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High on high

Into thin air; A Personal Account of the Mt. Everest Disaster ; Jon Krakauer

Anchor ISBN 0-385-49208-1, £4.62 at Internet book shop

Faced with the question "What is my oxygen saturation on a transatlantic Jumbo after a couple of drinks?" Bandolier has found a partial answer, in a review by Andrew Peacock (BMJ 1998;317:1063).

Commercial aircraft are pressurised but only to an altitude of 1800 to 2500 m, and inspired oxygen pressure will be lower than at sea level. This usually has little effect because patients do not exercise during the flight. However, in some patients the reduction in inspired oxygen pressure is critical and additional oxygen may be necessary. As a rule of thumb patients should have an arterial oxygen pressure breathing air greater than 9 kPa at sea level to give them an PaO2 at 1500 m above 6.7 kPa.

Into thin air is the story of an Everest expedition in 1996. The effects of hypoxia, on judgement and performance, are described in an enthralling and horrifying account. Just like most medical disasters, there was layer on layer of mistake before the inevitable became irretrievable. But that is just how medical, and other, accidents often occur. It isn't just one big thing going wrong - though that happens - but more often the accretion of little things going wrong.

This book is thrilling, terrifying and recommended.

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