm. r t.st. reduces blood circulation to the brain by almost half. That is why cylinders intended for breathing at high altitudes are filled not with pure oxygen, but with a mixture of it with 3-4% carbon dioxide.

A decrease in CO 2 content in the body disrupts the acid-base balance towards an excess of alkalis. Trying to restore this balance, the kidneys spend several days intensively removing this excess of alkalis from the body along with urine. This achieves acid-base balance at a new, lower level, which is one of the main signs of the end of the adaptation period (partial acclimatization). But at the same time, the amount of the body’s alkaline reserve is disrupted (decreased). When suffering from mountain sickness, a decrease in this reserve contributes to its further development. This is explained by the fact that a fairly sharp decrease in the amount of alkalis reduces the blood’s ability to bind acids (including lactic acid) formed during hard work. This is in short term changes the acid-base ratio towards an excess of acids, which disrupts the functioning of a number of enzymes, leads to disorganization of the metabolic process and, most importantly, inhibition of the respiratory center occurs in a seriously ill patient. As a result, breathing becomes shallow, carbon dioxide is not completely removed from the lungs, accumulates in them and prevents oxygen from reaching hemoglobin. In this case, suffocation quickly sets in.

From all that has been said, it follows that although the main cause of mountain sickness is a lack of oxygen in the tissues of the body (hypoxia), the lack of carbon dioxide (hypocapnia) also plays a fairly large role here.

Acclimatization

During a long stay at altitude, a number of changes occur in the body, the essence of which boils down to maintaining normal life person. This process is called acclimatization. Acclimatization is the sum of adaptive-compensatory reactions of the body, as a result of which good general condition is maintained, weight remains constant, normal performance and the normal course of psychological processes. A distinction is made between complete and incomplete, or partial, acclimatization.

Due to the relatively short period of stay in the mountains, mountain tourists and climbers are characterized by partial acclimatization and adaptation-short-term(as opposed to final or long-term) adaptation of the body to new climatic conditions.

In the process of adapting to the lack of oxygen in the body, the following changes occur:

Since the cerebral cortex is extremely sensitive to oxygen deficiency, the body in high altitude conditions primarily strives to maintain proper oxygen supply to the central nervous system by reducing the oxygen supply to other, less important organs;

The respiratory system is also highly sensitive to lack of oxygen. The respiratory organs respond to a lack of oxygen by first breathing deeper (increasing its volume):

table 2

Height, m		5000	6000
Inhaled volume air, ml			1000

and then by increasing the respiratory rate:

Table 3
	Breathing rate
Nature of movement	at sea level	at an altitude of 4300 m
Walking at speed 6,4 km/hour	17,2
Walking at 8.0 speed km/hour	20,0

As a result of some reactions caused by oxygen deficiency, not only the number of erythrocytes (red blood cells containing hemoglobin) increases in the blood, but also the amount of hemoglobin itself (Fig. 4).

All this causes an increase in the oxygen capacity of the blood, that is, the ability of the blood to carry oxygen to the tissues increases and thus supply the tissues with the necessary amount. It should be noted that the increase in the number of red blood cells and the percentage of hemoglobin is more pronounced if the ascent is accompanied by intense muscle load, that is, if the adaptation process is active. The degree and rate of growth in the number of red blood cells and hemoglobin content also depend on geographical features certain mountainous regions.

The total amount of circulating blood also increases in the mountains. However, the load on the heart does not increase, since at the same time the capillaries expand, their number and length increase.

In the first days of a person’s stay in high altitude conditions (especially in poorly trained people), the minute volume of the heart increases and the pulse increases. Thus, physically poorly trained mountain climbers have high 4500m pulse increases by an average of 15, and at an altitude of 5500 m - at 20 beats per minute.

Upon completion of the acclimatization process at altitudes up to 5500 m all these parameters are reduced to normal values ​​characteristic of normal activities at low altitudes. The normal functioning of the gastrointestinal tract is also restored. However, at high altitudes (more than 6000 m) pulse, breathing, and the work of the cardiovascular system never decrease to normal values, because here some human organs and systems are constantly under conditions of a certain tension. So, even during sleep at altitudes of 6500-6800 m The pulse rate is about 100 beats per minute.

It is quite obvious that for each person the period of incomplete (partial) acclimatization has different duration. It occurs much faster and with fewer functional deviations in physically healthy people aged 24 to 40 years. But in any case, a 14-day stay in the mountains under conditions of active acclimatization is sufficient for a normal body to adapt to new climatic conditions.

To eliminate the possibility of serious mountain sickness, as well as to shorten the acclimatization time, we can recommend the following set of measures, carried out both before leaving for the mountains and during the trip.

