Vitamins before climbing Elbrus. Human acclimatization in mountainous areas

Yesterday I gave a lecture at the MAI Mining School. I hope it will be useful to climbers and mountain tourists, and indeed to all mountain lovers.

1. Introduction. Many people are accustomed to thinking that by the time they leave for the mountains they need to be in peak athletic shape. To a first approximation, this is indeed true, and this idea can be used when constructing a training schedule throughout the year. However, upon closer examination, it becomes necessary to make certain adjustments.

Is maximum sportswear really necessary during security checks at the airport or during passport control? Or, perhaps, is it necessary when unloading expeditionary cargo from the vehicle at the beginning of the route? Of course not. You will need your maximum ability to withstand physical activity not at the beginning of a mountain sports event, but in its culminating phase, for example, during the days of the assault on the most important or most difficult peak.

The following figure shows a typical fitness versus time curve for a mountain sports event. This is not just a typical curve, it is a desired curve, because the implemented graphs may look more pessimistic. In this graph we see the growth of physical fitness to its maximum state in the middle of a mountain sports event and degradation towards its end due to exhaustion and accumulated fatigue.

Rice. 1. Typical fitness curve in a mountain sports event.

The maximum value of S max depends not only on the level of sports form S 0 at the beginning of the event, but also on the alpha angle, which characterizes the rate of its growth in the first weeks of being in the mountains. In other words, in the mountains you involuntarily continue to train, simply following the intended mountain program, and your ability to tolerate physical activity increases.

But this “training” may not take place, because in the mountains you will be under the influence of destabilizing factors that work to make you sick and, on the contrary, to degrade your form to zero.

2. Destabilizing factors. Destabilizing factors include: altitude, solar radiation, physical overload, hypothermia, dehydration, poor nutrition, poor hygiene, microorganisms brought from the city and local microorganisms.

Rice. 2. Destabilizing factors that impede the growth of sports form.

We are now talking about objectively existing problems that, one way or another, take place in a mountain event. Some degree of hypothermia will certainly occur, but it is within your power to try to avoid it as much as possible. The same goes for dehydration. Intense breathing in a snowy area, where there is nowhere to drink, leads to dehydration. But you have the power to remember to melt the water and pour it into your flask. Food in the mountains is always deficient to one degree or another. Fresh cucumbers will not be dropped off the plane for you. But it is in your power to carefully consider your diet, and try to compensate for the lack of vitamins and microelements with a special vitamin layout. The same applies to hygiene, excessive physical activity, and solar radiation. We will talk about height separately.

As for germs and viruses, you bring some of them in your body from cities. And they really want to multiply in your body. And the other part is made up of local microorganisms. Most often this is of various kinds, intestinal infections, which can be picked up on the road to the mountains, or even in the mountains through water from mountain animals.

So, all these, as we say, destabilizing factors, work against the growth of physical fitness. Under their influence, it is easy to bend and not become physically stronger.

3. Fitness, experience and health. So how do you ensure a good alpha angle?

This angle depends on your experience, your organization and, if you like, your wisdom. And it very much depends on the amount of health ( vitality) at the beginning of a mountain sports event.

As is known, and this has been published in many sources, peak athletic fitness does not correspond to maximum health. Athletes at the peak of their athletic performance, in particular, have reduced immunity. Therefore, the peak of sports form at the beginning of the event can result in its rapid degradation in the mountains under the influence of destabilizing factors. These are curves 2, 3 and 4 in Figure 3.

Rice. 3. Various types graphs of sports form in a mountain sports event.

Many experienced hikers and experienced high-altitude climbers generally “work” on curve 5, preferring not to train much before the mountains. They “travel out” at a good alpha angle, which is ensured by their extensive experience in resisting destabilizing factors and excellent natural health. This approach for people who are not very experienced and not too healthy leads to the implementation of a sluggish schedule 6. As always, the golden mean wins. Come to the mountains not at the peak of your fitness, but somewhere at the level of 60-70% of its maximum value, but always in excellent health. Then you will achieve the maximum, see curve 1.

To realize this wish, in the last month before leaving for the mountains, you should switch to a special regime of training and life in general.

4. Routine before going to the mountains. In order to increase the alpha angle in the last month before going to the mountains you need to:

1. Stop building up your fitness and switch to stabilizing training.

2. Refuse to participate in sports competitions.

3. Avoid stress.

4. Avoid emergency situations at work.

5. Don’t fall in love to the point of rut.

6. Get enough sleep.

7. Eat regularly and efficiently.

8. Don't overeat during the holidays.

9. Don't get drunk.

10. Cure teeth and other indolent diseases.

Now look at yourself, what are you doing in the last month before leaving for the mountains?

Obviously, this program may not be feasible for you. But it clearly shows, at least, what we should strive for. Now you have a choice. Either you seriously intend to achieve high results in the mountains, or you prefer to fall in love until the rut, which is perhaps no less valuable acquisition.

5. Effective, safe and non-debilitating acclimatization. Now let's move on to the question of how to resist the most important destabilizing factor - height. The following recommendations were developed based on the experience of managing teams (teams) from 1982 to 2009. During this time, I taught dozens of people how to climb at high altitude, and simply led hundreds of people through the stages of acclimatization. These recommendations do not apply to people with a special constitution, whose names and surnames are widely known. However, my experience is valuable because the conclusions derived from it are good for real teams. And in real teams there will always be weak links who, for example, did not manage to spend the last month correctly before leaving for the mountains. And these recommendations are good for everyone. When it comes to standing up to heights, you should not strive to become a superman. After all, none of the famous supermen have yet had their brains examined, as Vladimir Ilyich Lenin was done after his death.

By the way, the widespread belief that brain cells die at altitude is very superficial. Brain cells do not die from the realization that you are at a high altitude. They die from mountain sickness, in other words, from acute oxygen starvation. And this oxygen starvation It has more to do with your behavior than with your height. Nothing prevents us from organizing a more intense extinction of brain cells at an altitude of 4000 m than at an altitude of 7000 m. To do this, just take the train, arrive in Nalchik in the morning, then take a taxi to Terskol, then climb the Shelter of Eleven and the rest of the day and all that follows spend the night at this shelter. I assure you, in this situation, you will die more brain cells than when climbing a seven-thousander, taking into account all my subsequent recommendations.

In earlier texts on this topic, I wrote about effective and safe acclimatization. At the same time, in the concept of efficiency, I included the speed of the adaptation process and its reliability, in the sense that you are confidently acclimatized and will feel good at altitude. And by safety I meant the low probability of getting acute mountain sickness during the acclimatization process. Now, taking into account everything that I have said about sports form, it is advisable to add that we are also interested in acclimatization that does not weaken the body. In other words, proper acclimatization should give you strength at altitude. Or, if you want, keep the alpha angle large for a long time.

So I want to separate the two cases. In the first case, a person, being at 7000 m, feels well, does not suffer from altitude sickness, but at the same time he is tired and weak to perform much physical work. And in the second case, a person at 7000 m is full of strength.

Now we will say that we need effective, safe acclimatization that does not weaken the body.

6. Mountain sickness. The higher the altitude above sea level, the lower the air pressure. Accordingly, the pressure of that part of the air called oxygen is lower. This means that oxygen molecules are less common, and they no longer hit any surface as often, and in particular lung tissue. Therefore, they bind less intensively to hemoglobin in the blood. The oxygen concentration in the blood drops. Insufficient oxygen in the blood is called oxygen starvation or hypoxia. Hypoxia leads to the development of mountain sickness.

We list the typical manifestations of mountain sickness, ordered by severity of the disease. At each new stage of development of mountain sickness, its previous manifestations at earlier stages, as a rule, are not excluded, but only aggravated.

1. Increased heart rate.

2. Shortness of breath when physical activity.

3. Headache.

4. An excited state, which can be replaced by apathy to what is happening. Cheyne-Stokes breathing (periodic spontaneous deep breaths). Difficult transition to sleep. Restless sleep. Decreased performance.

5. Weakness. Nausea and vomiting. Increase in body temperature by 1-2 degrees.

6. Development of pulmonary edema or cerebral edema.

7. Coma and death.

The main treatment for acute mountain sickness is immediate descent.

Acclimatization, or more correctly, altitude adaptation is impossible without altitude sickness. Moreover, mild forms of mountain sickness involve mechanisms of body restructuring. But safe acclimatization should be accompanied by the first and second conditions and rarely by the third. And getting into the fourth state is already dangerous.

There are two phases of altitude adaptation based on the depth of changes in the body.

