Mountain medicine

Frostbite:

to save body heat for the most critical internal organs for self-preservation, our body sacrifices the peripheral zones that require greater heat expenditure (calories) to keep warm: toes, fingers, tip of the nose and ears.

Cold triggers a constriction of capillary vessels and an overall reduction in the amount of blood being channeled to the tissues, which get noticeably colder. Warning: wearing tight socks or two pairs of socks is a frequent contributing factor for frostbitten feet. When squeezed too tightly, the toes cannot move or be moved (to generate the "pumping" action of muscular contractions), which slows down circulation and accelerates the temperature drop.

This results in damage to the capillaries, which release small amounts of plasma that keep oxygen from reaching the tissues. In addition, the water inside each tissue cell transforms into tiny needles of ice that cause further damage to the tissues.

The main symptoms are:

• pain and tingling at first, followed by reduced tactile sensitivity (and less pain) with loss of color and severe temperature drop (Grade I frostbite);
• appearance of violet-red blisters that pop easily and leave surface-level sores (Grade II frostbite).

What to do:

• Call for help;
• Do not rub or massage the area (due to the risk of further tissue damage);
• Do not apply salves or powders, which are usually ineffective and often detrimental;
• Do not make the victim walk if the frostbite is in the lower limbs - the refreezing of body parts that have been revascularized can cause severe damage, and movement cannot reactivate circulation once it has stopped.
• Remove any clothing that is humid or that constricts the body part in question;
• Warm up the frozen body part gradually (never rapidly!) with heat packs or by submerging in water at a temperature of 38° to 42°;
• Cover the sores and blisters with sterile gauze, wrapping them without pulling tight.

Overexposure (hypothermia):

a general lowering of body temperature, as opposed to frostbite in a specific body part. In this case, the coldness causes a constriction in the blood vessels of all organs, damaging them and compromising their functionality. A prolonged state of hypothermia often results in death.

In addition to wind and humidity, which can also cause frostbite, overexposure is also promoted by:

• Physical tiredness;
• Insufficient food intake;
• Abuse of alcoholic beverages.

The main symptoms are:

• Sensation of extreme physical tiredness;
• Mental lethargy (irresistible sleepiness) and confusion;
• Extremely low body temperature;
• Intense paleness;
• Very slow breathing;
• Slow heartbeat (down to 30-40 beats per minute).

Warning:  never administer alcoholic beverages or massage the victim

What to do:

• Call for help;
• Insulate the victim from the ground;
• Warm their body up slowly and gradually starting with the chest, combining external warmth with internal heating by means of warm drinks (only if the victim is conscious).

Sprains

A frequent type of injury during outdoor activities is represented by sprains, which involve joint structure damage and subsequent swelling due to post-trauma hemorrhaging.

The ends of our bones are held in reciprocal relationships through a complex system of soft tissues (ligaments and capsules), which align the articular ends and allow certain movements while blocking others. When a bone is pushed violently into the joint, the capsule can be ripped and torn and result in more or less serious damage (contusions, torn ligaments, fractured malleolus).

The main symptoms are:

• Pain in the joint;
• Swelling and the appearance of bluish-black bruising in the overlying skin;
• More serious injuries can compromise joint stability and dramatically reduce the moveability of the free part of the limb.

What to do:

• Call for help;
• Immobilize the free part of the limb;
• Apply cold packs as soon as possible;
• For acute pain use pain-relief medicine.

Fractures

These concern the partial or complete breakage of bone segment. In excursionism this occurs most commonly in the limbs and can be classified as simple, closed or compound. In the first case, the bone is fractured but the ends of the bone are still in proper alignment; in the second case the ends are no longer aligned; in the third, bone fragments or shards perforate the overlying tissues (muscle, skin) to break through the body surface (a combined fracture/flesh wound).

The symptoms of simple and closed fractures are:

• Shooting pain when pressed and during efforts to move or when being moved;
• Appearance of swelling after a few minutes and a bluish-black skin color at the site of the fracture;
• Deformity of the fractured bone segment (for closed fractures);
• Inability to move the limb or fractured segment (for complete fractures).

