Dr. Kevin Yip

Dr Kevin Yip
Orthopaedic Surgeon
MBBS(UK), FRCS(EDIN), FAM(SING), FHKCOS(ORTHO)

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Extreme environments

Preventive measures

Basic physical fitness

Anyone traveling into remote places should first achieve basic physical fitness. A long hike should not be attempted before practicing its unfamiliar aspects, such as carrying a full backpack.
Equipment The equipment carried must be carefully chosen to meet the demands of the hike. Shoes should always be well worn-in and the backpack should fit well. Comfortable and appropriate equipment is a prerequisite for an enjoyable stay out in the open, and a change of clothes should always be carried.

Health

A strenuous hike not only may fail to restore health and strength, it may demand more than it gives in return.Anyone who has recently suffered a bad cold, bronchial infection, or similar infection should not indulge in a long, demanding hike. In such circumstances, staying in the area and taking short day trips with rests is more likely to be beneficial.

Body heat

It is vital to learn to conserve body heat, particularly in winter. Body heat is maintained by metabolizing food and by muscular work. During stays out in the open, demands are increased, and a hungry person feels the cold more easily, so a high-energy food intake is recommended. Alcohol and tobacco should be avoided. Damp clothes should not be allowed to dry on the body, as this causes heat to be lost by evaporation.

If the patient is conscious the following rules apply:

– The patient should be provided with dry, warm clothes.
– The patient should be forced to move about and activate the muscles.
– A warm, sweetened drink should be given. Too hot a drink causes the blood vessels of the skin to dilate so that even more heat is lost, the core temperature is lowered further and the heart may be damaged.
– The patient should, if possible, be taken indoors as soon as possible.
– Warming should be carried out slowly at normal room temperature. Heating packs and warmed blankets can help to rewarm the patient in mild cases.
– The patient should be taken to hospital as soon as possible.

If the patient is unconscious the following rules apply:

– Do not attempt to give anything to drink.
– Remove wet clothes.
– Warm the patient slowly at room temperature with the head at a lower level than the feet. Breathing and pulse should be checked.
– Warm blankets and heating pads can be used until the patient is transported to hospital.
– The patient should be taken to hospital as soon as possible where warming can be carried out under controlled conditions.

Sun or snow blindness

Sun or snow blindness is caused by ultraviolet rays, and is manifested as an inflammatory reaction in the conjunctiva and cornea of the eye. Visible sunlight and ultraviolet radiation are not the same; ultraviolet rays penetrate even when the weather is hazy and cloudy. As a preventive measure, tight-fitting, preferably dark-colored, sunglasses with side shields should be used. The sunglasses should be used at all times, as the eyes never grow accustomed to the strong ultraviolet radiation encountered during visits to snow-covered regions or when sailing.

Symptoms

– The affected person feels ‘gritty’ discomfort, swelling and pain in the eyes towards evening.
– The whites of the eyes become red, and the victim is disturbed by strong light.
– When the injury is severe, the affected person has to be led as if
blind.

Treatment

The injured person’s eyes must be protected from light. This is achieved by fitting a pair of sunglasses with small pieces of cardboard in which holes have been made for the pupils, so that the wearer can only just see to move about. Eye drops or eye ointments that have a relaxing effect on the ring muscle of the iris may be prescribed. Generally sun or snow blindness lasts for 2–4 days and does not result in any lasting disability.

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