Before a long high-mountain trip, including passes above 5000 in the route of your route m, all candidates must be subjected to a special medical and physiological examination. Persons who cannot tolerate oxygen deficiency, who are physically insufficiently prepared, or who have suffered from pneumonia, sore throat or serious flu during the pre-trip preparation period should not be allowed to participate in such hikes.

The period of partial acclimatization can be shortened if the participants of the upcoming trip begin regular general physical training in advance, several months before going to the mountains, especially to increase the body’s endurance: long-distance running, swimming, underwater sports, skating and skiing. During such training, a temporary lack of oxygen occurs in the body, which is higher, the greater the intensity and duration of the load. Since the body here works in conditions somewhat similar in terms of oxygen deficiency to being at altitude, a person develops an increased resistance of the body to the lack of oxygen when performing muscular work. In the future, in mountainous conditions, this will facilitate adaptation to altitude, speed up the adaptation process, and make it less painful.

You should know that among tourists who are physically unprepared for high-altitude travel, the vital capacity of the lungs at the beginning of the hike even decreases somewhat, the maximum performance of the heart (compared to trained participants) also becomes 8-10% less, and the reaction of increasing hemoglobin and red blood cells with oxygen deficiency is delayed .

The following activities are carried out directly during the hike: active acclimatization, psychotherapy, psychoprophylaxis, organization of appropriate nutrition, use of vitamins and adaptogens (means that increase the body’s performance), complete cessation of smoking and alcohol, systematic condition monitoring health, use of certain medications.

Active acclimatization for mountaineering and for high-mountain hiking trips has differences in the methods of its implementation. This difference is explained, first of all, by the significant difference in the heights of the climbing objects. So, if for climbers this height can be 8842 m, then for the most prepared tourist groups it will not exceed 6000-6500 m(several passes in the area of ​​the High Wall, Trans-Alay and some others ridges in the Pamirs). The difference lies in the fact that climbing to the peaks along technically difficult routes takes several days, and along complex traverses even weeks (without a significant loss of altitude at individual intermediate stages), while in high-mountain hiking trips, which have as a rule, they are longer, and less time is spent on overcoming the passes.

Lower altitudes, shorter stay at these W- honeycombs and a faster descent with a significant loss of altitude greatly facilitate the acclimatization process for tourists, and quite multiple alternating ascents and descents softens, or even stops, the development of mountain sickness.

Therefore, climbers during high-altitude ascents are forced to allocate up to two weeks at the beginning of the expedition for training (acclimatization) ascents to lower peaks, which differ from the main object of ascent to an altitude of about 1000 meters. For tourist groups whose routes pass through passes with an altitude of 3000-5000 m, no special acclimatization exits are required. For this purpose, as a rule, it is sufficient to choose a route such that during the first week - 10 days the height of the passes traversed by the group would gradually increase.

Since the greatest discomfort caused by the general fatigue of a tourist who has not yet become involved in the hiking life is usually felt in the first days of the hike, even when organizing a day trip at this time, it is recommended to conduct classes on movement techniques, on the construction of snow huts or caves, as well as exploration or training trips to height. These practical exercises and activities should be carried out at a good pace, which forces the body to react more quickly to thin air and to more actively adapt to changes in climatic conditions. N. Tenzing’s recommendations are interesting in this regard: at altitude, even in a bivouac, you need to be physically active - heat snow water, monitor the condition of tents, check equipment, move more, for example, after setting up tents, take part in the construction of a snow kitchen, help distribute ready-made food by tents.

Proper nutrition is also essential in the prevention of mountain sickness. At an altitude of over 5000 m The daily diet should have at least 5000 large calories. The carbohydrate content in the diet should be increased by 5-10% compared to normal nutrition. In areas associated with intense muscle activity, you should first consume an easily digestible carbohydrate - glucose. Increased consumption of carbohydrates contributes to the formation of more carbon dioxide, which the body lacks. The amount of fluid consumed in high altitude conditions and, especially, when performing intensive work associated with movement along difficult sections of the route, should be at least 4-5 l per day. This is the most decisive measure to combat dehydration. In addition, an increase in the volume of fluid consumed promotes the removal of under-oxidized metabolic products from the body through the kidneys.

The human body performing long-term intensive work in high altitude conditions requires an increased (2-3 times) amount of vitamins, especially those that are part of enzymes involved in the regulation of redox processes and closely related to metabolism. These are B vitamins, where the most important are B 12 and B 15, as well as B 1, B 2 and B 6. Thus, vitamin B 15, in addition to what has been said, helps to increase the body’s performance at altitude, significantly facilitating the performance of large and intense loads, increases the efficiency of oxygen use, activates oxygen metabolism in tissue cells, and increases altitude stability. This vitamin enhances the mechanism of active adaptation to lack of oxygen, as well as the oxidation of fats at altitude.

