High Altitude Risk Bingo

1. Pick the two highest capitals.

A. Cusco
B. Madrid
C. Andorra La Vella
D. Geneva
E. Addis Abeba

2. Early morning in Pang tent camp at 4510 meters , enroute to Leh. You wake up and realise that your friend is pale … and has stopped breathing !
Vital things to do within the first minute :

A. Start mouth-to-mouth breathing , and send runner to the army first aid post for oxygen.

B. Check level of consciousness , if neccessary with pain stimulation ( hard rub against sternum , sharp pressure against fingers ). If awakening , instruct to breathe deeply , and drink one liter of water.

C. Full CPR , two breaths , thirty heart compressions cycle. Eight mg dexamethason under the tongue.

D. Use watch/phone to measure heart rate during twenty seconds

E. Azetacolamide , if possible intravenously , high flow oxygen , evac to lower altitude

3.Your friend is back among living , looking a bit suprised at the emotionally charged atmosphere . What just happened ?

A. He became unconscious from hypoxia.
B. He had a cerebral edema .
C. He was breathing too much.
D. He had a allergic butter tea reaction.
E. He had low blood pressure from dehydration , and passed out while sleeping.

4. Pick the two lowest capitals.

A. Kathmandu
B. Quito
C. Sanaa , Yemen
D. Ulan Bator , Mongolia
E. Dodoma , Tanzania

5. This type of supplemental oxygen gives a valuable aid when ascending rapidly during

A. One minute
B. Fifteen minutes
C. One hour
D. Eight hours
E. One day

6. The worlds highest road tunnel is found in

A. Switzerland
B. Chile
C. Tibet
D. United States
E. Afghanistan

7. This medical grade oxygen tank is enough for moderate oxygen flow for altitude sickness victims during

A. thirty minutes
B. one hour
C. four hours
D. eight hours
E. one day

8. The mortality rate among climbers going beyond Everest Base Camp is circa :

A. 1 %
B. 3 %
C. 8 %
D. 15 %
E. 21 %

9. Sherpa mortality on climbing expeditions is

A. same as climbers
B. lower
C. higher

10. Worlds highest cable car is found in

A. France
B. Venezuela
C. Bolivia
D. India
E. China

11. Five fellow passengers on the plane to Lhasa from Kathmandu.Who is least likely to develop altitude sickness ?

A. Fiftyfive year old impatient academic , who stopped eight hours in Kathmandu to see Boudnath after the flight from the US. Slightly overweight.

B. Annoying Indian Nintendo wielding five year old that kicks the back of your seat durin the whole flight.

C. The twenty-eight year old mother of the same .

D. Long distance runner , twenty one years old, fresh from one weeks training in Goa.

D. Newari trader from Pokhara.

12. Who is the most likely to develop altitude sickness ?

13.

Boyle´s Law ( Robert Boyle , Irish scientist 1627-1691 ) is directly related to the medical condition known as :

A. HAPE
B. AMS
C. HACE
D. TIMS
E. HAFE

14.Which of these alternative/traditional remedies have a proven effect against altitude sickness ?

A. Soroche Pills (Andes)
B. High water intake
C. Coca ( Andes )
D. Hong Jian Tin/Rhodiola
E. None of the above

High Altitude Risk Bingo : the answers

1. The two highest : Cusco ( 3400) and Addis Abeba (2355).Addis Abeba was the home of Haile Selassie, ruler of Ethiopia and Rastafari icon , his palace is found just outside Addis at 3000 meters altitude.

Andorra La Vella (1023) is the highest European capital in the lilliput state of Andorra in the Pyrenees , and contrary to most expectations Madrid (677) is higher than Geneva (375) in Switzerland.

2. Correct answer : check that there is a pulse , and do nothing ( i.e. D) until breathing starts again, within twenty seconds.
3. Yes , he is pale , and so are you : everyone who has just arrived in Pang is , and will match the norm for home oxygen treatment for people with chronic lung disease. The pause in breathing comes from the battle between two impulses : hypoxia leads to increased breathing , but will lose everytime you blow off too much carbon dioxide and change the acidity levels in the blood. Acclimatization will make increased breathing possible by a change in acid balance , so will medicating with Diamox/azetacolamide.

4. Going backwards , from high to low : the highest capital on the list is Quito (2850) in Colombia , i.e. in the Andes. The second highest lies one thousand meters higher than Kathmandu and has a distinctive architecture that includes Ladakhi style toilets with an extra twist : separation between solids and fuels from the start :
Sanaa

Welcome to Sanaa (2250) on the Arabian peninsula , one of the oldest living cities in the world , the source for the oldest existing version of the Quran , that until the late 20th century included more than 50 000 Jews.

The two lowest capitals on the list lies close to the highest mountains on their continent : Kathmandu at 1280 meters is a hundred meters lower than Ulan Bator , and Dodoma (1120) is … miles away away from Kilimanjaro , the highest mountain in Africa.

5. Cue wild laughter in the ICU and ER coffee rooms : oxygen canisters like this hold around 95 % oxygen at hair spray can pressure , and this brand specifies it as lasting for around 25 breaths/inhalations. That equals around one minute of effective use for anyone under more than mild stress.

6. Highest road tunnel today : the Eisenhower Tunnel in Colorado at 3401 meters , a few meters higher than the Salang tunnel under the Hindukush range in Afghanistan. The Hindukush ( “death of the Hindus” ) remained a formidable obstacle for accessing the Afghan heartland until a Soviet aid program built the Salang tunnel in 1964 , that became the main inroad for the Soviet invasion in 1979. Both will be bested by the tunnel being built today linking Yunnan & Tibet.

7.Medical grade oxygen comes in steel or high grade composite tanks at a pressure of around 200 atmospheres , i.e. 200 times the pressure at sea level. This 2.5 liter tank thus contains 200 x 2.5 = 500 liters , which means 250 minutes of use at a flow of two liters per minute.

8. A: 1.3 %

9. C : Higher . Sherpas have the advantage of lifelong adaption , which is exploited in allowing them less acclimatization nights. They are also aware of the fact that aknowledging symtoms can mean not only losing income on their current climb , but also not getting a job on other expeditions.To add another physiological burden many have started to live where they are recruited , i.e. down in Kathmandu , which pushes them closer to lowland capacity.

10. The contenders are : the Gulmarg Gondola in kashmir, max elevation 3747.
The French cable car at Aiguille du Midi ends at 3777
The Venuzuelan Meridian cable car would be the clear winner , well over 4500 meters … if it actually ran.
The Loveland lift system in Colorado (US) : 3871 meters is surpassed only by the Jade Dragon Snow Mountain in Yunnan at 4500 meters.

11.A : combining two factors meaning lower risk : being 50+ years , and a long intercontinental flight ( cabin pressure equaling up to 2400 meters altitude) the same day.

12. Highest risk D : no known time at high altitude , young , male, competitive.

13. The lighter side of Boyles Law , which describes how gases expand with decreased surrounding pressure :
Boyles Law

The darker side : all gases expand when ascending …ooh.As in I really shouldn´t had that last curry. In medicalese HAFE : High Altitude Flatulent Emission.

14. E The only traditional medicine on the list is coca. The Soroche Pills sold in the Andes is a combination of ASA and caffeine , one of the most common hangover cures on the planet _ basically it´s just aspirin with a dash of caffeine. Rhodiola comes from the Soviet/Russian search for “adaptogens” , substances that are supposed to make us more invulnerable to environmental stress. High water intake is modern folklore on the web : the only attempt to present evidence for this strayegy is a study from Everest that showed that those with lowest fluid ( NB not water) intake had more symtoms … as in more headaches.