Mountain First-Aid and & Medicine
Having medical knowledge in the Andes mountains is a must!
How to treat the most common illnesses and pains?
Precisely in the Chilean Andes, from the north of Santiago, the sun is practically guaranteed. Requirements for each trip are hats or anything to cover the head, lip protection and sunblock lotion. If the head is exposed to sun irradiation for long periods of time, it will cause the vessels to dilate, which in turn could provoke the inflammation of the meninges. The symptoms are headaches and neck pain.
The head gets hot and then it aches, with nausea and vomiting.
Put the patient, with the trunk raised, in a fresh place. Cover the head and neck with wet cloths.
When the water is scarce the following must be taken into account
- Move slowly.
- Remain totally dressed, so that sweat doesn’t evaporate too fast.
- Do not eat salty food, since it increases thirst.
- The sensation of thirst can be attenuated by sucking stones or chewing grass stems.
- Breathe through the nose, since mouth respiration dries up the respiratory tract.
- If water starts to run out, drink short gulps or only dampen the mouth and lips.
- If water is again available, drink very slowly at the beginning.
Unlike insolation, body overheating, and not the direct irradiation of the sun, leads to serious sweating. If this loss is not taken care of, by ingesting liquids, the body can fall into a state of shock. Physical efforts under the midday sun must be avoided.
The heat produced by the body can no longer be evacuated, so temperature rises. The first indications are hot skin, headache, dizziness, nausea and cramps. Consciousness disorders and dypsnea can appear.
Measures for slight cases
Put the patient in a fresh and shaded place; open his or her clothes, fan and moisten the patient with cold water, but without wetting the body. In this situation it is particularly important that the person drink liquids, in the best of cases in the form of electrolytic beverages or black tea with a little of salt and sugar.
General indications in case of permanency under the heat
- Slow movements.
- Dress with light-colored light cotton clothes.
- Use cap and sunglasses.
- Drink a lot of liquids at regular intervals, at least three liters a day, and in the case of harder efforts, even more.
The flu is always caused by a virus and combines the symptoms of diverse colds, like shivers, fever, pain in the extremities, weakness, headaches, constipation and throat ache. A normal flu should last about a week.
If at all possible, fever should not be treated, as it is necessary to combat the pathogen agent. However, temperatures over 39º C should be lowered by firmly wrapping the calves with a wet towel of cold water and another loose towel over it, both of which must be changed every 10 minutes. As an alternative, fever can be lowered with aspirin.
Cough and bronchitis
The most harmless form of cough is the one that has whitish expectorations that result form the cleaning process of the lungs, since the pathogen agents are located in the mucose. Because of this, expectorations must be encouraged and not prevented. If the mucose turns yellowish or green, it is the signal of bacterial infection. If dyspnea and sharp pains appear, it could be pneumonia.
Lots of herbal tea or water should be taken to loosen the mucus; also inhalation and eventually the intake of expectorating medicine, like Ambroxol. Only in the case of dry cough, without any expectoration, an antitussive medicine can be taken for a short period of time (Codeine); be careful, if any signs of side effects appear, stop taking it immediately! In the case of a bacterial infection or the suspicion of pneumonia the only thing that helps is antibiotics. Dry air at high altitude (altitude cough) provokes an irritation of the respiratory tract and, if it is not treated, could also result in an infection.
As with cough, sore throat can take different forms that can be examined by looking into the pharynx, including the tonsils (in case they are still there). To do this, the mouth must open completely, take the tongue out and with the back of a spoon make pressure downward on the back of the tongue. This way it is easier to take a good look at the tonsils. If they are reddened, then it is a simple sore throat, easy to treat. If a yellowish, purulent layer appears over the tonsils it means the person has developed a full-blown tonsillitis. Additionally, difficulties to swallow, fever and the swelling of the lymphatic ganglions can appear.
To treat simple sore throats, some natural homely remedy is appropriate, like gargles with sage tea or taking some pills that are easy to find in the commerce. In the case of tonsillitis, antibiotics, like penicillin, should be administered under medical control.