In addition to them, vitamins C, PP and folic acid in combination with iron glycerophosphate and metacil also play an important role. This complex has an effect on increasing the number of red blood cells and hemoglobin, that is, increasing the oxygen capacity of the blood.

The acceleration of adaptation processes is also influenced by the so-called adaptogens - ginseng, Eleutherococcus and acclimatizin (a mixture of Eleutherococcus, Schisandra and yellow sugar). E. Gippenreiter recommends the following complex of drugs that increase the body’s adaptability to hypoxia and alleviate the course of mountain sickness: eleutherococcus, diabazole, vitamins A, B 1, B 2, B 6, B 12, C, PP, calcium pantothenate, methionine, calcium gluconate, calcium glycerophosphate and potassium chloride. The mixture proposed by N. Sirotinin is also effective: 0.05 g ascorbic acid, 0,5 G. citric acid and 50 g of glucose per dose. We can also recommend a dry blackcurrant drink (in briquettes of 20 G), containing citric and glutamic acids, glucose, sodium chloride and sodium phosphate.

How long after returning to the plain does the body retain the changes that occurred in it during the process of acclimatization?

At the end of a trip in the mountains, depending on the altitude of the route, changes in the respiratory system, blood circulation and the composition of the blood itself acquired during the process of acclimatization pass quite quickly. Thus, the increased hemoglobin content decreases to normal in 2-2.5 months. Over the same period, the increased ability of the blood to carry oxygen also decreases. That is, the body’s acclimatization to altitude lasts only up to three months.

True, after repeated trips to the mountains, the body develops a kind of “memory” for adaptive reactions to altitude. Therefore, the next time he goes to the mountains, his organs and systems are found faster along “beaten paths.” Right way to adapt the body to a lack of oxygen.

Providing assistance with mountain sickness

If, despite the measures taken, any of the participants in the high-altitude trek exhibit symptoms of altitude sickness, it is necessary:

For headaches, take citramon, pyramidon (no more than 1.5 g per day), analgin (no more than 1 G for a single dose and 3 g per day) or combinations thereof (troika, quintuple);

For nausea and vomiting - aeron, sour fruits or their juices;

For insomnia - Noxiron, when a person has difficulty falling asleep, or Nembutal, when sleep is not deep enough.

When using medications at high altitudes, special care should be taken. First of all, this applies to biological active substances(phenamine, phenatine, pervitin), stimulating the activity of nerve cells. It should be remembered that these substances create only a short-term effect. Therefore, it is better to use them only when absolutely necessary, and even then during the descent, when the duration of the upcoming movement is not long. An overdose of these drugs leads to depletion of the nervous system, to sharp decline performance. An overdose of these drugs is especially dangerous in conditions of prolonged oxygen deficiency.

If the group has decided to urgently descend a sick participant, then during the descent it is necessary not only to systematically monitor the patient’s condition, but also to regularly give injections of antibiotics and drugs that stimulate human cardiac and respiratory activity (lobelia, cardamine, corazol or norepinephrine).

SUN EXPOSURE

Sunburn.

From prolonged exposure to the sun on the human body, sunburns form on the skin, which can cause a painful condition for tourists.

Solar radiation is a stream of rays of the visible and invisible spectrum, having different biological activity. When exposed to the sun, there is simultaneous exposure to:

Direct solar radiation;

Scattered (arrived due to the scattering of part of the flow of direct solar radiation in the atmosphere or reflection from clouds);

Reflected (as a result of reflection of rays from surrounding objects).

The amount of solar energy flow falling on a particular area of ​​the earth’s surface depends on the height of the sun, which, in turn, is determined geographical latitude of a given area, time of year and day.

If the sun is at its zenith, then its rays travel the longest shortcut through the atmosphere. At a sun altitude of 30°, this path doubles, and at sunset - 35.4 times more than with a vertical incidence of the rays. Passing through the atmosphere, especially through its lower layers, which contain suspended particles of dust, smoke and water vapor, the sun's rays are absorbed and scattered to a certain extent. Therefore, the longer the path of these rays through the atmosphere, the more polluted it is, the lower the intensity of solar radiation they have.

With increasing altitude, the thickness of the atmosphere through which the sun's rays pass decreases, and its most dense, moist and dusty lower layers are excluded. Due to the increase in atmospheric transparency, the intensity of direct solar radiation increases. The nature of the intensity change is shown in the graph (Fig. 5).

Here the flow intensity at sea level is taken to be 100%. The graph shows that the amount of direct solar radiation in the mountains increases significantly: by 1-2% with an increase in every 100 meters.