7. Short-term altitude adaptation. Short-term altitude adaptation is a quick response of the body to hypoxia. The mechanisms of such a response are activated “on the spot.” The body's first reaction is the mobilization of oxygen transport systems. The breathing rate and heart rate increase. There is a rapid release of hemoglobin-containing red blood cells from the spleen.

Blood is redistributed in the body. Cerebral blood flow increases because brain tissue consumes many times more oxygen than muscle tissue. This leads, by the way, to headaches.

At this stage of acclimatization, a weak supply of circulating blood to other organs disrupts the body’s thermoregulation, increases sensitivity to cold influences and infectious diseases.

Short-term adaptation mechanisms can only be effective for a short time. The increased load on the heart and respiratory muscles requires additional energy consumption, that is, it increases oxygen demand. Thus, a positive feedback effect or “vicious circle” occurs, which leads to the degradation of the body. In addition, due to intensive breathing, carbon dioxide is intensively removed from the body. A drop in its concentration in arterial blood leads to weakening of breathing, since carbon dioxide is the main stimulator of the respiratory reflex. This is a second additional mechanism that aggravates degradation.

Thus, in the short-term adaptation phase, the body works for wear and tear. Therefore, if the transition to the second phase - to long-term altitude adaptation is delayed, then sharp forms mountain sickness

8. Long-term altitude adaptation. This is a profound change in the body. This is exactly what we want to get as a result of acclimatization.

In contrast to short-term adaptation, this phase is characterized by a shift in the main field of activity from transport mechanisms to oxygen utilization mechanisms, to increasing the efficiency of using the resources available to the body. Long-term adaptation is already structural changes in the body in the systems of transport, regulation and energy supply, which increases the potential of these systems. Conventionally, the nature of structural changes can be represented as follows:

Tab. 1. Restructuring of the body in the phase of long-term adaptation.

The expansion of the vascular network of the heart and brain creates additional reserves to supply these organs with oxygen and energy resources. The growth of the vascular network in the lungs, combined with an increase in the diffusion surface of the lung tissue, increases gas exchange.

The blood system undergoes a complex of changes. The number of red blood cells and the content of hemoglobin in them increases, increasing the oxygen capacity of the blood.

In addition to the usual adult hemoglobin, embryonic hemoglobin appears, capable of attaching oxygen at a lower partial pressure. Young red blood cells have more high level energy exchange. And young red blood cells themselves have a slightly changed structure; their diameter is smaller, making it easier to pass through the capillaries. This reduces blood viscosity and improves its circulation in the body. Reducing blood viscosity also reduces the risk of blood clots.

The increase in the oxygen capacity of the blood is complemented by an increase in concentration in the myocardium and skeletal muscles muscle protein - myoglobin, capable of carrying oxygen in a zone of lower partial pressure than hemoglobin. An increase in the power of glycolysis in all tissues during long-term adaptation to hypoxia is energetically justified and requires less oxygen. Therefore, the activity of enzymes that break down glucose and glycogen begins to increase, new isoforms of enzymes appear that are more suitable for anaerobic conditions, and glycogen reserves increase.

At this stage of acclimatization, the efficiency of the functioning of tissues and organs increases, which is achieved by an increase in the number of mitochondria per unit of myocardial mass, an increase in the activity of mitochondrial enzymes and the rate of phosphorylation and, as a consequence, a greater yield of ATP at the same level of oxygen consumption. As a result, the heart's ability to extract and use oxygen from flowing blood at low concentrations increases. This allows you to ease the load on transport systems - the respiratory and heart rate decreases, and the cardiac output decreases.

With prolonged exposure to high-altitude hypoxia, RNA synthesis is activated in various parts nervous system and, in particular, in the respiratory center, which makes it possible to enhance breathing at low concentrations of carbon dioxide in the blood, improving the coordination of breathing and circulation.

9. Gradual and stepwise acclimatization. We can now describe the step-by-step process of acclimatization through two phases of altitude adaptation. You rise to heights. There is not enough oxygen, and short-term adaptation mechanisms are activated. Outwardly, this manifests itself as mild mountain sickness. After some time, long-term adaptation mechanisms are activated and the symptoms of mountain sickness disappear. The height has been mastered.

Now you can rise to even greater heights. There is not enough oxygen again, and short-term adaptation mechanisms are activated again. Increased heart rate, mild shortness of breath, possible headache. And again, after some time, further structural restructuring of the body takes place, and the symptoms of mountain sickness disappear. The height is mastered again, etc.

The result of the structural restructuring of the body in the long-term adaptation phase can be assessed by the maximum height H a, at which the heart rate does not exceed the usual values ​​for the plain, say, 70 beats per minute.

Now the described process of step-by-step acclimatization can be conventionally displayed in the form of a graph, see Fig. 4

Rice. 4. The process of gradual acclimatization.

The red line on the graph is the height of the participant in the mountain sports event. For simplicity, it is depicted as if he is transported to greater and greater heights instantly.

The blue line on the graph is the height H a at which the heart rate does not exceed the usual values ​​for the plain; this line characterizes the result of the structural restructuring of the body.

The yellow-colored area between these graphs characterizes the amount of load that the body receives under the influence of hypoxia. The larger the yellow area, the more the body weakens, the worse for the growth of athletic form.

Three gamma angles characterize the intensity of the long-term adaptation process. These angles decrease because the athlete’s body gets tired from the effects of hypoxia, from a long stay at an ever-increasing altitude. A large and long-lasting yellow area after the third ascent characterizes the risk of getting mountain sickness with serious consequences.

Thus, if you only go up all the time, then the body gets tired and exhausted. As a result, the restructuring of the body takes place less and less intensively.

This is a very bad way to acclimatize. Much more effective is stepwise acclimatization, which involves a sequence of ascents and descents with ascents each time to higher and higher altitudes. It is important that between these rises there are intervals of recovery at low altitudes. These recovery intervals allow the body to accumulate strength, due to which the mechanisms of long-term adaptation will take place more intensively.

An altitude graph is usually called a line reflecting the life of an individual or group in the mountains, which is drawn in the T [time] and H [altitude] axes. So, the altitude graph during stepwise acclimatization has a sawtooth shape. We will call each tooth an exit to the highlands, and the depressions between the teeth will be called restoration intervals. The lower the height of the recovery intervals, the better. At altitudes above 5000 meters, the body’s recovery practically does not occur.

Acclimatization must be planned. The most important part of such planning is the construction of the desired altitude schedule. When constructing altitude graphs, we will operate with the altitude of overnight stays and obey two rules (rules of 500 and 1000 meters):

1. At an undeveloped height, you should not rise more than 500 meters per day from overnight stay to overnight stay.

2. The altitude of overnight stays in the next trip to the highlands should not exceed the maximum altitude of overnight stays in previous trips by more than 1000 meters.

The first rule limits the yellow area by limiting the height of the riser step. And the second rule regulates the recovery process and guarantees large values ​​of the gamma angle, excluding the situation shown in Fig. 4 after rising to height H3.

Now let’s build a high-altitude climbing schedule for a team of climbers who arrived at an altitude of 3200 and rest in the base camp at an altitude of 4200. When constructing the schedule, we will not take into account restrictions from the relief and will add only one day of rest between climbs for recovery (this is not at all a lot ).

Rice. 5. Stepped acclimatization according to the rules of 500 and 1000 meters.

And, nevertheless, the program for climbing to a peak with an altitude of 7000-7200 meters requires 19 days.

Of course, rules 1 and 2 are to a certain extent arbitrary and replacing the numbers 500 and 1000 with 600 and 1200 will not lead to much trouble. But a gross violation of these rules risks disrupting the acclimatization of the weakest link in your team.

By the way, the transition to the standards of 600 and 1200 does not bring much acceleration, reducing the 19-day program to 18 days.

Rice. 6. Stepped acclimatization according to the rules of 600 and 1200 meters.

In the graphs presented, the tops of the peaks occur during overnight stays. For comfortable and safe acclimatization, this is not the best option. It’s good when the overnight stay is lower than the maximum altitude of the previous day, at least 300-400 meters. However, when climbing with work “from camp to camp”, overnight stays on the peaks of the saw are very typical.

10. Night is the moment of truth. When mountain sickness occurs, a person is most vulnerable at night. At night, he relaxes, mobilization on the part of the nervous system disappears, and the tone that is maintained through volitional efforts disappears. At the same time, self-monitoring of the participant’s condition and monitoring of his condition by teammates ceases.