It is very rare to develop some illness, like the flu or colds, at the high altitudes of Chilean mountains. This is probably because of the dry altitude air, the ultraviolet rays that kill germs and the sparse population. A cold caused by a virus would be, unfortunately, very difficult to treat. Only the symptoms could be somehow attenuated, with homely remedies or with medicines. If additionally, pain appears in the face, forehead or jaws with yellowish nasal secretions, it exists the danger of sinusitis, which can be treated with antibiotics. However, these usually have no effect, because the paranasal sinuses are badly irrigated so the medicaments cannot get to them. Problems to sleep because of a plugged nose can be treated with drops that alleviate the swelling of the mucose.
Unfortunately, burns are one of the most common lesions in excursions. The undue manipulation of fuel and kitchenettes, overheated table oil or hot saucepans provokes, easily, these painful experiences. Bad weather induces to cook inside narrow, two-person tents, where boiling water can easily spill out of the swaying kitchenettes, or even the tent could burn completely. We once lived, personally, through the experience of an exploding gas cartridge at the foothills of mount Aconcagua and we witnessed how fast a tent can burn.
Burns are classified in four degrees. In the first degree, the most external layer of the skin reddens, provoking pain; typical of sunburns. In second degree burns, additional blisters appear. In third degree burns, all the layers of the skin are irremediably destroyed (necrosis) and can only be treated with skin transplants. The fourth degree is made evident by the carbonization of the concerned body areas. Burns that affect more than 15% of the body can, additionally, cause shock accompanied by high pulse and low blood pressure.
If a person is burning, the fire must be immediately put out with water or a mantle or blanket. Then, the heated tissue must be cooled down, if at all possible with abundant clean, not-too-cold water. When the burns affect extended areas of the body, attention must be put not to allow the body to cool down too much. A general cooling of the wounds can lower the degree of the burns considerable. The burnt pieces of clothes that detach easily from the wound must be taken out; the ones that are strongly adhered must be left that way, cutting the piece around the wound. Then, loosely bandage the wounds with aluminum-covered bandages to protect them from the germs. Never burst the blisters. If burns cover more than 9% of the body surface, the injured must be immediately evacuated by air. As an example, 9% corresponds to the surface of a hand.
Chile is not characterized by illnesses like diarrhea, even less in trekking or mountain excursions. However, only boiled or filtered water should be used in base camps with many persons. In isolated mountainous areas we have always drunk water from streams, without ever having a problem, so far.
It at possible, don’t treat right away with medication. Through diarrhea, the pathogen agents are eliminated faster, so the body should be given a day or so more. What’s important is to compensate the loss of fluids by drinking electrolytic beverages, black tea or hot soups. Coal tablets can also be taken that help to mechanically eliminate the germs. If diarrhea is treated with medicine (e.g. Loperamida) the dosage should be adjusted in such a way as not to completely paralyze the intestine. In case of side effects, like high fever, diarrhea should be treated additionally with antibiotics.
Stomach ache can have a variety of causes. However, only a few of them can be treated during an excursion, and even less by persons without any knowledge. Whereby, in case of stomach ache the first thing to estimate is if the excursion should be canceled, and not the treatment.
- The stomach ache that comes with a normal diarrheadisappears when the diarrhea is adequately treated.
- Black feces could be caused by a bleeding stomach ulcer. In this case, the person should descend immediately and see a doctor.
- Colics may come from biliary or kidney calculi.
- Pain in the lower right part of the abdomen, accompanied by fever (generally 38ºC to 39º C), lack of appetite, nausea or vomiting can be the indication of appendicitis. Next, the appendix swells, fills with pus and finally necroses. If the appendix cleaves, the pus and bowel contents pour into the abdominal cavity. The consequences could be a dangerous peritonitis. Putting the patient with the trunk lifted and the knees slightly bended alleviates the discomfort.
