1.Winter season started and it will last up to March 2015, and personal protection and prevention of its hazards to maintain a healthy life is essential. Not only in high altitude, but also those occur in low altitude in the plains of northern India, where effects of cold climate become more complicated due to extreme cold. Cold may exist with very low atmospheric humidity as in Rajasthan or in Punjab or with high humidity and rain fall as in Sikkim and J and K or in NE FA or with low humidity as in the north Indian plains. Height above 3000 meters in the western and 4000 meters in eastern Himalayas represent the same climatic conditions as in the arctic region.Here the temperature in winter ranges between minus 20 C to minus 50 C, there is not much vegetation, the cold is dry cold and is accompanied by severe biting winds with snow particles moving in the air, and deep snow drifts are common. Frost-bite and snow blindness are common dangers.
2.Below that altitude and above the winter snow line at about 2000 meters in western and 2500 in eastern Himalayas, subarctic condition overcome. Melting snow in summer produces watery mud.Winds are cold but less severe because of the protection given by forests and scrub.Atmospheric temperature is normally very low and the region has pleasantly cool summers and the great revers take origin here.Though snow storms are often and frost-bite may occur.Trench foot is more common risk and chilblain is the most common hazard and happens down to the lowest height of this region.
In foothills up to 1000 meters height the climate is humid and warm in summer with high rain in monsoon and with tropical forests and winter seasons are mild.Below the height of winter snow line
the climate is semi-liar to the higher temperature zones with forests,cold is severe in winter but not as more as to produce frost-bite or trench foot,but chilblain is common in susceptible individuals.In western parts,winter rains comes and summers are pleasant.
3.Local effects of severe cold climate are frost-bite,trench foot and chilblains.Frost bite is due to freezing of protoplasm,trench foot is due to the stagnation of circulation and chilblain is due to an allergic type of reaction to cold insusceptible individuals.The area become red and there is irritation specially when the patient is in bed or sitting in front of fire.Frost bite occurs in lower and upper extremities and exposed superficial areas like nose tips and ear lobes.While the tissue temperature goes down below the critical temperature,the the protoplasm in the cells wholly frozen and the cellular frame work gets disrupted and causing negative changes in the affected tissue.Two clinical types are recognized; acute and insidious.Acute frost-bite occurs and develops in extreme cold weather with high wind.Trench foot occurs above the critical tissue temperature in combination with dumpiness due to circulatory stagnation.
4.First aid should be started by removing the individual to a sheltered place soon.Patient must be put in sleeping bag or wrapped in blankets and insulated around between him and ground.The best way of warming the patient is by immersing him in a warm bath,the temperature of which should be 35 C.
Then it should be brought up gradually to 40 C in 10 to 15 minutes.Moisture is a good thermal conductor and its presence in contact with skin interferes with natural insulating action on the skin.Presence of moisture in clothing increases its thermal conductivity.Local blood supply stagnation allows local temperature to be lowered.Physical inactivity increases the risk of cold injuries.Activity decreases the liability to reduce them and is an important prophylaxis against cold injuries.Nutrition plays an important role in resisting cold effects and malnutrition increases a person to cold injuries.Vitamin A and C deficiency also increases healing power of tissues.Fatigue,fear and anxiety are common in cold climate specially at high altitude cause increasing the liability to cold injuries.Local injury or skin infection increases the particular part to cold injuries.Use of tobacco increases the risk of frost bite and alcohol consumption in large quantities increases local cold injuries.
5.Preventive and control measures.The clothing should be in many layers and loose.Wool is the good material.and the outer layer should be wind proof.Boots/shoes socks gloves and head covering should not be tight Snow clothing must be worn and training for its proper use should be given.Damp clothing must be changed soon.In cold weather 2 pairs of socks are worn.Boots should be loose fit,otherwise,inflict injury on feet and toes,if it is so tight;kept soft and water proof,and every person should have an extra pair of dry socks and boots,to change into if his feet get wet.If the person has to work in water or slush,gum boots are of great advantage.Snow boots are used with extreme cold clothing.boots should be used after trying them out with thick woolen socks after walking at least 50 yards and while standing. Socks should not be tight.every person should have 4 pairs of good woolen socks all the time.Regular checking is necessary.Badly torn socks become dangerous,bad one must be changed soon.
(a)The feet should be inspected before going to bed every night.They must be washed with warm water and dried and applied with little animal or mineral Vaseline before sleeping every night.This helps 'supercooling' and avoid frost-bite.Individuals with ulcers and abrasions should not be exposed to out side in extreme cold weather till it is healed.Foot powder should be used before wearing socks in the morning to reduce dampness and friction with socks.Venous circulatory congestion and stagnation must be avoided,persons should not sit for long periods in enclosed places or upon the railings with feet hanging down and especially over the edges of seats.Too tight clothing also causes venous block.
(b)Shelter from strong wind is necessary.while resting or sleeping.Regular moderate exercise to keep up circulation with out causing any exhaustion or excessive sweating should be taken regularly. Wringing of toes and fingers should be practiced regularly and face muscles should be wrinkled to keep up the circulation.If the tip of nose or ear lobes or cheeks of the one is affected the other persons draw attention and first aid is given.To maintain general heat of the body caloric requirement in the cold is higher,due to higher metabolism.There fore to maintain general heat of the body,the caloric value of food must be taken,hot and adequate appetizing meals to be consumed.Well cooked and nourishing hot foods and drinks increase resistance to cold,promote mental and physical well being and prevent the body against infection,fatigue and dangers of climate extremes.Vitamin C in the form of multivitamin tablets should be taken during extreme cold climate to resist the body from hazards.