If a positive feedback (vicious circle) occurs, for example, of this nature - the heart weakens because it lacks oxygen, it pumps blood weaker and weaker, and from this the oxygen deficiency increases even more. So, if such a vicious circle occurs, a person can degrade overnight to complete morning incapacity or death.

At the same time, a successful overnight stay at altitude allows you to adapt to this altitude to the greatest extent. Therefore, night is the moment of truth.

A very good indicator is heart rate. The evening pulse can be quite significant and exceed 100 beats per minute in mild forms of mountain sickness. But the morning heart rate should drop to 80-90 beats per minute. If the morning pulse exceeds 105 beats per minute, this means that the person has not mastered the altitude overnight and must be escorted down. Further ascent from the overnight stay upwards at such a morning pulse is very likely to lead to severe mountain sickness and the group will only waste time descending the victim from an even higher altitude.

It is necessary to properly prepare for bed. Sleep must be sound.
First of all, you can't tolerate a headache. It is especially typical when the head hurts in the evening after completing the daily plan. This is explained by the fact that muscle work during physical activity stimulates intense work of the lungs and heart. Since a person has two circles of blood circulation, blood is automatically pumped through the brain by the same contractions of the heart. And the brain does not experience oxygen starvation. And in the evening in a tent with little physical activity, oxygen starvation of the brain develops.

So, it has been noticed that headaches destabilize the body. If you tolerate it, it will only intensify, and your overall health will continue to deteriorate. Therefore, if you have a headache, you must immediately take the pills. This is citromon 500 or even 1000 mg. Soluble solpadeine has an even stronger effect, which not only relieves headaches, but also relieves general state inflammation or, as it were, “restlessness” in the body. If you have elevated temperature, then it will remove this temperature too.

It is in this normalized state that you should approach sleep. Naturally, you should not get drunk on coffee. Make sure that the tent is well ventilated so that you do not burn out oxygen at night, exacerbating oxygen starvation. Before going to bed, coat your lips with sunscreen (it contains ingredients necessary for the skin) or special lipstick. And put a layer of onions saved from dinner behind your cheek. Keeping onions in your mouth for a long time will protect you from the proliferation of microbes in the mouth and throat. If you have a runny nose, put a star under your nose, but I even like to put it in my nostrils. All the things you need to go to sleep should be in your personal box near your head. There should also be a flashlight nearby.

Now the next typical phenomenon. You can't sleep. This is very bad. Try to relax while listening to the player. If you have already lost an hour of sleep, then you need to use the tablets immediately. I love diphenhydramine. It not only has the effect of a sleeping pill, but is an antihistamine and relieves inflammation in the body. Sometimes you have to take two tablets.

A typical mistake is to suffer from insomnia. Some people say that sleeping pills will make them groggy in the morning. As a result, they do not get enough sleep, and this makes them even more lethargic than from sleeping pills. But the worst thing is that they do not spend the night effectively in terms of long-term altitude adaptation (small gamma angle). A sleepless night is very dangerous for the development of altitude sickness.

In 2005, Yu.M. When I first reached 5500 I couldn’t fall asleep. He said that he was bothered by the wind and the flapping of the tent. In fact, he had altitude sickness. For some reason, spending the night at 5250 on the previous trip to altitude did not restructure his body properly. He refused to take the pills. In the morning he was lethargic, but efficient. We continued to climb and stood around lunch at an altitude of 5900 so that Yu.M. I was able to rest and sleep for half a day.

The next day he woke up lethargic again. On the climb he was already 200-300 meters behind. He complained that his legs couldn’t move, but otherwise “everything is fine.” We spent the night on the top of Kyzylsel at an altitude of 6525 meters. I was very afraid that he would deteriorate overnight and we would have to save him. However, everything worked out well, and we completed the traverse, descending from the top along another ridge. Even below, after this traverse, he felt an absolute lack of strength and went home.

I'm 90 percent sure that a couple of diphenhydramine tablets taken in the evening at 5500 would have absolutely changed the course of events.

So, the overnight stay is the moment of truth. It’s good when the overnight stay is lower than the maximum altitude of the previous day, at least 300-400 meters. The same Yu.M., being an experienced high-altitude climber, likes to take a walk in the evening, gaining at least 200 meters above the tent (if the terrain allows it).

11. Mistakes and tragedies. Now let's plot some real events. The red line, as before, reflects acclimatization according to the 500 and 1000 m rules.

Rice. 12. Erroneous altitude charts of real expeditions.

First, green graph. I don't know exactly how long it took the climbers to set up base camp. Well, let's say 3 days. It was installed at an altitude of about 4000 m.

Then there was an acclimatization trip. The height is not indicated, but it is written like this:

"...We went on our first acclimatization hike on August 8. There was a lot of snow on the glacier and, especially, on the ridge. Where last year we climbed almost 1000 m in one day, we walked a maximum of 200 m, raking the trench in front of us with avalanche shovels And the snow kept falling and falling... On August 13, all groups returned to base camp..."

Based on this text, I drew a climb to 5200. Then the climbers spent 5 days in the base camp and began climbing to the top. The ascent took place on the 8th day of this high-altitude climb. As you can see, the 1000-meter rule was violated - after reaching 5200, the climbers immediately went to 7400.

Morning of the 9th day of release. Height is about 7300 meters.

"...We get ready slowly. We help I. get dressed, and he is the first to get out of the tent to bask in the sun. After 15 minutes, D comes out. He called out to I., but he does not respond. He sits on a rocky ledge and seems to be sleeping. We all jump out of the tent, and it becomes clear to us that this is not a dream, but the quiet death of our wonderful comrade..."

This is such night degradation! Then, on the descent from the summit, two more exhausted climbers fall off and die.

Guess what famous tragedy I wrote about?

Second, purple graph. On the graph we see very sharp and bold climbs in acclimatization trips, between which the team recovers for 3-4 days. And this is no wonder. Overcoming altitude sickness wears down the body.

The training process is slowed down. At altitude, due to excessively severe mountain sickness, strength is depleted, training does not occur, and at the bottom, climbers sit in the base camp for several days, and training again does not occur.

After going out to 6400 with an overnight stay in the area of ​​6000 meters, we immediately go out to 7700. This is a bit abrupt. The 1000 meter rule was violated.

As a result of mistakes made, the speed on the day of the assault is extremely slow. Instead of returning to the assault camp at 7200 at 3 pm, the climbers return late at night. One of them falls from an ice break in the dark and injures his hand. Another comes in such a debilitating condition that he cannot come down the next day. Then the climbers arrange a day at an altitude of 7200 m. On this critical day, with a 50/50 probability, the exhausted participant could die or recover. As a result of a heroic struggle for his condition, using all his enormous high-altitude experience, he manages to stabilize his condition, and over the next two days the climbers descend safely to base camp.

And this is about a very recent story.

12. Driving to high altitudes. Starting acclimatization at an altitude of more than 4000 meters leads to wear and tear on the body. Such acclimatization does not give strength later. All subsequent stages at high altitudes will also occur sluggishly. And the already acclimatized team will work with low power, still sluggishly.

Therefore, if you want to be strong at high altitudes, do not skip the acclimatization stage at an altitude of 3200-3700 meters.

13. Containment. The point of the 500 and 1000 meter rules is containment. It is containment that is the main leitmotif of effective, safe and non-debilitating acclimatization. You should not get ahead of the pace of body restructuring in the long-term adaptation phase. Phases of mountain sickness from the 4th onwards weaken the body and hinder the growth of athletic fitness. Don't tear your claws, and you will have great athletic shape, and everything will be easy and safe for you.

Containment does not only refer to the construction of desired altitude schedules and their implementation. The leitmotif of deterrence permeates everything and, in particular, the behavior of each participant in a mountain sports event.

You trained all year, competed in all sorts of running and skiing competitions, and took part in marathons. You are a lifelong athlete. But as soon as you arrive in the mountains, you should forget about your sportiness.

In the first days, I categorically do not recommend straining. And I want it so bad! Finally, the long-awaited season has begun, alpine meadows are illuminated by the morning sun, high snow-white mountains are in the distance! Ahead on the path there is a 10-meter rise. How great it is to lightly grit your teeth and playfully fly up onto it with your strength, especially since then the path is flat and you can catch your breath. Don't do this, control yourself. All those little tears tend to add up and you'll get too tired. But you are gaining altitude, and at night you have to overcome the load from hypoxia, from the yellow spot in Figure 4.

At night, your tired heart will beat faster, pumping oxygen-depleted blood. It will get more and more tired. Now there is not enough oxygen even for its effective operation. The heart weakens, oxygen becomes even less, the heart weakens more and more - a vicious circle! In the morning, nausea, vomiting, blue lips, weak and rapid pulse. Instead of continuing the hike, the group goes down. It’s good if it walks, worse if it carries.