Pain test when appendicitis is suspected
Put pressure with the palms of the hands on the side of the abdomen where there is no pain. When you lift the hands abruptly, the abdomen tenses. In the case of appendicitis, this produces a strong pain. Before even the slightest suspicion of appendicitis, the person must descend immediately and see a doctor.
Assisting the patient
In an excursion to mount Tupungato, near Santiago, a participant suffered a heart attack. Before the helicopter arrived, two days had passed, in other words a lot of time filled with fears and uncertainties. Mountaineer mates and trekkers don’t have, in most cases, medical or psychological training, and have not thought about how to react when faced with injured people in these extreme situations. It could be thought that in these situations calm is lost easily. But with most people quite the contrary automatically happens. Logic thinking can save lives, besides, a serene behavior calms down the patient. Empty promises from a lay person about a speedy improvement or a quick rescue, are immediately detected and produce more suspicion than trust. The person taking care of the patient should not pretend to be cheerful, neither overtly express his fears, but to calmly recognize his modest knowledge and explain, based on arguments, every step to take. Neither pity, nor alcohol or quieting pats will have the desired effect.
The skin protects the body from external pathogen agents, regulates its temperature and takes care of gas exchange. If an injured person is conscious and is having a big hemorrhage, the priority has to be to stop it immediately.
Serious wounds bleed profusely, often in a pulsating manner. First thing to do is to raise the affected part, if at all possible. It is recommended, additionally, to attend to the patient while he or she is sitting or lying down, since the person could collapse. As first measure, a pressure bandage must be applied. To do this, a padding made of gauze is applied firmly over the wound and then this is wrapped with a bandage. If there is no gauze available to make the padding, pieces of cloth or paper towel can be used as an alternative. Too tight a bandage causes obstructing in the veins, which then tend to protrude, so the bandage must be loosen a bit. If with all this the hemorrhage continues, a second bandage must be wrapped over the first one. Serious hemorrhages must also be stopped with bandages, and not with a tourniquet (ligature) on the affected extremity, since they can lead to serious nerve lesions and therefore to amputation. Only when everything else has failed and medical assistance if far away should a tourniquet be applied.
Slight injuries and scrapes
Cleanse carefully the skin around the injury area. Next, wash the injury with drinking water and eliminate strange bodies with tweezers. Let dry and apply an antiseptic (iodine). Bandage the wound with a sterilized compress and gauze. Change the bandages daily, if possible
Swelling and reddening accompanied with pain and pus formation are indications that a local infection has appeared. If it is not treated, the infection can spread dangerously to the rest of the body. In these cases the bandages must be changed daily, the injury cleaned and antiseptic applied, and depending on the situation, antibiotics must be administered (penicillin in high doses). If the infection worsens and produces high fever, the excursion must be immediately interrupted, maintaining the application of antibiotics.
Persons without knowledge are seldom capable of suturing an open wound. It is a lot easier to close the wound with no traumatic suturing sterile strips (Steristrips). The open wound (usually a cutting wound) must be cleansed and cured according to the instructions just mentioned. Next, secure the borders of the wound with suture strips. Lastly, bandage the wound with sterilized material. If the wound gets infected, the suture strips must be taken out without replacing them. As an alternative, sterilized adhesive strips can be used (leucoplast suture strips). They must be cut so that the contact with the wound is reduced to a minimum.
Some trekkers get blisters in every excursion, others almost never. Excepting this celestial injustice, many are the occasions for rubbing with the consequences of a disagreeable accumulation of fluids under the epidermis.
How to prevent blisters
- Wet skin helps the formation of blisters. Socks moistened by sweat can be changed or dried during pauses.
- Socks made of smooth tissue produce less rubbing with the skin.
- Mountain shoes that are too loose or badly tied can also produce rubbing.
- Many trekkers put special anti-blister patches in the most risky areas or simply use leucoplast strips. Adhesive tape that doesn’t allow air flow must absolutely be taken out at nights.