The total intensity of the direct solar radiation flux, even at the same altitude of the sun, changes its value depending on the season. Thus, in summer, due to rising temperatures, increasing humidity and dust reduce the transparency of the atmosphere so much that the flow value at a sun altitude of 30° is 20% less than in winter.

However, not all components of the spectrum of sunlight change their intensity to the same extent. The intensity increases especially sharply ultraviolet rays are the most active physiologically: it has a pronounced maximum at a high position of the sun (at noon). The intensity of these rays this period in the same weather conditions the time required for

redness of the skin, at an altitude of 2200 m 2.5 times, and at an altitude of 5000 m 6 times less than at an altitude of 500 winds (Fig. 6). As the altitude of the sun decreases, this intensity drops sharply. So, for a height of 1200 m this dependence is expressed by the following table (the intensity of ultraviolet rays at a sun altitude of 65° is taken as 100%):

Table4

Height of the sun, degrees.
Ultraviolet ray intensity,%		76,2	35,3	13,0

If the clouds of the upper tier weaken the intensity of direct solar radiation, usually only to an insignificant extent, then denser clouds of the middle and especially lower tiers can reduce it to zero .

Scattered radiation plays a significant role in the total amount of incoming solar radiation. Scattered radiation illuminates places in the shade, and when the sun is obscured by dense clouds over an area, it creates general daylight illumination.

The nature, intensity and spectral composition of scattered radiation are related to the altitude of the sun, air transparency and cloud reflectivity.

Scattered radiation in a clear sky without clouds, caused mainly by atmospheric gas molecules, is sharply different in its spectral composition both from other types of radiation and from scattered radiation in a cloudy sky. The maximum energy in its spectrum is shifted to the region of shorter waves. And although the intensity of scattered radiation under a cloudless sky is only 8-12% of the intensity of direct solar radiation, the abundance of ultraviolet rays in the spectral composition (up to 40-50% of the total number of scattered rays) indicates its significant physiological activity. The abundance of short-wavelength rays also explains bright blue color the sky, the bluer of which is more intense the cleaner the air.

In the lower layers of air, when solar rays are scattered from large suspended particles of dust, smoke and water vapor, the maximum intensity shifts to the region of longer waves, as a result of which the color of the sky becomes whitish. In a whitish sky or in the presence of light fog, the total intensity of scattered radiation increases by 1.5-2 times.

When clouds appear, the intensity of scattered radiation increases even more. Its magnitude is closely related to the number, shape and location of clouds. So, if when the sun is high, the sky is covered by clouds by 50-60%, then the intensity of scattered solar radiation reaches values ​​equal to the flux of direct solar radiation. With further increase in cloudiness and especially as it thickens, the intensity decreases. With cumulonimbus clouds it can be even lower than with a cloudless sky.

It should be taken into account that if the flux of scattered radiation is higher, the lower the transparency of the air, then the intensity of ultraviolet rays in this type of radiation is directly proportional to the transparency of the air. In the daily course of changes in illumination, the highest value of scattered ultraviolet radiation occurs in the middle of the day, and in the annual course - in winter.

The magnitude of the total flux of scattered radiation is also influenced by the energy of the rays reflected from the earth's surface. Thus, in the presence of clean snow cover, scattered radiation increases by 1.5-2 times.

The intensity of reflected solar radiation depends on physical properties surface and the angle of incidence of sunlight. Wet black soil reflects only 5% of the rays falling on it. This is because reflectivity decreases significantly with increasing soil moisture and roughness. But alpine meadows reflect 26%, polluted glaciers - 30%, clean glaciers and snow surfaces - 60-70%, and freshly fallen snow - 80-90% of the incident rays. Thus, when moving in the highlands on snow-covered glaciers, a person is exposed to a reflected flux that is almost equal to direct solar radiation.

The reflectivity of individual rays included in the spectrum of sunlight is not the same and depends on the properties of the earth's surface. Thus, water practically does not reflect ultraviolet rays. The reflection of the latter from the grass is only 2-4%. At the same time, for freshly fallen snow, the reflection maximum is shifted to the short-wave range (ultraviolet rays). You should know that the lighter the surface, the greater the amount of ultraviolet rays reflected from the earth's surface. It is interesting to note that the reflectivity of human skin for ultraviolet rays is on average 1-3%, that is, 97-99% of these rays falling on the skin are absorbed by it.

Under normal conditions, a person is faced not with one of the listed types of radiation (direct, scattered or reflected), but with their total impact. On the plains, this total exposure under certain conditions can be more than twice the intensity of exposure to direct sunlight. When traveling in the mountains at medium altitudes, the intensity of radiation in general can be 3.5-4 times, and at an altitude of 5000-6000 m 5-5.5 times higher than normal flat conditions.