What happened to your luckier friend that night? He, too, began to develop this destructive process, but its pace was slower, since he was much less tired during the day. At the same time, a revolution began in his body. The metabolism changed, hemoglobin and hundreds of other necessary and still unstudied compounds began to be produced at an accelerated pace. The oxygen concentration in the blood increased. The heart began to beat calmer, it could finally rest. In the morning, my friend woke up cheerful with a moderate pulse - 86 beats per minute.

This kind of restructuring began for you too, but you didn’t have time to help. It's all about the speed of both processes. The rate of degradation must be less than the rate of adaptation.

When I was still young, my uncle, the USSR champion in the high-altitude class, taught me this: “When you go uphill with a backpack, your heart rate is inevitably high. But walk in such a way that your breathing does not falter, so that your breathing is calm and uniform.” And this should be applied to the weakest link of the team. Otherwise, what is the point of your successful personal acclimatization if you have to waste time, weakening the movement schedule, taking unplanned days or rollbacks with the descent of a sick participant downstairs.

Since we’re talking about the first days in the mountains, I’ll give you altitude graphs before the first climb to 6000, implemented by my teams over the past three years. And next to it there are three more schedules, the implementation of which led to negative consequences. All these graphs are built taking into account the race, since acclimatization also takes place during the race. Long rides in the high Asian mountains explain the apparent effect that in Asia the heights are tolerated “easier” than in the Caucasus.

Actually this is not true. There is no such harmful gas "Caucasin" and oxygen substitute "Asian". The composition of the atmosphere is the same. As for humidity, which is often cited to explain this apparent effect, when precipitation condenses, the humidity is the same everywhere and is close to 100%. Therefore, drizzling rain or wet snow in the Pamiir occurs in the same humid air as drizzling rain or wet snow in the Caucasus. And everything becomes completely the same, but the Caucasus and Asia do not exist. Well, of course, there are more sunny days in the Pamirs, but I have never noticed that when the weather suddenly deteriorates, the manifestations of altitude sickness get any noticeably worse.

So let's move on to the charts.

This time the theoretical saw built according to the 500 and 1000 meter rules is highlighted in green. The blue graphs are our expeditions of 2007, 2008 and 2009. The very sluggish climb in the first 8 days of the Pamir Marathon 2009 does not have any special “high-altitude idea”, we just carried the load with the shuttle and laid out the throws, the load at the start was too large.

A sharp peak of up to 4700 on the 4th day of acclimatization in 2008 was achieved without backpacks in a radial climb to the peak of 4713. With overnight stays on these days, everything was divine.

Colors close to red reflect graphs with unfavorable consequences.

Raspberry chart 2003 An experienced high-altitude climber, having several ascents of seven-thousanders behind him, including Pobeda (7439), arrives at an altitude of 3600 m on the first day. The next day he climbs to the base camp at an altitude of 4600 m. He spends another day at base camp, and only in the evening he begins to develop altitude sickness so severe that he almost dies. Fortunately, in a state of “near death”, they manage to transport him down.

Red schedule 2007 A group of tourists drove to an altitude of 3500 meters and on the same day rose to 3750. The next day they passed a simple pass with an altitude of 4200 m and spent the night at 3750. On the third day of acclimatization, they spent the night at 4300 m. And on the fourth day they crossed pass 3A altitude 4800 m, after which we spent the night at 4400. In the morning, cerebral edema was diagnosed in one of the participants.

Here's what they write about his condition: "...Symptoms: inadequate, unstable, severely inhibited, cannot walk independently, without assistance, attention quickly depletes, makes mistakes when performing simple tasks...". After this, rescue operations were organized using a helicopter.

Orange schedule 2009 For two days, tourists traveled to the Pamirs and drove to an altitude of 4400 m. Over the next 3 days, they crossed a pass at an altitude of 5200 meters. How many people vomited and how often - I have no data about this. After the pass, many in the group had a temperature of 38-40.

With some delay, as in the case of 2003, at an altitude of 4100 m, the participant in the hike became especially ill. At night she experiences weakness, fever and shortness of breath (while lying down). Then tourists arrange a day trip, during which the patient’s condition stabilizes.

The victim was very lucky that she was able to stabilize her condition at an altitude of 4100 m. If her condition had required a drop in altitude, say, to 3300 meters, she would have died. Because there was nowhere to drop the altitude. The height of 4100 corresponded to the bottom of the huge valley of the Eastern Pamirs.

14. Be careful, athlete! But look at an excellent athlete, a first-class skier. He remained cheerful when everyone else was sick at 3900. But what was happening? At an altitude of 4500, when all the recovered participants felt quite tolerable, he began to lag behind. And the higher, the more
stronger. After spending the night at 4800 he has nausea, vomiting, a pale face, blue nails - it’s time for him to go down.

The fact is that his powerful heart responded to the challenge of 3900 in the usual way for an athlete - a high pulse. Athletes can endure high-pulse work for a very long time. This is business as usual for them. Therefore, the restructuring in his body did not begin.

Just, for God's sake, don't get me wrong, I'm not at all urging you to quit all training. You need to train. First, to be broadly healthy. Then the adaptation mechanism will better turn on. And only, secondly, to be powerful in order to quickly, quickly hang the rope at 5800 under a threatening ice break.

But on grass at the very beginning of a mountain sports event, the athlete does not have a noticeable advantage, moreover, he is at risk. After all, everything happened because neither he, nor the leader, nor the group paid attention to his special story: “So healthy - what will happen to him? So..., some kind of malaise.”

Of course, this does not apply to those who already have solid high-altitude experience. And this is because one of the main components of high-altitude experience is a quick reaction to the first signs of lack of oxygen, to the sight of snow-white peaks, to the smell of wormwood, finally! The mechanism of long-term adaptation is activated clearly, to the fullest, and does not depend on whether the first days in the mountains are easy or difficult to bear.

If you like, it's a conditioned reflex. Pavlov taught dogs to secrete gastric juice when the bell rang. So why can’t an experienced high-altitude climber learn to produce hemoglobin immediately upon arrival in Osh, from the Asian heat, from the crowd at the market, from the anticipation of a quick trip to his favorite mountains?

I know that my altitude sickness is already kicking in in Osh or Kashgar. I feel it.

15. Reacclimatization. After returning from the mountains, acclimatization disappears as quickly as it appeared. The body does not need an excess of oxygen. It is harmful. From here bad feeling in the first days of city life after descending from high altitude. After 10 days, your hemoglobin will drop to normal levels and you will feel better. Therefore, May trips to Elbrus are absolutely useless for the summer in terms of acclimatization. But they are useful for gaining high altitude experience.

However, why May? Winter ascents are no less useful for high-altitude experience.

In general, the rapid loss of acclimatization is often forgotten, and this becomes the cause of many tragedies. MAI climbers probably remember the consequences of being imprisoned in Dushanbe between the peaks of Korzhenevskaya and Communism in 2007. This did not lead to tragedy. But the imprisonment of the May mountaineer Valentin Suloev in the Alai Valley between the peaks of Lenin and Communism may have become one of the main reasons for his death at an altitude of 6900 meters in 1968. At the peak of Communism he also fell ill, and these two factors, acting together, ensured him night degradation. Now, if he had gotten sick, being perfectly acclimatized, he would not have died.

A similar story happened with the famous “Himalayan” Vladimir Bashkirov. Before climbing Lhotse, he took a break and spent a significant amount of time in the city of Kathmandu after his previous ascent. On the descent from Lhotse he died.

16. High altitude experience. High-altitude experience is a person’s ability to adapt to high mountains, acquired as a result of repeated trips to the mountains in the past. High altitude experience has subconscious and conscious components.

The subconscious component of high-altitude experience includes the body’s memory of triggering adaptive reactions at altitude. The body of an experienced person carries out the acclimatization process faster and more efficiently. The subconscious component also includes unconscious stereotypes of correct behavior at heights.

The conscious component of high-altitude experience includes the knowledge acquired by a person about the reaction of his body to altitude, about how to carry out acclimatization more gently, about the inadmissibility of overload during the acclimatization process, about individual symptoms that precede the exacerbation of not only mountain sickness, but also other diseases typical for an individual , for example, sore throat, bronchitis, furunculosis, hemorrhoids, gastritis.

Thanks to conscious high-altitude experience, the climber monitors the condition of his body and takes measures to prevent the development of diseases at altitude.