After loosing about 500 ml (in adults) of blood or fluids in general, the body cannot continue to be supplied with enough oxygen. An increase in pulse, governed by hormones, attempts to compensate this inconvenience. If this doesn’t lead to sufficient oxygen supply, this supply will be interrupted for less important organs, like skin, muscles, liver and kidneys. In addition, the organism can compensate for about 20% of fluids loss by using cellular fluids. If nothing is done, this can cause a thrombosis, collapse, cardiac beat alteration, coma or even death.
Symptoms of shock
Pallor and wet skin, pulse over 100, fast breathing, fearful behavior and subsequent consciousness perturbation and collapse.
Position of the patient in shock
Because of the dilatation of blood vessels, blood concentrates in arms and legs. Raise the person’s legs about 40 cm from the soil so as to put this blood into circulation. Lay the affected person on a mattress or cushion and cover him with a sleeping bag to prevent cooling. This stressing situation conduces to an increase in oxygen consumption. A few calming words from the rescuer help to offset this effect.
If shock was produced by a strong hemorrhage, it must be stopped in priority. Next, the lost fluids must be replaced. However, if the digestive system is not working, the affected person will not be capable of absorbing the liquids ingested orally, since they will provoke vomiting. Taking into account the conditions in open-air, a replacement for an infusion is to give very small quantities of liquids, if at all possible, through the buccal mucose, where they can be absorbed.
Even if the affected person gets a lot better, the excursion must be canceled in order to evacuate the person.
It is wrongly supposed that active persons run a low risk of having a heart attack. During our expeditions we have, unfortunately, experienced quite the opposite; even a 30-years-old suffered one in an occasion. A person without knowledge cannot make the difference between an angina pectoris and a heart attack, so in case of doubts, it should always be supposed that we are facing a heart attack. Nonetheless, people with angina are generally aware of their condition (a feeling of tightness in the chest) and carry the adequate medicine with them (nitroglycerine in capsules or spray). In an infarct of the heart, the total shutoff of one or more of the coronary vessels is produced, leading to an oxygen deficiency. This produces the necrosis of the affected myocardium.
- Strong chest pain.
- Blue lips due to the lack of oxygen.
- Anxiety, cold sweat, pallor, weakness.
- In occasions, pain in the arm, back and/or abdomen; feeling of tightness in the neck.
- Diabetics usually have no detectable symptoms.
- Avoid any movements, to keep oxygen consumption low.
- The damaged heart can no longer transport enough blood. To reduce the blood accumulation around the heart caused by this condition, the patient must be placed with the trunk raised.
- High altitude expeditions (Atacama, Tupungato volcano) should always carry oxygen, for safety reasons. In case of a heart attack, it can be applied at a rate of 6-8 lt/min.
- In case of heart failure, cardiac massage and artificial respiration should immediately start.
- Transport the patient quickly and with extreme care, if at all possible, by helicopter.
Loss of consciousness
If a rescuer finds an injured person unconscious, without knowing the causes, the following points should immediately be checked
- Is the person breathing (chest moves up and down, breathing noises)?
- Is the person bleeding profusely?
- Is the person in shock?
- Does the person have damages from heat?
- Can the person be awakened by painful stimulus (e.g. rubbing the sternum)?
Sideways leaning safety position
In general, the person should be placed leaning sideways so as not to choke if vomiting occurs. At the same time, the head should be bended slightly backwards to prevent the tongue from blocking the respiratory tract. In case of pallor (shock or fainting) the legs should be additionally raised. On the contrary, if the skin has its normal color or is reddened (heat hurts, heart attack) the trunk should be raised.
If, despite having the respiratory tract cleared, the person cannot breathe, do not waste any time; and anyways, if the person were breathing, this measure would do no damage to him or her. The method nose-to-mouth is more hygienic, in most cases, than mouth-to-mouth.
- The rescuer must kneel beside the head of the affected person. Next, the head must be bended backwards, the jaw stretched forward and the mouth closed. The thumb of the rescuer lower hand must be placed between the lower lip and the point of the chin in order to close the patient’s mouth.
