BASIC MEDICAL CARE - Medicine for Mountaineering and Other Wilderness Activities - page 9

withhighaltitudecanberelievedsafelywithacetazolamide( Chapter24:DisordersCaused
by Altitude ) .
Analgesia
Analgesics should be supplied liberally, but judiciously, in wilderness situations. The
risk of narcotic addiction for individuals with painful injuries or illnesses is essentially
nonexistent, particularly when the agents are administered for a week or less.
Thehazardofstronganalgesicsconsistslargelyoffurtherdepressingcerebralactivityin
a person whose central nervous system function is already impaired as the result of a head
injury or an illness. Depressed cerebral function is typically manifested by impaired res-
piration—breathing is slower and shallower. Further depression of respiration by narcotics
canleadtosignificanthypoxia,particularlyathighelevations.Apersonwithaseverehead
injury might stop breathing altogether, which usually is catastrophic.
For individuals who do not have a head injury, analgesics can relieve severe discomfort
andtheassociatedemotionaldistress.Formanyindividualswithtraumaticinjuries,control
of pain reduces the severity of shock. Analgesia promotes healing by allowing people with
painful injuries or illnesses to sleep restfully. Many individuals are more aware of pain
at night when nothing is diverting their attention. For three or four days after a major in-
jury—sometimes even longer—strong analgesia may be needed.
Major analgesics have so much sedative effect that a sleeping medication is not needed.
Indeed, administering a sleeping medication with a major analgesic would be hazardous.
Warmth
Individuals who are ill or injured must be kept warm. At low environmental temperat-
ures, persons with severe illnesses or injuries may not be able to generate enough heat to
maintain body temperature, even in a sleeping bag, and like individuals with hypothermia,
may require external sources of heat ( Chapter 26: Cold Injuries ).
Lower Altitude
Evacuation from altitudes above 15,000 feet (4600 m) promotes recovery. Individuals
with diseases of the lungs or heart should be taken as low as possible, preferably below
8000 feet (2400 m), and provided with supplemental oxygen if it is available.
Coughing
People who are immobilized with a severe injury or illness usually do not breathe
deeply,particularlyifbreathingispainful.Asaresultofdiminishedrespiratoryexcursions,
their lungs are not fully expanded and fluid accumulates in the immobile segments. These
collections are an ideal medium for bacterial growth, which leads to pneumonia. (Such in-