We can discuss for hours how to prevent of sickness from appearing during our expeditions. From allergic reactions, to gastric infections and diarrhea, constipation, cold, Khumbu cough, blocked nose, eye dryness and infections, ear infections, gynecological problems, insect bites, blisters, cuts and small traumas. These are the most common heath issues you are most likely to experience during the course of any expedition, but on high altitude climbing the real challenge is how to prevent and fight altitude related illnesses, such as Acute Mountain Sickness (AMS).
There is a long list of places in the Internet where to find information on how to build a first aid kit, but I found quite difficult to find a comprehensive list of what to include in the kit for high altitude expeditions. During most of the big climbs I’ve done, I relied on my basic first aid kit for generic health issues such as most of the things mentioned in my previous line. For my biggest challenge ever, Khan Tengri 2012 Expedition, I had the same kit with extra medicines, and for high altitude sickness I relied on the big medical kit we carried as a team during the expedition. This, when I see it retrospectively, is a mistake for two reasons. A communal medical kit might not have enough supplies for several climbers falling ill during the course of the same expedition. And secondly, you might have unexpected reaction to some of the drugs included in the kit. During that expedition we were lucky to have two doctors in the climbing team, but most of the times you have to rely in your or someone else’s knowledge when fighting sickness. In big and complex commercial expeditions, such as the ones carried out to the eight thousanders, medical consultancy is included or available as basecamp service. However you should not expect the yaks to carry up a whole pharmacy. In places like the Khumbu Valley in Nepal is not difficult to find doctors climbing or working in some of the most transited villages. However they are not always are fully stocked with drugs and they must charge you accordingly. Bring your own kit and you’ll be better prepared to fight illness and make it to the summit and back home safe and happy.
This post contains a list of things to include in your personal medical kit / first aid kit. It is highly advisable to go through the list with your doctor and make sure none of the medicines are contraindicated considering your medical history and current condition. You should get guidance on how to administer each medicine and carry instruction written in a piece of paper stored in the kit. In certain circumstances you might be unable to think clearly, and these instructions should be easy to read and understand by you or your climbing partners. Some directions on the dose are included here, but all this information is to be carefully reviewed and discussed with your doctor. This list is designed for someone very healthy like me (thanks god!), and it does not consider certain pre-existing conditions such as diabetes, asthma, epilepsy, allergies, high blood pressure, etc.
For certain destinations some of the medicines can get you into legal issues, so it worth investigating that in advance, and carrying a letter from the doctor if necessary.
I have divided the list in two sections. The first one contains things that must be included in the kit as bare minimum, it’s the kit you must carry with you at all times to cope with emergencies. The second contains a list of extra things that will help you fighting other common illnesses and will make your trip more pleasant by helping with minor issues.
Basic high altitude aid kit:
- Plasters, Elastic band, Gauze pads, Adhesive dressings, Burn and Blister dressings, Antiseptic Gauze pads, Antiseptic cream, Tweezers and Needles – cuts and small traumas
- Diamox (Acetozolamide) – 250mg tablets, 2 times a day, 30 per person – Cerebral and Pulmonary Edema (HACE, HAPE). 125 mg about an hour before bedtime - Periodic breathing
- Nifedipine – 10mg tablets, 3 times a day, 12 per person – Pulmonary Edema (HAPE)
- Dexamethasone – 4mg tablets, 6 times a day, 20 per person – Cerebral Edema (HACE)
- Ciprofloxacin Antibiotic – 750mg tablets, 2 times a day for 3 days, 10 per person – Diarrhea caused by bacterial infections
- Loperamide – 2mg capsules taken up to 8 times normally after defecating, 10 per person – Relieving effects of diarrhea
- Azithromycin Antibiotic 500mg daily for 3 days, 5 per person – To treat many different types of infections caused by bacteria, such as respiratory infections, skin infections, ear infections as well as diarrhea
- Paracetamol – 500mg tablets, two every 4-6h, 20 per person – To treat many conditions such as headache, muscle aches, backache, toothaches, colds, and fevers.