- The rescuer inspires normally and puts his or her mouth over the nostrils of the patient. The lips put a slight pressure on the nose.
- The rescuer then blows the air into the nose. The rescuer inspiration is done by turning the head sideways so as not to breathe the air exhaled by the patient.
- Put an ear close to the nostrils to check the noise of exhalation.
If there is no pulse, breathing is stopped, the person in unconscious and the pupils are dilated it means the heart has stopped beating. In this case, cardiac massage and artificial respiration should be started right away. Through the pressure exerted on the sternum, the heart gets compressed against the spinal column, which pushes the blood to flow in the arteries. When the heart is let to decompress, it fills again automatically with blood. Cardiac massage is always complemented by artificial respiration. Ideally, several rescuers are available, so one takes care of artificial respiration (kneeling beside the head) while another one does the cardiac massage (kneeling beside the chest).
Cardiac massage with one or more rescuers
- The affected person lies down on a flat, firm surface, with the legs slightly raised to facilitate the reflux of blood to the heart.
- Open the fingers of one hand and put the hand heel on the lower part of the sternum. Next, put the other hand over the first one and, in this position, totally extend the arms maintaining a straight back; now start the compression movement downward using all the weigh of the trunk. The frequency should be 100 massages per minute. Every 20 massages, the patient must receive artificial respiration twice. When more than one rescuer is available, massage and artificial respiration must be given simultaneously. If there is only one rescuer, remember that cardiac massage must be resumed as soon as possible.
For a lay person, it is often difficult to make the difference between a sprain, a fracture or a tendon rupture. Generally, sprains are caused by a violent action, like twisting. The hurt tendons generate hematomas, swelling and pain.
- Immobilize the affected part.
- At the beginning, quickly cool down the affected area. This reduces the swelling, which would impede irrigation. Stream water or a wet t-shirt can be used to this end during excursions.
- Raising the extremity also reduces swelling.
- After cooling down the affected area as much as possible, swelling can be avoided by a support bandage (elastic bandage).
Dislocations occur when a bone gets out of its articulation (luxation) and stays in a dislocated position. Serious traumatic luxations provoke, additionally, tendon rupture and blood vessels or cartilage lesions. During excursions, the most common luxation is the painful shoulder dislocation. While descending 6 000 m mount Marmolejo one of our participants skidded on a snow field and dislocated a shoulder as he tried to stop from falling. Because he didn’t have any other lesions, we proceeded to apply the shoulder reduction maneuver. The arm was immobilized with a sling for a few days and, later on, the participant even ascended the almost 7 000 m mount Aconcagua. If kneecaps, shoulders or finger articulations are not reduced as soon as possible, permanent damage can occur, due to the strangled nerves or blood vessels. Luxations of the toes are rare during excursions because of the good protection offered by hiking shoes. In principle, dislocations and fractures must be first treated and then immobilized.
Dislocations provoke cramps and swelling of the surrounding muscles. If there are no other lesions, (tendon rupture, fractures) except for the luxation itself and if, in addition, no dangerous nerve or blood vessels strangulation exist, then the articulation must be put back in its normal place as soon as possible.
- The affected person must lie down on a pad or mattress.
- Take the person’s wrist firmly with a hand. With the other hand take the injured person’s arm just under the elbow. Tense his or her arm by pulling it steadily in a direction opposite the body. This movement brings about the relaxing of the muscles.
- Flex the person’s arm at the elbow putting it in a vertical upward position. At the same time, the rescuer hand holding the elbow continues to pull the injured person’s arm in a direction opposite the body.
- The patient’s flexed arm must be put slowly on the floor directed towards the head, without stopping pulling the arm. Remain in that position, continuously pulling the arm, for about 10-25 minutes.
- If after this period of time you notice a clear sign of muscle relaxation, then tha arm has to be moved downwards, as if the affected person was going to throw a ball.
- The reduced arm must be immobilized in a sling for several days and be controlled by a doctor at the first occasion.