What to do:

• Call for help;
• Assess the possibilities for transporting the victim;
• Remove anything that might constrict the damaged limb (e.g., shoes) before swelling sets in;
• For compound fractures, immobilize the fractured bone fragments without making any effort to re-align them;
• For open fractures, disinfect the flesh wound and cover it with sterile gauze without making any effort to push the bone fragments back under the skin surface.

Dislocations

Joints are formed by the ends of two opposing bones that are connected by a joint capsule.  A dislocation is when the end of one of these bones ruptures the joint capsule and is moved out of its normal position.

Most dislocations involve the shoulder joint, but elbow and knee cap dislocations are not uncommon.

The symptoms of a dislocation are:

• Similar to those of a simple fracture, but localized at a joint.

What to do:

• Call for help;
• Do not try to move the bone back to its normal position;
• Immobilize the joint.

Head injury

With head injuries, what seem to be minor traumas at first can at times have serious consequences that do not become apparent until some time has passed. With this in mind, every case involving a head injury should be handled as a serious trauma and treated at a hospital.

If the victim insists that this is unnecessary, always consider how the injury itself may be influencing their capacity to assess their own physical condition.

The most important symptoms are:

• Loss of consciousness: failure to respond to external stimuli;
• Altered state of consciousness: inability to respond coherently to the rescuer's questions, disorientation;
• Cannot remember what happened;
• State of agitation;
• Convulsions, dizziness, nausea;
• Bleeding from the ears;
• Signs of limb paralysis;
• Cardiac-respiratory arrest.

What to do:

• Call for help;
• Apply ice or snow to the head;
• Position the victim with their head higher than their feet
• Never give them anything to eat or drink (risks of vomiting and suffocation);

Avoid moving the neck (possibility of undetectable vertebral damage).

External hemorrhaging

Hemorrhaging/bleeding happens when tissues are damaged in a way that releases blood from its vessels. Hemorrhaging is considered external when blood fluids exit the body from an open wound.

External bleeding can be arterial or venous in nature.

The former is very dangerous because it involves the rapid loss of large quantities of blood, and can be recognized by the blood's bright red color and the fast speed of blood loss.

What to do:

• Call for help;
• Use two fingers to compress the artery upstream (closer to the heart) from the wound, apply a sterile gauze and tie it firmly to compress the bleeding area;
• Do not use a tourniquet unless the bandage compress is ineffective and you know the proper procedure.

The latter case is signaled by the dark red color of the blood and the slower, less abundant blood loss.

What to do:

• A tight bandage over the area of bleeding is usually sufficient.

Internal hemorrhaging

This happens when blood vessels deep inside the body are damaged and no blood exits from the body. It is usually fairly difficult to detect, unless the damage is near an organ that communicates with the outside (lungs, kidneys, stomach).

The most significant symptoms are:

• Intense paleness;
• Weak, rapid pulse;
• Fainting sensation when you try to stand up;
• In more serious cases, loss of consciousness.

Warning: these symptoms are also shared with other conditions, so call for help immediately if you suspect internal hemorrhaging because rapid intervention is critical.

Infections

This is about the penetration and multiplication of microorganisms (such as viruses or bacteria) into the human body, and can be caused by injuries when body tissues come into direct contact with infectious agents.

What to do:

• Disinfect the wound with abundant quantities of disinfectant: oxygen peroxide (not painful - bubbling brings any tiny foreign bodies that may have penetrated the tissues to the surface), iodine tincture, boracic water, merbromin, povidone iodine... Avoid using alcohol, if possible, which is painful and poisonous to the tissues;
• Cover the wound with sterile gauze and attach them securely.

Mountain sickness

This sickness can occur at altitude if you climb too rapidly, and the initial symptom is a headache that, when coupled with symptoms like loss of appetite, nausea or vomiting, fatigue and weakness, dizziness or lightheadedness, insomnia and irritability, should pinpoint the diagnosis right away.