When planning climbs to peaks and passes, it is necessary to take into account the high-altitude experience of the event participants. For example, in the rules for conducting sports mountain hikes, a participant is not recommended to exceed his altitude experience by more than 1000 or 1200 meters (this threshold was set differently in different years).

It is more consistent, however, to limit the height of overnight stays to such a threshold. For example, after climbing Elbrus from “barrels” or from the Shelter of the Eleven, in the next event do not plan overnight stays above 4000 + 1200 = 5200 m.

High altitude experience is acquired slowly over several years. But it lasts for a long time. The loss of two or three seasons for already acquired high-altitude experience is not critical. For example, after climbing Aklangam (7004) in 2002, I had a break. In 2003, I only climbed up to 5975 m. And in 2004, I broke my leg and managed to visit 5000 m only once. This did not stop me from carrying out a magnificent hike in 2005 with a traverse of three peaks with heights of 6525, 6858 and 7546 meters. And I felt great there.

This lecture is intended to help increase your high-altitude experience, I mean its conscious component.

Additional literature.

3. A.A. Lebedev.

For fans of the scientific approach, I can also recommend this book. It was published in large numbers and is available in many libraries.

Contains several sections dedicated to preparation for Everest-82

Expand discussion thread

Expand discussion thread

Expand discussion thread

Expand discussion thread

Expand discussion thread

Expand discussion thread

Expand discussion thread

Expand discussion thread

Expand discussion thread

Expand discussion thread

Ilya, thanks for the useful additions.

So I did a little research. Source data taken from
table kindly suggested by Comandante

Due to the temperature latitudinal change in the exponent, the difference between the Central Caucasus and the Central Pamirs turned out to be about 40 m, and between the Central Caucasus and the Himalayas - about 110 m.

That's why weak Caucasus and Asian exist :-))

But the physiological effect, I’m sure, is explained by the acclimatizing effect of long rides. This influence is much stronger.

At climbing Kilimanjaro, the higher you rise, the thinner the air becomes, that is, in it concentration drops necessary for life oxygen, as well as other constituent gases. At the top of Kilimanjaro, lungs full of air contain only half oxygen but from the amount that a full breath would contain at sea level. If there is enough time, human body adapts to an oxygen-poor environment, starting to produce more red blood cells. But this takes weeks, which few can afford. Therefore, almost everyone who climbs a mountain (or another mountain above 3000 m) experiences the effects of altitude. unpleasant symptoms , which are called altitude or mountain sickness (in mountaineering slang - “ miner"). These include shortness of breath, dizziness, lightheadedness, headache, nausea, loss of appetite, insomnia and, as a consequence of all this, exhaustion and irritability. These symptoms appear at the end of the second or third day of climbing Kilimanjaro. Usually they should not be a cause for great concern, but vomiting should be taken seriously: it is necessary to restore the amount liquids in organism. At altitude, moisture loss occurs very quickly, imperceptibly at first, but soon incapacitates a person, increasing altitude sickness.

Much more dangerous acute attack mountain sickness when it turns into chronic form. In English it is called acute mountain sickness ( AMS). Its symptoms include all of the above plus one or more of the following: very severe headache, shortness of breath at rest, flu-like state, persistent dry cough, heaviness in the chest, blood in saliva and/or urine, lethargy, hallucinations; the victim cannot stand upright, think critically and assess the situation. In this case IMMEDIATELY descend to a lower altitude, without stopping, even at night. Keep in mind that it is in the morning, in the pre-dawn hours, that the course of the disease worsens. At the same time, as stated above, the patient may think that he is able to continue to climb - this is not the case. The last word here belongs to the guides.

The sick person is accompanied downstairs by an assistant guide, without damage for the rest of the group. Ignoring the signs of acute mountain sickness can lead to death due to swelling of the brain or lungs. Several people die from this every year on Kilimanjaro. It is impossible to predict in advance who will suffer from altitude sickness, even in a well-equipped medical institution: this trouble awaits young and mature, athletic and not so athletic, beginners and even experienced climbers, so watch your health, don't hide, if you feel unwell, and listen to the guide's instructions.

There are methods proven over decades of climbing reduce risk altitude sickness. First of all, this is a gradual step-by-step acclimatization. It is this principle that is embedded in, when before Kilimanjaro (5895 m) we climb the neighboring lower mountains of Meru (4562 m) or Kenya (Lenana Peak 4985 m), before Elbrus (5642 m) - to the four-thousanders Kurmychi or Cheget, etc. Altitude acclimatization after climbing or trekking is maximum within 1-2 months, after six months it's fading away. Many people successfully use this when planning their trips, successively visiting increasingly higher altitude areas. As for any physical training at sea level (at aerobic mode), then they few help the normal functioning of the body at altitude. On the contrary, they often play a cruel joke on athletes: having become accustomed to enduring loads, they continue to move at the same pace at altitude, not paying attention to the symptoms of altitude sickness, until it knocks them down, so it is necessary emergency evacuation. Ordinary people move more slowly, react sensitively to their condition, so their body rebuilds more efficiently, and they more often reach the top. What a paradox! Really, the quieter you go, the further you'll get.

In addition, effective acclimatization contributes to right way of life(as far as possible), quitting smoking, alcohol, and, as far as possible, yoga (we have extensive experience in supporting yoga tours). In terms of nutrition, the simplest thing that can be offered is vitamins And raisin helping the heart. You should start using it two weeks to a month before climbing, in the morning, pour half of it into a glass and soak it overnight. Dried fruits They help a lot in the mountains, these are the same raisins, dried apricots And prunes. They need to be slowly dissolved under the tongue. Two or three 300 gram bags are enough for two weeks.

Medication support acclimatization is a very big topic. For anyone specifically interested in this, we can recommend the works of Igor Pokhvalin, a professional doctor and high-altitude mountaineer. Briefly, up to altitudes of 6500 m, after which real high-altitude mountaineering begins, the situation looks like this. Some medications are claimed to relieve the problem of altitude sickness. But opinions about their advantages and disadvantages are diametrically opposed, therefore, before using anything, consult with a medical specialist. Most of the controversy is around the most commonly used drug. It's widely known diacarb, in the West - diamox, or acetazolamide. In fact, no one yet fully knows whether it cures the cause of mountain sickness, or only reduces symptoms, thereby masking vital indications for emergency evacuation, such as a splitting headache. In this case, if you do not turn down immediately, you may experience cerebral edema, leading to depression of the respiratory centers. Therefore, professional organizers of commercial climbs on mountains more serious than Kilimanjaro, such as Aconcagua and McKinley, advocate against preventive use Diacarba(daimoxa). However, on Kilimanjaro many people use it as doping. As a result, at the top you can often see elderly pensioners from the West who outwardly feel better than the younger ones - this is the miracle of dymox. The British Medical Association recommends starting this drug for three days before ascending to a high altitude, about 4000 m. For Kilimanjaro, this corresponds to the morning of the first day of ascent. Diacarb (and its Western counterpart) has two known side effects: first of all, it is extremely effective diuretic(originally created to reduce eye pressure). The majority are forced to relieve themselves at least every two hours, including at night, which in itself problem(climbing out of the tent and lack of sleep). As mentioned above, all lost fluid must be restored, and this means drinking not less than 4 liters per day (and not 2, as without Diacarb). The second point is tingling and numbness in the tips of the fingers and toes. Moreover, some point out bad taste in the mouth. However, most people feel better at altitude if they take Diacarb. Alternative – modern drug hypoxene(it is significantly more expensive) or gingko biloba(gingko biloba) 120 mg twice a day, starting a few days before climbing. The latter medicine is not suitable if you are prone to nosebleeds. On our travels we successfully use asparkam (panangin), distributing a tablet to all participants in the morning and evening during the climb. This is vitamin c K And Mg, which helps the heart work and oxygen saturation of the blood ( placebo effect also cannot be overestimated). Finally, the simplest thing - aspirin or its combination with citramon or codeine. Theoretically, it thins the blood, it passes through the capillaries more easily, and the headache goes away. There is an opinion that this is also only masks symptoms(applies to any painkillers), so use moderation and caution in everything. Never climb above tree line (about 2700 m) if you have temperature, nosebleeds, severe cold or flu, inflammation larynx, respiratory infection.

The bottom line is: most preferable correct acclimatization, preventing the occurrence of attacks of mountain sickness. Returning to our route, we draw your attention to the fact that all our groups that went down the combination climbed to its top not only V in full force , but also alert enough to appreciate the unique places they pass through.