- The affected person lies on the floor with the legs folded. The rescuer takes in each hand the thigh and calf of the person and slowly stretches the leg entirely.
- If the kneecap doesn’t automatically jump backwards, it must be pushed a little with the fingers until snap it in place.
- With a support bandage in the knee, the person may be transported, despite the pain.
Finger dislocations are caused, during excursions, by serious falls and often are accompanied by fractures. In these cases, the affected finger is twisted in a strange way in relation to the hand.
- The dislocated finger must be taken over the luxated articulation, while the other hand of the rescuer holds the affected person’s hand.
- First, the finger is pulled in the direction where it points, opposite the hand.
- Now, the finger can be put into the right position, without stopping the pulling.
- The affected finger must be splinted and the patient brought to a doctor.
Fractures are classified as exposed and closed. In exposed fractures the broken bone pierces the surrounding skin. Exposed fractures bring about additional risks, due to blood loss and the danger of infection. However, a closed fracture can also provoke dangerous internal hemorrhages. These are generally noticed by the swelling and hardening of the affected extremity. The blood loss can lead to shock, which must be treated in the corresponding manner.
- First, the wound must be cured and the hemorrhage stopped.
- If the fractured extremity is in unnatural position, it must be put in its original position to prevent pain. In order to do this, the bone ends must be separated at the fracture area by pulling them in opposite directions and, while keeping this tension, straighten the extremity. In exposed fractures, the displaced bone is put back under the skin. To avoid infection the injury and its surroundings must be disinfected before straightening the extremity. If a resistance is detected the procedure must be immediately stopped. If it is an articulation fracture, there could be additional damages, so articulations should be straighten only if there are strangled nerves or blood vessels. This is noticed by the lack of irrigation and alterations in sensitivity. If this is not the case, the articulation should be splinted as is, in its current position, and then evacuate the patient with utmost care.
- Locally cooling the affected area further reduces the irrigation of the damaged vessels.
- Next, the affected extremity must be immobilized with splints and raised.
- Evacuate the injured person.
The exposed fracture area is, in most cases, uncovered and so it is visible. A closed fracture, on the other hand, is more difficult to distinguish from a sprain. If the fracture is not evident, not even through a perceptible careful palpation, then the following test can be applied:
- Parts of the bone are visible through the open wound.
- Abnormal position of the extremity.
- Abnormal motion of the extremity.
- Bones friction.
- Painful sensation
- Limited movements
Even the slightest movements cause severe pain in a fractured extremity. Splints guarantee the immobility of the injured extremity during evacuation. As material to make splints are parts of the equipment, like walking sticks, pad mattresses, backpack aluminum frameworks, and also natural materials like branches.
- Collect al the necessary material to make the splints.
- In order to reduce unnecessary pain, the material must be dimensioned to fit the affected extremity.
- Pad the extremity with soft material (clothes).
- Splints must be applied tightly, but without impeding blood circulation, which must be controlled every 15 minutes. To fix the splints you can use broadcloths or, as an alternative, pieces of clothes.
- In low temperatures the affected extremity must be protected from the cold.
Splints for leg fractures
In leg fractures, muscular contractions can cause additional painful damages, by the perforation of tissue provoked by the pointy ends of the broken bones. This is why the splints must be put while continuously pulling the fractured leg in a direction opposite the body. This measure cannot be applied to articulation fractures.
Splints for arm fractures
The arm must be inserted into a hunk of padded mattress, previously cut to measure and immobilized, supporting it with a broadcloth or loop.
After first curing a wound, next, the area must be protected from damaging external influences, or prop the extremity up. There are numerous ways to apply a bandage, be it with broadcloth, gauze or compresses. However, in case of emergencies, it is difficult to apply a bandage without previous practice. The ideal thing is to assist to a professional first-aid course. For people without knowledge, the most appropriate thing, because of its simplicity, is to use ready-made bandages packs or a combination of gauze and compresses. In this case, first the compress is applied to the injury, fixing it with gauze. Covered compresses are preferred since they don’t stick to the wound.