As has already been shown, with increasing altitude the total flux of ultraviolet rays especially increases. At high altitudes, their intensity can reach values ​​exceeding the intensity of ultraviolet irradiation under direct solar radiation in plain conditions by 8-10 times!

By affecting exposed areas of the human body, ultraviolet rays penetrate human skin to a depth of only 0.05 to 0.5 mm, Causing, at moderate doses of radiation, redness and then darkening (tanning) of the skin. In the mountains, exposed areas of the body are exposed to solar radiation throughout the daylight hours. Therefore, if the necessary measures are not taken in advance to protect these areas, body burns can easily occur.

Externally, the first signs of burns associated with solar radiation do not correspond to the degree of damage. This degree is revealed somewhat later. Based on the nature of the injury, burns are generally divided into four degrees. For the sunburns under consideration, in which only the upper layers of the skin are affected, only the first two (lightest) degrees are inherent.

I is the mildest degree of burn, characterized by redness of the skin in the burn area, swelling, burning, pain and some development of skin inflammation. Inflammatory phenomena pass quickly (after 3-5 days). Pigmentation remains in the burn area, and sometimes peeling of the skin is observed.

Stage II is characterized by a more pronounced inflammatory reaction: intense redness of the skin and detachment of the epidermis with the formation of blisters filled with clear or slightly cloudy liquid. Complete restoration of all layers of skin occurs in 8-12 days.

First degree burns are treated by tanning the skin: the burned areas are moistened with alcohol and a solution of potassium permanganate. When treating second degree burns, primary treatment of the burn site is performed: wiping with gasoline or 0.5%. solution of ammonia, irrigating the burned area with antibiotic solutions. Considering the possibility of infection while traveling, it is better to cover the burn area with an aseptic bandage. Rarely changing the dressing promotes the rapid restoration of affected cells, since this does not damage the layer of delicate young skin.

During a mountain or ski trip, the neck, earlobes, face and skin suffer the most from exposure to direct sunlight. outside hands As a result of exposure to scattered, and when moving through the snow and reflected rays, the chin, lower part of the nose, lips, and skin under the knees are subject to burns. Thus, almost any open area of ​​the human body is susceptible to burns. On warm spring days when driving in the highlands, especially in the first period, when the body does not yet have a tan, under no circumstances should you be allowed to remain in the sun for a long time (more than 30 minutes) without a shirt. Tender skin The abdomen, lower back and sides of the chest are most sensitive to ultraviolet rays. We must strive to ensure that in sunny weather, especially in the middle of the day, all parts of the body are protected from exposure to all types of sunlight. Subsequently, with repeated repeated exposure to ultraviolet irradiation, the skin becomes tanned and becomes less sensitive to these rays.

The skin of the hands and face is the least susceptible to ultraviolet rays.

Rice. 7

But due to the fact that the face and hands are the most exposed areas of the body, they suffer most from sunburn. Therefore, on sunny days, the face should be protected with a gauze bandage. To prevent the gauze from getting into your mouth when breathing deeply, it is advisable to use a piece of wire (length 20-25 cm, diameter 3 mm), passed through the bottom of the bandage and bent in an arc (rice. 7).

In the absence of a mask, the parts of the face most susceptible to burns can be covered with a protective cream such as “Ray” or “Nivea”, and the lips with colorless lipstick. To protect the neck, it is recommended to sew double-folded gauze to the headdress from the back of the head. You should especially take care of your shoulders and hands. If with a burn

shoulders, the injured participant cannot carry a backpack and all of its additional weight falls on other comrades, then if the hands are burned, the victim will not be able to provide reliable insurance. Therefore, on sunny days, wearing a long-sleeved shirt is mandatory. Back sides Hands (when moving without gloves) must be covered with a layer of protective cream.

Snow blindness

(eye burn) occurs during a relatively short (within 1-2 hours) movement in the snow on a sunny day without protective glasses as a result of the significant intensity of ultraviolet rays in the mountains. These rays affect the cornea and conjunctiva of the eyes, causing them to burn. Within a few hours, pain (“sand”) and lacrimation appear in the eyes. The victim cannot look at light, even a lit match (photophobia). Some swelling of the mucous membrane is observed, and later blindness may occur, which, if measures are taken in a timely manner, disappears without a trace in 4-7 days.

To protect your eyes from burns, it is necessary to use safety glasses, the dark glasses of which (orange, dark purple, dark green or brown) significantly absorb ultraviolet rays and reduce the overall illumination of the area, preventing eye fatigue. It is useful to know that orange color improves the sense of relief in conditions of snowfall or light fog and creates the illusion of sunlight. Green color brightens up the contrasts between brightly lit and shadowed areas of the area. Because bright sunlight, reflected from the white snow surface, has a strong stimulating effect on the nervous system through the eyes, then wearing safety glasses with green lenses has a calming effect.