Not every sports group has a person with a medical education. This material is intended for those who can only rely on themselves. This article is about what medical preparations take them on a hike, and in what cases and how to use them.

Hiking in the mountains carries many risks, the first of which is health problems for the participant as a result of an accident or illness. The situation with the provision of medical care in the mountains for fans of extreme tourism and mountaineering has changed quite radically several times in recent years (from the purchase of recently fashionable “full” medical insurance, which involves a helicopter flight to help the insured participant, to the complete absence medical care in the high mountain zone). At the same time, the annual flow of athletes to the mountains is not decreasing, but increasing. And not every sports group has a person with a medical education. That is why those who are attracted by mountain peaks and passes are now so keenly interested in the issues of providing first aid on hikes and climbs. Of course, a snowboarder or skier, just like a climber or mountain hiker, can suddenly get sick or injured. But the peculiarities of organizing such a holiday still provide for the presence of a doctor either in a hotel or in the nearest locality. In contrast to a group of athletes making a climb or a long hike through deserted places. Therefore, this material is intended for those who can only rely on themselves. In a huge amount of methodological literature on the topic of first aid, one of the main reasons for its absence or incomplete provision is, first of all, the psychological unpreparedness of those around them to quickly make a decision and take specific actions that can save the life of a victim in trouble. Recalling my personal experience, I will only say that I came to the mountains for the first time in my last year of medical school, and encountered a real accident after having already worked as a surgeon for a couple of years, and having performed more than two dozen independent operations. I remember the panic that possessed me when, in the light of flashlights, I assisted a climber who had broken his hip in the Alibek mountain camp, having reached him with a group of rescuers on the Dzhalovchatsky glacier late at night. There was no anesthesiologist, no operating nurses, no work colleagues nearby. I, like that guy, was lucky; I was able to quickly numb the open fracture of the hip and apply a splint using four hastily connected ice picks, and everything ended up without complications. Since then, I have remembered this state of uncertainty well, and during my classes on medical care in the mountains, I tried to highlight the most basic thing that, in my opinion, everyone who goes to the mountains should know. It should be noted that my method justified itself: in 2001, at the Ullu-Tau alpine base, while climbing to the top of Sarykol, a 40-year-old second-rate student from Kazan was struck by lightning during a thunderstorm. The day before, his department gave me a medical exam for the right to enter the sports group. It turned out that the dose of Dexamethasone I gave after the classes was successfully and quickly used as directed right on the Sarykol ridge, which saved the climber’s life. When the rescuers brought him to the camp 5 hours later, his clothes were charred and torn to shreds, and in his heel there was a gaping “entry mark” from a lightning bolt the size of my fist. At the same time, the victim was conscious, and even asked what was in the dining room for dinner.

Dexamethasone(as well as Dexon, hydrocortisone, etc.) is a corticosteroid - a drug of the adrenal cortex group, with the introduction of one or two doses in the body stimulates the production of adrenaline, and is an excellent anti-shock agent. I consider it the main tool in the fight against shock, which has proven itself in extreme situations. When should corticosteroids be used in emergency medicine? Indications will be all cases of severe shock, bleeding, cardiovascular failure, as well as freezing and hypothermia. How do you know when you need to use corticosteroids? In the case when the pulse rate is more than 100 beats per minute, and the pressure is less than 100 mm Hg, that is, the pulse on the victim's wrist will either not be determined or will be felt with difficulty. In the case where the victim received multiple fractures and injuries. The introduction of only painkillers for severe and combined injuries will not help the work of the heart, and the pressure can decrease significantly, which will lead to a deterioration in the condition, and even death. In case of severe bleeding, both external and internal, one of the signs of which will be a similar increase in heart rate and a decrease in blood pressure. In case of lightning strikes, hypothermia and freezing. The hormones of the adrenal cortex in this case will act as a stimulant of cardiac activity, and will increase the chances of the victim to survive. Also, hormones of the adrenal cortex are administered with the development of pulmonary edema - severe heart failure, often found in high-altitude mountaineering. These drugs have no contraindications, it makes no sense to talk about getting used to them in the case of 1-2 doses, and the effect of using these drugs is simply amazing!

Diuretics in ampoules - Lasix, Diacarb - also always in my extreme first aid kit. With any closed or open injuries of the skull - concussion and contusion of the brain, fracture of the base of the skull, intracranial pressure is always increased. And an increase in pressure in a confined space, which is the cranium, is fraught with serious complications, including the death of the victim due to wedging of the cerebellum into the posterior cranial fossa. Diuretics reduce intracranial pressure, and thereby reduce the risk of severe complications. How to determine the presence of a traumatic brain injury? A blow to the face or the entire head, accompanied by even a short-term loss of consciousness, nausea or vomiting, loss of orientation or memory (especially for events that preceded the injury), as well as loss of consciousness (coma) - all of the above most likely indicate that the victim has traumatic brain injury.

With any traumatic brain injury, in addition to diuretics, I also advise you to enter any sedative(soothing) means, because in sleep the brain's need for oxygen is sharply reduced, which means that the injury will act less destructively on the subtle structures of the brain, primarily on the departments associated with conscious activity. In my practice, there was a case when the role of a sedative (calming) drug was performed by ordinary Diphenhydramine in a solution, which I had to administer fractionally (that is, at equal intervals of time) to an injured climber from the Moscow region, who received a severe cranial injury under the route 5A category of difficulty on the top of Tyutyu-Bashi -brain injury: fracture of the base of the skull. The severity of the injury was then complicated by the almost complete tearing off of the victim’s left cheek, which had to be “sewn” back into place at the “Paradise” overnight stays under local anesthesia. The victim was in an extremely excited state, trying to get out of the akya, cursing and even trying to fight. And if it weren’t for the administration of small doses of diphenhydramine every half hour, the rescue team would hardly have been able to drag him into Akye along the glacier moraine to the road to the Adyrsu gorge, where the bus was waiting for us. Therefore, I believe that it does not really matter what kind of sedative to use, and since most drugs in this group are available only by prescription, you can use Diphenhydramine or Suprastin - antiallergic drugs that have a good hypnotic and sedative effect. We are, of course, talking about injection ampoules. And one more small addition - a victim with a cranial injury must apply cold to the head during transportation. Reducing the temperature of the head tissue protects the brain during injury and increases the chance of restoration of brain structures after recovery. You can use hypothermic bags from car first aid kits; just apply them to your temples or to the site of impact to mitigate the consequences of a traumatic injury. If there are no bags, a plastic bottle with water from a stream, or snow placed in a plastic bag will do. With pulmonary edema (acute heart failure), blood stagnates in the lungs, manifesting itself as bubbling, pink frothy sputum, and gurgling in the chest area. Pulmonary edema develops as a complication of acute pneumonia (pneumonia) or as a decrease in the contractile function of the left heart during high-altitude ascents. An example is the development of pulmonary edema during the ascent of Everest in 1982, team doctor Vyacheslav Onishchenko, who had to be urgently transported down from under the summit, accompanied by injections of cardiac drugs. Administration of diuretics and corticosteroids will help maintain cardiac activity and remove excess fluid from the lungs in such cases. It is also recommended to elevate the victim’s head and upper torso to make it easier for him to breathe, and apply tourniquets to the upper thighs to limit blood flow to the heart.

Another tool that is excellent for use in climbing or hiking conditions, I think Ketanov(ketorolac). An aspirin-type analgesic (painkiller), Ketanov is much stronger than the analgin and paracetamol recommended by Kropf, and it relieves any severe pain, including from multiple fractures with severe combined trauma. Answer to frequently asked question– whether to administer painkillers to a victim who is unconscious at the moment is unambiguous - it is necessary to administer, since, being without signs of consciousness, the victim also experiences pain, he simply cannot express it. Exactly strong pain can lead to the development of painful shock, which was the cause of death of a third-rate climber who fell on a snowy slope while climbing to the top of Via Tau in 1995, when I worked as a doctor at the Shkhelda alpine base. The exact same hip fracture as my first victim in 1982 in Alibek became the cause of death here only because the group of climbers in which the accident occurred did not have painkillers in the first aid kit. I will also say that the analgin solution is oil-based, and the injection takes much longer to dissolve than when Ketanov is administered.

The medicine that I definitely take with me to the mountains is also Baralgin. This drug has good analgesic properties, and at the same time works as an antispasmodic - a drug that relieves spasms in various “colic” - renal, liver, stomach. The addition of Baralgin to Ketanov for pain relief of any fracture enhances and prolongs the effect of both drugs. Baralgin can be used in isolation in the same way as No-shpu in case of diseases of the gastrointestinal tract, severe headaches and increased blood pressure during acclimatization. As a rule, I take both Baralgin and No-shpa both in ampoules (for emergency care) and in tablets (for the treatment of diseases).