(c)Personal cleanliness,dry clothing,ventilated shelter,warm bed and recreational facilities are helpful.At least 2-3 hot baths in a week in snow bound and cold environs are necessary.bathing places should be sheltered from snow fall and wind.Do not use too much soap as it removes the greasy material and decreases insulation and advantage of supercooling phenomenon.Contact with cold metals should be avoided.Metal articles should be covered with adhesive taps.Touching cold metals with bare hands peels off a thin layer of outer skin,especially when the hands are dump. Alcohol never should be consumed in excess over a short duration.It should be taken at all when likely to be exposed to cold wind,Smoking must be always in moderation or if possible be avoided.Once the cold injury occurs,it should be definitely prohibited.Once a person suffered cold injury due to high altitude effects,must not be exposed to a semi-liar risk again.
(d)First aid and early treatment is aimed at arrest and prevention of tissue damage.All cold injury cases must be treated as lying cases and transferred to a sheltered place by stretcher in warm surroundings and given extra cloths and blankets,at high altitude oxygen must be given through mask.All tight clothing should be loosened and boots/shoes removed and affected part to be kept at complete rest and the part must be gently and thoroughly cleaned,and wrapped in sterile dressing.Blisters should not be opened.The body should be warmed slowly,but affected limb must be warmed up quickly with warm water at about 42C. The limb must be kept continuously warm for a long time after thawing.Rest,nourishing diet and sleep are necessary to the patient,hot nourishing fluids and meals are helpful in restoring morale and health. Alcohol is contraindicated as it cause heat loss and smoking should be avoided totally.
(e)There is no specific prevention or treatment for chilblain.To improve local circulation such as a hot paraffin wax bath and ultra violet rays are help full.When the skin is intact a paint containing 50% menthol in a compound tincture of benzoin or ointment with 3% of camphor and 0.5% of phenol in linolin paraffin mixture should be rubbed gently into the chilblains every night and morning,after immersing the affected parts in warm water and drying them nicely.Chaffing of cheeks and lips can be prevented by applying lip salve or paraffin jelly.
(f)Effects at high altitude.These are encountered in high altitude aviation and mountaineering.The most frequent and important clinical problems unexpectedly meeting at high altitude are Acute mountain sickness,Acute pulmonary edema,Chronic pulmonary hypertension,coronary and cardiovascular insufficiency and congestive heart disease,manifestations of diabetes mellitus,Psychological effects,etc.Prolonged exposure to hypoxia may produce other minor effects after a long time are Dimness of vision,loosening of teeth,loss of weight,indigestion,anaemia,loose bowels,thyroid deficiency,increase severity of infections,etc may be met in contest.These symptoms normally disappear with in 4 to 5 weeks of move to the plain areas.A high protein diet is necessary in high altitude areas due to subnormal tissue metabolism.The atmosphere being cold,the air has very low atmospheric moisture contents.Much water is so lost from the body through the breath.Lack of interest,irritability,insubordination,and lengthening of reaction time may happen.There is no increased incidence of psychiatric break downs at high altitudes in comparison with plain areas.Lack of concentration and mental impairment may occur on arrival at high altitude as a part of acute mountain sickness for few days which may subside with in few days.If not cured during this period such persons may be brought to sea level and become normal.
6.Prevention of effects of high altitude environments. All individuals going to high altitude should be examined.The persons with sound health of cardiovascular and respiratory system should be selected for long residence in high altitude.The ascent should be slow and in stages,like 3000,3700,4300,5000 meters.It is better to avoid alcohol consumption and evening meals should be consumed 2 hours before sleeping.If any one develop with respiratory distress,more cough or fever develops they should be brought down to a height below 1500 meters and treated soon.Gradual acclimatization is the most important preventive measure against sudden effects of high altitude hypoxia. Avoiding trips to higher altitudes if suffering from nose and throat infections.and avoidance of excessive consumption of alcohol and smoking,and adequate consumption of fluids.well cooked food and sufficient rest and,
and also healthy recreation reduce the effects of hypoxia.In order to counteract this increased protein consumption is required.Due to hypoxia the fats can not be well metabolized,there fore,low fat consumption is substituted by high carbohydrate intake meets meets the physiological needs.Fats require more oxygen for its katabolism than the carbohydrates per gram,and per 100 calorie out put.Water drinking must be adequate.This should be had through often drinks.The high altitude foods meets these requirements.
7.First aid and early managements.Complete rest in bed,warmth,and nutritional diets will relieve minor symptoms.Aspirin will relieve most of symptoms including sleeplessness.head ache,cough and irritability.It should not be taken as a preventive measure or more than one .g.(2 tablets) with in 8 hours with medical advise.It is easier to work during day but sleep may be disturbed or difficult for first few nights..A sleeping tablet may be given under medial advise.persons showing mental irritability,impaired judgement,severe headache vomiting etc,should be removed to a lower shelter at 3000 meters for 3-4 days.Then they can be ascent again to higher shelter.
Individuals suffering from irritable cough and lung edema,pain chest,breathlessness or bruise co-lour in the body,vomiting sensation,severe giddiness etc should be rested soon and given oxygen.They should not be left alone.Arrangements should be made for sudden removal to an altitude below 2000 meters if complaints prevail.Complete bed rest,continuous oxygen and and rapid evacuation to a lower altitude are the 3 initial MUSTS.The congested lungs normally clear with in 6 to 48 hours after removal to a lower altitude.In addition to atmospheric hypoxia it is possible at high altitude to give a rise to psychological voidness,and the appetite becomes poorer,the re activity becomes slower and duller,the ability to grasp the situation becomes blunted and the attitude of mind may assume inclination.This makes a man interpret wrongly and disregard administrative tasks or his health.
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