The use of safety glasses made of organic glass in high-altitude and ski trips is not recommended, since the spectrum of the absorbed part of ultraviolet rays in such glass is much narrower, and some of these rays, which have the shortest wavelength and have the greatest physiological impact, still reach the eyes. Prolonged exposure to such, even reduced amounts of ultraviolet rays, can eventually lead to eye burns.

It is also not recommended to take canned glasses on a hike that fit tightly to your face. Not only the glass, but also the skin of the area of ​​the face covered by it fogs up heavily, causing an unpleasant sensation. Much better is the use of ordinary glasses with sides made of wide adhesive plaster (Fig. 8).

Rice. 8.

Participants of long hikes in the mountains must have spare glasses at the rate of one pair for three people. If you don’t have spare glasses, you can temporarily use a gauze blindfold or put cardboard tape over your eyes, making narrow slits in it first in order to see only a limited area of ​​​​the terrain.

First aid for snow blindness: rest for the eyes (dark bandage), washing the eyes with a 2% solution of boric acid, cold lotions from tea broth.

Sunstroke

Heavy painful condition, which suddenly occurs during long treks as a result of many hours of exposure to infrared rays of direct solar flow on an uncovered head. At the same time, during a hike, the back of the head is exposed to the greatest impact of rays. The resulting outflow of arterial blood and a sharp stagnation of venous blood in the veins of the brain lead to swelling and loss of consciousness.

The symptoms of this disease, as well as the actions of the team when providing first aid, are the same as for heat stroke.

A headdress that protects the head from exposure to sunlight and, in addition, maintains the possibility of heat exchange with the surrounding air (ventilation) thanks to a mesh or a series of holes, is a mandatory accessory for a participant in a mountain trip.

“The only things better than mountains are mountains,” so say many who have at least once found themselves alone with these harsh giants. But no matter how strong our emotional perception is, the fact remains that at altitude the body begins to work differently.
20 years ago, one of the most famous tragedies in the history of world mountaineering occurred. On May 11, 1996, eight climbers died while climbing the highest mountain in the world.
What happens to us in the highlands, why, despite the clean mountain air in the mountains, we begin to suffocate and how to climb Everest without oxygen - read in our material.

Oxygen starvation

Many of us have at least once found ourselves in the mountains, and not even necessarily very high ones. And upon arrival we felt “out of place” - overwhelmed and lethargic. But after one or two days these unpleasant symptoms went away on their own. Why is this happening?

Due to the fact that we get used to high atmospheric pressure, living in a city almost on a plateau (for Moscow this is an average of 156 meters above sea level), when we get into mountainous areas our body experiences stress.

This is because the mountain climate is, first of all, low atmospheric pressure and thinner air than at sea level. Contrary to popular belief, the amount of oxygen in the air does not change with altitude; only its partial pressure (tension) decreases.

That is, when we breathe thin air, oxygen is not absorbed as well as at low altitudes. As a result, the amount of oxygen entering the body decreases - a person experiences oxygen starvation.

That’s why when we come to the mountains, often instead of the joy of clean air filling our lungs, we get headaches, nausea, shortness of breath and severe fatigue even during a short walk.

Oxygen starvation (hypoxia)- a state of oxygen starvation of both the entire organism as a whole and individual organs and tissues caused by various factors: holding your breath, painful conditions, low oxygen content in the atmosphere.

And the higher and faster we rise, the more severe the health consequences can be. At high altitudes there is a risk of developing altitude sickness.

What are the heights:

• up to 1500 meters – Low altitudes (even with hard work there are no physiological changes);
• 1500-2500 meters – intermediate (physiological changes are noticeable, blood oxygen saturation is less than 90 percent (normal), the likelihood of altitude sickness is low);
• 2500-3500 meters – high altitudes (altitude sickness develops with rapid ascent);
• 3500-5800 meters – very high altitudes (mountain sickness often develops, blood oxygen saturation is less than 90 percent, significant hypoxemia (decreased oxygen concentration in the blood during exercise);
• over 5800 meters – extreme altitudes (severe hypoxemia at rest, progressive deterioration, despite maximum acclimatization, constant stay at such altitudes is impossible).

Altitude sickness– a painful condition associated with oxygen starvation due to a decrease in the partial pressure of oxygen in the inhaled air. Occurs high in the mountains, starting at approximately 2000 meters and above.

Everest without oxygen

The highest peak in the world is the dream of many climbers. The awareness of the unconquered mass with a height of 8848 meters has excited minds since the beginning of the last century. However, for the first time people reached its summit only in the middle of the twentieth century - on May 29, 1953, the mountain finally conquered the New Zealander Edmund Hillary and the Nepalese Sherpa Tenzing Norgay.