Antibiotics It is advisable to have with you, primarily because their antimicrobial effect is much stronger than that of other anti-inflammatory drugs. Of the antibiotics, I give preference to Bioparox, a universal aerosol antibiotic with a wide spectrum of action that easily relieves inflammation in respiratory tract for bronchitis, tracheitis, as well as for sore throat and sinusitis. I use Sumomed, a new generation antibiotic, only if the disease occurs with a high (above 38) temperature and is accompanied by severe intoxication (sweating, chills, nausea). Sumomed can be used both for inflammation of the gastrointestinal tract (not to be confused with poisoning!), and for lung diseases, in particular pneumonia. The Sumomed package contains only 3 tablets, each of which should be taken once a day, preferably at the same time. The drug Sumomed does not require the simultaneous use of agents that affect the intestinal microflora, since it does not cause dysbacteriosis. Simply put, you will avoid diarrhea (diarrhea) that accompanies the use of strong antibiotics without taking special medications.

Imodium and Bacteriophage in an emergency first aid kit they are used to eliminate food poisoning and diarrhea (diarrhea). Many believe that this is one and the same thing, but meanwhile, this is not so: diarrhea (diarrhea) is a symptom of poisoning or some other problem in gastrointestinal tract. In case of poisoning (poison entering the body), there are also other symptoms, for example, nausea and vomiting, but they disappear as a result of getting rid of the cause of the disease. Imodium very quickly (within several hours) is able to stop even the most intense diarrhea, but the Bacteriophage will affect not only the symptom of poisoning, but also destroy the poison or pathogens in the intestines. Together with these, Bacteriophage acts more slowly, so the presence of both of these remedies in an emergency first aid kit is mandatory.

Kit dressings(bandages and adhesive plaster), as well as Yoda and solution Diamond green(green stuff), sorbents in the form activated carbon (if necessary, taking at least 5 tablets of which will be effective!) or Smecta sachets (small, but no less effective!), Traflu or Coldrex powders from colds(which is nothing more than a mixture of paracetamol, ascorbic acid and filler), Mezim or Festal tablets(in case of personal preferences for local delicacies such as lamb kebabs and khichin) will complement a certain universal set medicines, which makes sense to take with you to the mountains. One more thing about dressing material - there is never too much of it. You must have at least three sterile packages of bandages and at least one package of sterile gauze wipes. Separately, I want to talk about antioxidants, drugs that improve metabolism at high altitudes and contribute to greater endurance on the route. One of these means is ascorbic acid, which stimulates metabolic processes in the body and provides a surge of strength during prolonged exercise, even for a very tired person. I deservedly consider it the second effective antioxidant Riboxin, a drug that increases cardiac output (by the way, a light doping), and significantly increases endurance under heavy loads at altitude. Frequently mentioned on forums alcohol tinctures Peony evasive, Rhodiola rosea, Eleutherococcus, Golden root never delighted me, firstly, because of the alcohol component, and secondly, because of significant side effects in the form of increased excitability and increased blood pressure. In addition, they increase the weight and volume of the first aid kit.

Many will be surprised when I say that I have listed the main means of emergency medical care. And yet, this is exactly so. In the mountains you can only die from certain injuries and their complications, so a small set of medicines, used wisely and according to indications, will help save the lives of yourself and your comrades in any unusual situation in the mountains.

I will briefly discuss the key issues of adaptation to hypoxia in high altitude conditions. You already know that some people genetically do not have the ability to adapt to altitudes of about 2500 m. This is due to the lack of genes responsible for the synthesis of respiratory enzymes, without which oxygen transport to the most important organ - the brain - is impossible. External breathing can be effective, but tissue breathing cannot, and sometimes this situation cannot be overcome, so the selection of participants and their high-altitude experience are very important. People who do not know their ability to adapt to altitude represent a high risk group, up to acute death, most likely due to impaired brain function. Therefore, when it comes to selecting for the benefit of the climbers themselves, this must be taken very seriously. In the course of many ascents to high altitudes, the body develops its own adaptive survival mechanisms and reasonable pharmacological nutrition with various necessary drugs only accelerates and optimizes this adaptation, and is not something like a drug. The drug at high altitudes, by the way, is oxygen from a cylinder, and not, for example, multivitamins or eubiotics. You yourself know that it is not the heart and liver that suffer the most, but the control organ - the brain.

Conventionally, the stages of ascent can be divided into:

1. Preparation period before leaving for the mountains, which includes long-term moderate and high-intensity exercise in conditions of high oxygen debt. That is, here we teach slowly and lovingly our organs and tissues to work with a lack of oxygen - we improve the indicators of using it very rationally by tissues and train their “patience” in conditions of still relative, and not absolute (as in high mountains) insufficiency. In addition, by means of rational empirical selection, we accustom ourselves (adopt) to taking pharmaceuticals. At this stage, through trial and error, we establish a dialogue with the body. We track progress and quality, and recovery time. Which drugs are recommended at the stages will be listed below.

2. Acclimatization (altitude adaptation) directly in the mountains. The most important thing in the first stages of being at altitude is not to “twitch”. Brain hypoxia deprives the climber of the ability to be critical of himself. In a state of mild hypoxic euphoria, everything seems accessible. People often try to organize competitions in how to climb quickly. This is extremely dangerous, because... instantly disrupts adaptive mechanisms. The result of this is hypoxic depression of consciousness, depression, apathy and the addition of respiratory and cardiovascular failure.

Issues of pharmacological support are very relevant. In this situation, the doses of drugs are increased with the correct emphasis on the time of their administration (before the load, during it and after it). Medical self-monitoring and condition monitoring (pulse, pressure, oxygenation, i.e. blood saturation with oxygen using a pulse oximeter device - a small clothespin with a screen that is put on your finger) is very desirable. The timing of acclimatization depends on various factors, but without listing them, I will say that we can reduce them. Successful acclimatization is climbing to a high peak and successfully descending from it. Experienced high-altitude climbers develop so-called high-altitude experience, which simply means well-trained adaptation capabilities.

3. Reacclimatization– that is, acclimatization to the conditions of low altitudes. Oddly enough, there are also peculiarities here. They consist of reducing the doses of drugs, rather than completely abandoning them. The existing opinion that after descending into the valley the problems ended is not entirely true. Here, high partial pressure of oxygen complicates tissue repair processes, and alcohol, as a drink of victory, in large doses sharply inhibits tissue respiration enzymes and the function of brain neurons. There are cases when very experienced high-altitude climbers died in Kathmandu amid complete safety and abundance of oxygen and water.

Thus, organizers of commercial climbs should inform ambitious climbers about the extremely high risk of high-altitude experimentation. It is also dangerous for people whose parents or grandparents had episodes of frequent heart attacks that caused death.

Part 2

1. Climb quickly, taking into account previous high-altitude experience, which is called “taking a running start.” Possible only to a very prepared person with the right attitude towards heights. You can climb a low seven-thousander this way, but realistically, even for an amateur, this height is no more than 3000 - 3500. Any delay here is dangerous, and especially bad weather, which is not uncommon in the mountains. This is a choice, but not the best and I would not recommend practicing it often. With the use of pharmaceuticals, this ceiling can be raised to 5000, in the conditions of the Caucasus, for example, and up to 6000 – in the conditions of Equatorial Africa. Air temperature and other factors significantly affect altitude tolerance.