What to do:

• The first and most effective remedy is to climb down to a lower altitude, especially when preparing to pass the night. It is critical, in fact, to sleep at a lower altitude than the maximum altitude reached during the day's climb;
• Another helpful tactic is a high carbohydrate diet, which ensures more energy and oxygen than provided by lipids and proteins;
• It is important to consume large quantities of liquids in order to restabilize your metabolic consumption;
• More severe cases may require medical intervention.

Tetanus

Even today this illness is nearly incurable, which makes it especially important to take the necessary precautions. It is contracted through contact with tetanus bacillus spores (a microorganism common to the intestines of herbivores) which can be encountered in mulch, mud, shards of wood and rusty metal. This microorganism favors reproducing itself in particularly dirty and poorly disinfected wounds, and the resulting sickness affects the nervous system and causes painful contractions of muscle groups that can lead to respiratory paralysis.

What to do:

• Prevention is the only effective tool: check your last vaccination date (mandatory every 10 years) and stay up-to-date with booster shots.

Electrocution

Electrical shocks from lighting strikes cause different kinds of damage: burns, violent involuntary muscle contractions, fractures, ventricular fibrillation (alteration of the cardiac rhythm - cardiac arrest). In the most serious case of cardio-respiratory arrest, rapid intervention in the form of cardiac massage and artificial respiration is required (the Basic Life Support - B.L.S. course is recommended).

Snake bites

This type of incident is only moderately dangerous and is not nearly as threatening as many believe. The poison dosage injected by the animal, in the worst of cases, amounts to about half of the lethal quantity for adults (the risk is higher for children and individuals in a weak state of health).

The snakebite serum, which used to be considered an essential provision for hikers, is used rarely now and only by specialized medical experts (given the high risk of anaphylactic shock and the difficulty of distinguishing poisonous from non-poisonous snake bites). The effects of the poison reach their peak about 3 to 4 days after being bitten, which means there is usually plenty of time to take action. The main factors that determine the danger level are:

• The concentration of the poison (lower in the fall and shortly after another bite);
• The vascularization of the bite zone (higher risk when bitten near arteries - neck face, internal thigh... - lower risk for peripheral zones - feet, hands...);
• Presence of bacteria on the animal's teeth;
• Motor activity of the victim after the bite (better to limit movement as much as possible to reduce vascular activity, which accelerates the spread of the poison).

What to do:

• DO NOT cut the wounded tissue: given the smallness of snake teeth, there is a fairly low chance that the poison has entered into circulation. An incision, on the contrary, could actually increase contact with the blood and worsen a situation that was not that serious.
• Sterilize the affected zone;
• Wrap and immobilize the region or part of body that was bitten in order to reduce circulatory activity;
• If the bite victim is less than 7-8 years in age, get them to a hospital as soon as possible.

Cramps

These are spastic contractions of one or more muscles that can last up to 10 minutes or longer and cause pain lasting for several days.

Cramps develop from an imbalance in the ratio of mineral salts to extracellular liquids (e.g., lack of potassium, calcium, magnesium or sodium) and are promoted by high outside temperatures, poorly oxygenized muscle tissue and fatigue. Under these conditions, the muscle contracts in an involuntary and often painful manner.

What to do:

• Depending on which muscle has contracted, position the victim in a way that lengthens the muscular fascia in question;
• Massage is less effective and, after an acute episode, can increase residual pain;
• Drink sugary liquids (maximum 7% by volume) containing sodium chloride (NaCl - table salt, one gram per liter).

State of shock

This is a serious, common situation with the wounded in which various organs enter a state of crisis because of reduced blood flow. This happens often in cases of internal or external hemorrhaging and multiple severe injuries (even in the absence of overt hemorrhaging).

The most significant symptoms are:

• Paleness and cold sweats;
• Heart rate - very high in frequency but weak in intensity;
• Rapid, shallow breathing;
• State of agitation or, sometimes, sleepiness.

What to do:

• Call for help;
• Try to alleviate the pain (which increases the shock);
• Keep them warm;

If possible, transport the victim with the head held lower than the feet (to facilitate blood and oxygen transport to the brain).