In the summer of 1980, a person overcame another obstacle - the famous Italian climber Reinhold Massner climbed Everest without auxiliary oxygen in special cylinders, which are used on climbs.

Many professional climbers, as well as doctors, pay attention to the difference in the sensations of the two climbers - Norgay and Massner - when they reached the top.

According to the memoirs of Tenzing Norgay, “the sun was shining, and the sky - in my entire life I had never seen a bluer sky! I looked down and recognized places memorable from past expeditions... On all sides around us were the great Himalayas... Never before have I seen such a sight and never I won’t see anything more – wild, beautiful and terrible.”

And here are Messner’s memories of the same peak. “I sink into the snow, heavy as a stone from fatigue... But there is no rest here. I am exhausted and exhausted to the limit... Another half hour - and I’m finished... It’s time to leave. There is no feeling of the greatness of what is happening. I’m too tired for this.”

What caused such a significant difference in the descriptions of the two climbers’ triumphant ascent? The answer is simple - Reinhold Massner, unlike Norgay and Hillary, did not breathe oxygen.

Inhaling at the top of Everest will bring three times less oxygen to the brain than at sea level. This is why most climbers prefer to conquer peaks using oxygen cylinders.

On eight-thousanders (peaks above 8000 meters) there is a so-called death zone - a height at which, due to cold and lack of oxygen, a person cannot stay for a long time.

Many climbers note that the most simple things tying your shoes, boiling water or getting dressed becomes extremely difficult.

Our brain suffers the most during oxygen starvation. It uses 10 times more oxygen than all other parts of the body combined. Above 7500 meters, a person receives so little oxygen that disruption of blood flow to the brain and brain swelling can occur.

Cerebral edema is a pathological process that manifests itself excessive accumulation fluid in the cells of the brain or spinal cord and intercellular space, increasing brain volume.

At an altitude of more than 6,000 meters, the brain suffers so much that temporary bouts of insanity can occur. A slow reaction may give way to agitation and even inappropriate behavior.

For example, the most experienced American guide and climber Scott Fischer, most likely having suffered cerebral edema, at an altitude of more than 7000 meters, asked to call him a helicopter for evacuation. Although in in good condition Anyone, even a not very experienced climber, knows perfectly well that helicopters cannot fly to such a height. This incident occurred during the infamous 1996 Everest climb, when eight climbers died during a storm on the descent.

This tragedy became widely known due to the large number of climbers who died. The ascent on May 11, 1996 killed 8 people, including two guides. On that day, several commercial expeditions simultaneously climbed to the summit. Participants in such expeditions pay money to guides, and they, in turn, provide maximum safety and everyday comfort to their clients along the route.

Most of the participants in the 1996 climb were not professional climbers and were heavily dependent on bottled auxiliary oxygen. According to various testimonies, 34 people simultaneously went out to storm the summit that day, which significantly delayed the ascent. As a result, the last climber reached the summit after 16:00. The critical ascent time is considered to be 13:00; after this time, guides are required to turn clients back in order to have time to descend while it is still light. 20 years ago, neither of the two guides gave such an order in time.

Due to the late ascent, many participants did not have oxygen left for the descent, during which a powerful hurricane hit the mountain. As a result, after midnight, many climbers were still on the mountainside. Without oxygen and poor visibility, they could not find their way to the camp. Some of them were rescued single-handedly by professional climber Anatoly Boukreev. Eight people died on the mountain due to hypothermia and lack of oxygen.

Jump from the stratosphere

The stratosphere is a layer of the atmosphere that is located at an altitude of 11,000 to 50,000 meters. It is in the stratosphere that the layer is located that determines the upper limit of life in the biosphere. In other words, no living organisms can survive above this point.

On October 14, 2012, Austrian skydiver Felix Baumgartner made a jump from the stratosphere.

He set a record for the height of his jump, the distance he covered in free fall (more than 36,000 meters), and also became the first person to break the sound barrier without a vehicle.

The stratospheric balloon lifted Baumgartner in a pressurized capsule to an altitude of almost 39,000 meters. One of the main difficulties of such a jump was that a person is forced to stay above the Armstrong line for a long time at an altitude of about 19,000 meters.

At this altitude, the atmospheric pressure is only 47 millimeters of mercury, and water boils at 37 degrees Celsius. Depressurization at altitudes above 18,900 meters leads to blood boiling.

Because of these difficult conditions, Baumgartner was equipped as an astronaut. Together with equipment, he weighed 118 kilograms. His suit had an oxygen supply system, an altimeter, and a heated and highly tinted helmet glass for ultraviolet protection.

About mountain air and acclimatization

And yet our body can adapt to very difficult conditions, including high altitudes. In order to be at an altitude of more than 2500-3000 meters without serious consequences, to an ordinary person one to four days of acclimatization are required.