- Ibuprofen – 600mg tablets, dose depends on the condition to treat, must be taken with food, 20 per person – To reduce fever and treat pain or inflammation caused by many conditions such as headache, toothache, back pain, menstrual cramps, or minor injury
- Micropur Forte water sanitizer – 1 tablet per liter of water, 50 per person
- Aspirin – Used as an analgesic to relieve minor aches and pains, as an antipyretic to reduce fever, and as an anti-inflammatory medication.
- Diphen (diphenhydramine) – 25mg tablets, one or two every 4-6h – To treat sneezing, runny nose, itching, watery eyes, itching throat, and other symptoms of allergies and the common cold. Is also used to suppress coughs, to treat motion sickness and to induce sleep. Used with epinephrine in the treatment of severe allergic sock
- Amoxycillin 250mg and Metronidazole 200mg – Additional antibiotics to be used under medical supervision
- Calmatel (Piketoprofen) – 60g ointment tube – Analgesic, antipyretic and anti-inflammatory preparation. Ideal to treat small traumas.
- Blastoestimulina – 50g ointment tube – Cicatrizant and antibiotic preparation. Ideal for cracked skin on hands, and the typical infections around the nails, or skin irritation between legs.
- Liposic ophthalmologic gel – To treat eye dryness and ophthalmological issues at night
- Artelac eye drops (hypromellose) – To treat eye dryness and ophthalmological issues during the day
- Panadol Hot Lemon and Honey – Cold and flu relief
- Pseudoephedrine 60mg 3 times a day or Xylometazoline Nasal spray – Blocked nose
- Strepsils – Sore Throat Lozenges with anesthetic. Also useful for mouth sores
- Cough Lozenges, e.g Doctor Andreu
- Mouth sore gel
- Supralax Senna constipation tablets – To be taken in the evening, prior going to bed – A natural herb laxative, helpful in treating constipation.
- Afterbite wet tissues – Relief from insect bites
- Thermomether (must not brake under extreme temperatures)
- Depending on your skills you may want to include other items such as scalpel, synthetic suture and vinyl globes.
Other important things to bring and make sure we are protected against external factors that produce health issues are
- Sunscreen and moisturizer, to protect the skin from the sun and prevent the dry skin from developing cracks that can get infected
- Lip balm & sunscreen
- Mosquito repellent wet tissues
You can also purchase one First Aid Kit designed for outdoor activities, such us the Lifesystems Mountain First Aid Kit and complement it with some of the things listed in this post.
Basic Lifesystems First Aid Kit with some additions and the extra kit with essential things such as the emergency condom.
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Before you go
Visit your doctor at least six months before you leave for your expedition, get a blood test done to make sure you are doing fine with things like glucose and iron levels, which can seriously affect hemoglobin saturation and oxygen delivery at high altitude. Have a full dental check and cleaning done before departure, a minor dental problem at sea level can become a serious issue in a long high altitude expedition. If you suffer from eye dryness like I do, I recommend you to visit your ophthalmologist one week before departure to have you eye lids and tear ducts cleaned. That prevents the awkward dryness and ophthalmological issues from appearing. I did that before my last expedition and I climbed with fresh eyes and no bothering during the whole trip.
Make everybody aware of your medical conditions, the symptom and treatment. Your illness could become a risk for everyone in your group. If you need especial medication make clear labels and instructions, have spare supplies and split the kit to lower the chance of losing it all. Ask your doctor to prepare an official letter, explaining your condition, treatment and contact details.
Get first aid training for you and your climbing partners. Make sure they know about AMS and how to treat it. Think about what you will do if things go wrong
Consult with you travel nurse about vaccinations and make sure these are not contraindicated for high altitude climbing.
During the course of the expedition
BE HONEST WITH EVERYONE ABOUT CHANGES IN YOUR MEDICAL CONDITION.