2. Method of “stepped” acclimatization, or as they call it in Western Europe, the “saw teeth” method. In this case, acclimatization is the result of a relatively long period of time, but this method is the most effective in all respects. Firstly, it is correct, secondly, it is reliable and I can recommend it as the most effective. Again, its timing can be shortened and rationalized to suit a specific situation. Its meaning is to rise and bivouac as high as possible, descend and rest as low as possible. This is one cycle. With each subsequent ascent, we reach greater heights and reliably consolidate the previous experience. 2-3 such cycles for a mountain of 7000 - 8200 and we can count on success at good conditions. Complete “absolute” rest and at the lowest possible altitude is very important; I would call it simply deliberate idleness. Each subsequent tooth of this “saw” is steeper than the previous one. I note that only an experienced person can correctly assess the situation. For a beginner, this experience must be gained from scratch. An additional day of “rest” at altitude is a big minus, so everything must be calculated accurately. The use of oxygen at high altitudes is justified from the point of view of preventive resuscitation, but its importance should not be overestimated. Oxygen can turn from a friend into an enemy here and cause some, including fatal, complications. It itself can cause bronchospasm and pulmonary edema, due to the very low temperature and dryness at the outlet of the reducer. It can contribute to dysregulation of the brain’s perception of the situation and, as a result, sometimes paradoxical or incorrect decisions. We are adapted to inhaling an oxygen-nitrogen mixture (this is air), and not to aspirating pure oxygen with a small admixture of “outboard” air. Simplifications and amateurism in these matters are very expensive. Considering that many of us do not have a genetic mechanism for stimulating hematopoiesis (blood formation, the formation of a larger number of red blood cells - carriers of the oxygen acceptor - hemoglobin) and we develop these mechanisms (unlike the Sherpas) through a difficult process of adaptation, it is necessary, at least general outline imagine what to do... By the way, Sherpas have thicker blood with an overall higher content of hemoglobin and red blood cells. But they also have a higher risk of thrombosis, and as a consequence of heart attacks and strokes. Let’s not connect this here with their short life expectancy; let’s give these wonderful guys their due. Often, to maintain the image of a super Sherpa, they do amazing, but very dangerous things for their lives. However, this is a topic for another conversation.

Part 3

The substantiation of rational and preventive therapy, from the point of view of modern concepts of normal and pathological physiology and clinical resuscitation, must begin, firstly, with a correctly set training process, Secondly from reasonable appointments pharmacological agents. Let me make a reservation right away that we are not talking about drugs prohibited by the IOC Doping Committee. After all, therapeutic doses of vitamins or hepatoprotectors are not considered doping, just as a complete and balanced diet is not considered doping. It must be said that research on this issue was carried out in different countries, but the most rational and effective acclimatization system, as well as scientifically and practically sound, is the “old Soviet” one. Here, as an example, we can cite G. Rung’s article “On the prevention of mountain sickness during high-altitude ascents” in the yearbook “Defeated Peaks” for 1970- 71. It has not lost its relevance even now, although the technology for obtaining modern medicines greatly expanded their capabilities effective application. The Americans proposed using a literally universal solution for our purposes: only two drugs “Diamox” and “Dexamethasone” for all occasions. It looks tempting, but very rarely lives up to expectations. What I offer is the result of almost 25 years of my own experience. We can say that this empirical experience was tested not only by me and on me. I have never made a secret of this, as this article is proof of. My friends agree with me that it works, just as a reasonable and systematic approach cannot fail to work.

So: Our goal is to preserve the performance and functional activity of the main organs, create conditions for their active adaptation and optimize recovery processes. A high-altitude climber should be treated like an intensive care unit patient. From a medical point of view, this is a critical condition, this is a clinical case. The most important organ is the brain. Without oxygen, its structures die within 5 minutes. Hypoxia, and this condition is inevitable in the mountains, causes serious dysfunction of the regulatory centers of the brain and triggers a “switching off” mechanism, first of all, cortical processes and then, as hypoxia progresses, more stable subcortical centers. In addition, with the inevitable dehydration (dehydration) of the body and aggregation (gluing and formation of microthrombi and complexes of blood cells), the blood thickens, its fluidity properties and oxygen saturation change sharply. The blood flow to the brain is disrupted, swelling and death are possible. This is not uncommon, for example on Everest. In addition, the self-control mechanism changes and the risk of making inadequate or completely absurd decisions increases.

So, how do we do it: Before leaving for the mountains, as already mentioned, these are trainings in conditions of oxygen debt. By this we "train" the neurons of the central and peripheral nervous system and cause changes at the biochemical level. Neurons activate their own respiratory enzymes, neurotransmitters, accumulate ATP and other types of "fuel". I will not go into details, but will simply list and briefly comment on the prescriptions for drugs at this stage in order of their importance:

• Multivitamins(meaning modern high-tech preparations that include complexes of fat- and water-soluble vitamins and macro- and microelements). It can be "Vitrum", "Duovit", "Centrum", They are taken at all stages and are the basic therapy. The dosage is defined in the annotation. This is usually a one-time dose in the morning. during breakfast. In the mountains, especially during the period of early acclimatization, the dosage can be doubled.
• Our friends" enzymes, including enzymes of tissue respiration - these are mainly proteins; we obtain them by synthesis from food. It is mandatory to take a complex of digestive enzymes. These are, as a rule, pancreatic enzymes, and the drugs: “Mezim”, “Biozym” and others, which are modern market can't be counted. The main requirement is your individual adaptation to any of them. The dosages are indicated in the recommendations, but in the mountains you select the dose empirically depending on the nature of the food. These first two points are the basis for the prevention and elimination of protein-vitamin deficiency.
• Hepatoprotectors– drugs that protect the liver, on the function of which a lot, if not everything, depends. Hypoxia is a kick to the liver. Therefore, it is necessary to take drugs such as Karsil, Livolin or other drugs. Karsil is inexpensive, well tolerated and completely harmless. Dose 1t. 2-3, or more often once a day.
• Taking eubiotics. These are preparations of living beneficial bacteria that are extremely necessary for us. We are talking about a very important point... About 1.5 kg of mixed bacterial flora “lives” in the large intestine of an adult. In a healthy person (where have you seen these?) 98% are anaerobes (beneficial bacteria that do not need oxygen to live) and 2% aerobes (they need oxygen for life). In reality, we all suffer from varying degrees of dysbacteriosis, that is, a violation of not only this ratio, but also the appearance of harmful flora. There are more aerobes, and they consume our tissue oxygen, and in colossal quantities. With the help of Linex, Bifiform or analogues, we restore justice and, as a result, get more oxygen. This is the main, but not the only plus. Dosage: at least 2 weeks before leaving for the mountains, 1 caps. 3-5 times a day. It would be very correct to also include probiotics and prebiotics. These are breeding grounds for our friends and the products of their vital activity. In the mountains, doses can be increased. There will be no overdose. The names of specific medications can be clarified in 10 minutes at any serious pharmacy. Next, let's talk about a minimum of drugs directly for the brain.
• Essential for the brain amino acid glycine, dissolve 2 t under the tongue 2-3 times a day. It improves the tolerance of hypoxia by brain cells and in combination with the next point (6).
• Energy drug "Mildronat" is the perfect couple. In addition, Mildronate is very important in the prevention of heart failure. Take it 1-2 capsules 3 times a day. Be sure to start taking it 2 weeks before the mountains, in a smaller dosage.
• Adequate sleep is extremely important for restoring brain function, especially at altitude. This is almost always a problem. Solving it with the help of psychotropic drugs is dangerous and unsporting. The drugs are available and almost safe Donormil or Sonat. If you take them in the indicated doses, there will be no problems. The author and his friends have had positive experiences with these drugs on Everest, up to 8300. Wonderful sleep with easy awakening and a feeling of rest. During sound sleep, the brain consumes significantly less oxygen, restores the activity of centers and accumulates energy. These processes occur only exclusively in sleep. In short, sleep is the best prevention of cerebral edema. I will repeat once again, be sure to try each of these drugs before the mountains. Like any medicine, they can cause allergies, rare side effects and other possible troubles. Make sure they are harmless, adapt your body to each of them, select individual doses, include them in training process and see the effect. This creative approach will pay off, believe me. This is a different level of life, if you want, this is another chance at life.

Each participant in the hike should have a small personal first aid kit and know how to use the medications included in it. The main component of such a first aid kit are medicines for your “native” diseases. No one knows better than you and your doctor how best to deal with them. Be sure to tell the coordinator and guide about your illnesses and what medications you are taking.

If you have any doubts about your health before going on a hike, be sure to consult your doctor.

List of personal first aid kit for a hike

1. Medicines against “your” diseases in the right quantities. Consult your doctor before going.
2. Hygienic lipstick, 1 pc. Yes, guys definitely do too.
3. Sterile bandage, 1 piece 5x10 cm or 7x14 cm.
4. Sterile cotton wool 25 g or cotton pads 15 pcs.
5. Iodine or brilliant green in a pencil 1 pc. (optional)
6. Elastic bandage for the number of sore joints (minimum 1) or bandages/knee pads.
7. Anesthetic lung, 1 plate.
8. Bactericidal patch, 10 strips. Additionally, you can take a patch in a roll.
9. Peroxide 25 ml, in a plastic bottle.
10. 10 throat lozenges and 5 sachets of Fervex/Coldrex powder

For climbing and trekking at altitudes above 5000 m, take Diamax (Diacarb) and/or Hypoxen. On long hikes, take additional vitamin complexes, you can start drinking a week or two before the start.