As for altitudes above 5000 meters, it is almost impossible to adapt to them normally, so you can only stay at them for a limited time. The body at such altitudes is not able to rest and recover.

Is it possible to reduce the health risk when staying at height and how to do it? As a rule, all health problems in the mountains begin due to insufficient or improper preparation of the body, namely lack of acclimatization.

Acclimatization is the sum of adaptive and compensatory reactions of the body, as a result of which good general condition is maintained, weight, normal performance and psychological state are maintained.

Many doctors and climbers believe that the best way to adapt to altitude is to gain altitude gradually - make several ascents, reaching higher and higher heights, and then descend and rest as low as possible.

Let's imagine a situation: a traveler who decides to conquer Elbrus, the highest peak in Europe, begins his journey from Moscow at 156 meters above sea level. And in four days it turns out to be 5642 meters.

And although adaptation to altitude is genetically embedded in us, such a careless climber faces several days of rapid heartbeat, insomnia and headaches. But for a climber who sets aside at least a week for the climb, these problems will be reduced to a minimum.

While a resident of the mountainous regions of Kabardino-Balkaria will not have them at all. Highlanders' blood naturally contains more erythrocytes (red blood cells), and their lung capacity is on average two liters larger.

How to protect yourself in the mountains when skiing or hiking

• Gradually gain altitude and avoid sudden changes in altitude;
• If you feel unwell, reduce the time you ride or walk, make more rest stops, drink warm tea;
• Due to high ultraviolet radiation You can get a retinal burn. To avoid this in the mountains you need to use Sunglasses and headdress;
• Bananas, chocolate, muesli, cereals and nuts help fight oxygen starvation;
• You should not drink alcoholic drinks at altitude - they increase dehydration of the body and aggravate the lack of oxygen.

Another interesting and, at first glance, obvious fact is that in the mountains a person moves much slower than on the plain. In normal life, we walk at a speed of approximately 5 kilometers per hour. This means that we cover a distance of a kilometer in 12 minutes.

To climb to the top of Elbrus (5642 meters), starting from an altitude of 3800 meters, a healthy acclimatized person will need on average about 12 hours. That is, the speed will drop to 130 meters per hour compared to normal.

Comparing these figures, it is not difficult to understand how seriously altitude affects our body.

Why is it that the higher you go, the colder it gets?

Even those who have never been to the mountains know another feature of mountain air - the higher it is, the colder it is. Why does this happen, because closer to the sun the air, on the contrary, should warm up more.

The thing is that we feel heat not from the air, it heats up very poorly, but from the surface of the earth. That is, the sun's ray comes from above, through the air and does not heat it.

And the earth or water receives this ray, heats up quickly enough and gives off heat upward to the air. Therefore, the higher we are from the plain, the less heat we receive from the earth.

Inna Lobanova

Tips and instructions

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, 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.

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 teams, 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 sick person may experience pathological rare breathing (so-called “periodic” breathing, caused by a decrease in the level of carbon dioxide in the blood), mental disorders, 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, small exercise stress useful as it stimulates anaerobic processes metabolism 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, disturbance taste sensations and so on.).

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 mountains, especially high ones, other factors are added to the decrease in oxygen content in the air: physical fatigue, hypothermia, as well as 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 go through a “vicious circle”, complications will arise, and the climber’s life may be in jeopardy. 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 primarily due 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 - with 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, bad dream with symptoms of suffocation, and the state of health immediately improved with rapid loss height.
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 (than younger man, the worse it 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, the body begins to pathological disorders: insufficient supply of oxygen to the brain and lungs leads to the development 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 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, when 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 due to cerebral edema is compression medulla 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 respiratory tract(asphyxia) 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 enhance cardiac output, and corticosteroids, which stimulate the heart and increase blood pressure.

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). Such organ diseases abdominal cavity like perforation of an ulcer or acute appendicitis, it is 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, visual acuity may decrease, pain sensitivity, mental disorders.

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 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 medium degree 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: patients have trouble 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 bad physical well-being, rapid fatigue, heaviness throughout the body, preventing 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. 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 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 upper third 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. Cerebral edema is relieved by fractional (repeated) administration of diuretics (diacarb, furosemide), mandatory administration of sedatives or sleeping pills, which reduce the brain’s need for oxygen, and mandatory cooling of the victim’s head (lowering the temperature by several degrees reduces brain swelling 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 information and psychological preparation,
• good physical training,
• 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 in the best sense of the 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 an 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 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 escapes into nature - to the mountains, 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 mild case and moderate disease, it can be overcome by 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,
• at sharp drop pressure or deterioration of general condition - intramuscular injection 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 undergo strict selection for professional 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 the 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