If you get sick, make an effort not to spread viruses and bacteria among all expedition members. You should observe strict hygiene using sop and hand disinfectors regularly, especially when entering in mess tents and other communal areas, and when leaving the toilet.
If you take medicines, write down everything and changes in you condition.
Our mess tent in Khan Tengri basecamp, a festival for viruses and bacteria. Entry was prohibited without washing hands.
Acetazolamide – Myths, Use & Dosage
Acetazolamide (Diamox®) is a medication that forces the kidneys to excrete bicarbonate, this re-acidifies the blood, balancing the effects of the hyperventilation that occurs at altitude in an attempt to get oxygen. This re-acidification acts as a respiratory stimulant, particularly at night, reducing or eliminating the periodic breathing pattern common at altitude. Its net effect is to accelerate acclimatization, it makes a process that might normally take about 24-48 hours speed up to about 12-24 hours.
Common side effects include numbness, tingling, or vibrating sensations in hands, feet, and lips. Also, taste alterations, and ringing in the ears. These go away when the medicine is stopped. Since acetazolamide works by forcing a bicarbonate diuresis, you will urinate more on this medication. Uncommon side effects include nausea and headache. A few climbers have had extreme visual blurring after taking only one or two doses of acetazolamide.
It is highly advisable to consult with your doctor and test the medication if possible.
For treatment of AMS:The recommend a dosage is 250 mg every 12 hours. The medicine can be discontinued once symptoms resolve
For Periodic Breathing: 125 mg about an hour before bedtime. The medicine should be continued until you are below the altitude where symptoms became bothersome
If acetazolamide is stopped, symptoms will worsen: There is no rebound effect. If acetazolamide is stopped, acclimatization slows down to your own intrinsic rate. If AMS is still present, it will take somewhat longer to resolve; if not – well, you don’t need to accelerate acclimatization if you ARE acclimatized. You won’t become ill simply by stopping acetazolamide
Acetazolamide hides symptoms: Acetazolamide accelerates acclimatization. As acclimatization occurs, symptoms resolve, directly reflecting improving health. Acetazolamide does not cover up anything – if you are still sick, you will still have symptoms. If you feel well, you are well.
Acetazolamide will prevent AMS from worsening during ascent: Acetazolamide DOES NOT PROTECT AGAINST WORSENING AMS WITH CONTINUED ASCENT. Plenty of people have developed HAPE and HACE who believed this myth.
Acetazolamide will prevent AMS during rapid ascent: This is actually not a myth, but rather a misused partial truth. Acetazolamide does lessen the risk of AMS, that’s why we recommend it for people on forced ascents. This protection is not absolute, however, and it is foolish to believe that a rapid ascent on acetazolamide is without serious risk. Even on acetazolamide, it is still possible to ascend so rapidly that when illness strikes, it may be sudden, severe, and possibly fatal.
Treating Acute Mountain Sickness (AMS)
The mainstay of treatment of AMS is rest, fluids, and mild analgesics: paracetamol, aspirin, or ibuprofen. These medications will not cover up worsening symptoms. The natural progression for AMS is to get better, and often simply resting at the altitude at which you became ill is adequate treatment. Improvement usually occurs in one or two days, but may take as long as three or four days. Descent is also an option, and recovery will be quite rapid.
A frequent question is how to tell if a headache is due to altitude. Altitude headaches are usually nasty, persistent, and frequently there are other symptoms of AMS; they tend to be frontal (but may be anywhere), and may worsen with bending over. However, there are other causes of headaches, and you can try a simple diagnostic/therapeutic test. Dehydration is a common cause of headache at altitude. Drink one liter of fluid, and take some paracetamol or one of the other analgesics listed above. If the headache resolves quickly and totally (and you have no other symptoms of AMS) it is very unlikely to have been due to AMS.
We had to use it the last night in basecamp…