This document provides an overview of basic aeromedical transport presented by Dr. Sutuspun Kay Kajornboon. It discusses the physiological impacts of decreased atmospheric pressure at altitude, including hypoxia from reduced partial pressure of oxygen and trapped gas problems. It outlines the physiological zones defined by altitude and describes symptoms of hypoxia. Factors affecting tolerance to hypoxia are listed. Prevention and treatment of middle ear and sinus barotrauma and gastrointestinal gas expansion problems are covered. The document also addresses environmental stressors encountered during flight like noise, vibration, glare, low humidity, and unusual motion.
This document provides an overview of basic aeromedical transport presented by Dr. Sutuspun Kay Kajornboon. It discusses the physiological impacts of decreased atmospheric pressure at altitude, including hypoxia from reduced partial pressure of oxygen and trapped gas problems. It outlines the physiological zones defined by altitude and describes symptoms of hypoxia. Factors affecting tolerance to hypoxia are listed. Prevention and treatment of middle ear and sinus barotrauma and gastrointestinal gas expansion problems are covered. The document also addresses environmental stressors encountered during flight like noise, vibration, glare, low humidity, and unusual motion.
This document provides an overview of basic aeromedical transport presented by Dr. Sutuspun Kay Kajornboon. It discusses the physiological impacts of decreased atmospheric pressure at altitude, including hypoxia from reduced partial pressure of oxygen and trapped gas problems. It outlines the physiological zones defined by altitude and describes symptoms of hypoxia. Factors affecting tolerance to hypoxia are listed. Prevention and treatment of middle ear and sinus barotrauma and gastrointestinal gas expansion problems are covered. The document also addresses environmental stressors encountered during flight like noise, vibration, glare, low humidity, and unusual motion.
This document provides an overview of basic aeromedical transport presented by Dr. Sutuspun Kay Kajornboon. It discusses the physiological impacts of decreased atmospheric pressure at altitude, including hypoxia from reduced partial pressure of oxygen and trapped gas problems. It outlines the physiological zones defined by altitude and describes symptoms of hypoxia. Factors affecting tolerance to hypoxia are listed. Prevention and treatment of middle ear and sinus barotrauma and gastrointestinal gas expansion problems are covered. The document also addresses environmental stressors encountered during flight like noise, vibration, glare, low humidity, and unusual motion.
By: Sutuspun Kay Kajornboon, M.D., Dip. Av. Med. (UK) Director, Civil Aeromedical Center, BMC
Date: 2011
TROPOSPHERE From sea level to FL 300-600 Depending on temperature Temperature Lapse Rate 1.98 oC / 1,000 ft. Water Vapor : Seasons & Weather, Turbulance Most Flying occurs
Dr. Sutuspun Kajornboon
Physiological Division PHYSIOLOGICAL ZONE: MSL to 10,000 ft. PHYSIOLOGICAL DEFICIENT ZONE 10,000 ft. to 50,000 ft. SPACE - EQUIVALENT ZONE
> 50,000 ft.
Dr. Sutuspun Kajornboon
Physiological impact of decreased atmospheric
pressure Decrease of Atmospheric Pressure Decrease of Partial Pressure
TUC 20 - 30 min 10 min 3 - 5 min 1 - 2 min 30 - 60 sec 15 - 30 sec 9 - 12 sec
Factors Affecting Tolerance to
Hypoxia - I
altitude time rate of ascent exercise cold illness
Factors Affecting Tolerance to
Hypoxia - II
fatigue drugs and alcohol smoking stress and workload physical fitness hangover
TRAPPED GAS DISORDERS
Gas Expansion at Altitude
80k 10 x
53k 4x
34k
18k 1x
The Middle Ear
Outer ear
Inner ear
Eardrum
Eustachian tube
Gas Expansion in the Ear - Climb Pressure in the middle ear is greater than the outsides pressure.
Gas Contraction in the Ear - Descent Pressure in the middle
ear is less than the
outsides pressure.
Acute Barotitis Media
Eardrum
Eustachian tube
BAROTITIS MEDIA An acute/chronic traumatic inflammation caused by pressure difference between the air in the middle ear and that of the surrounding atmosphere. Symptoms: pain, deafness, tinnitus and occasionally, vertigo.
Prevention Equalized pressure by: Chewing action or moving jaw side to side Yawning or swallowing Valsalva Do not fly with a cold.
Valsalva Maneuver
Take a deep breath.
Hold the nostrils shut tight. Tense the cheek & neck muscles. Force pressure similar to blowing your nose. ( Strong short burst )
The Sinuses
Ethmoidal sinuses
Sphenoidal sinus
Frontal sinus Maxillary sinus
Barosinusitis Media Signs: fullness around the eyes area to sharp stabbing pain
: trace of blood with nasal discharge
Treatment & Prevention
Seek treatment for URI/Sinusitis Do a valsalva maneuver for relief Use antihistamine nasal spray
Intestinal Gas Expansion
Sea Level 10,000 ft. 30.000 ft. 40,000 ft. 50,000 ft.
= = = = =
1.0 1.5 4.0 7.0 17.0
Liter Liter Liter Liter Liter
Gas Expansion in the Stomach
Gas Expansion in the Large Bowel
Gas Expansion in the Small Bowel
Prevention Avoid gas producing food. Chew your food completely. Avoid drinking large amount of liquid before flight. Start the day with good bowel habits Avoid chewing gum during ascent
RELIEF OF SYMPTOMS
Belching (upper GI)
Passing wind (lower GI) Maintain level flight (for cockpit crew) Descent to lower altitude if pain is severe (for cockpit crew)
Gas Expansion in the Lungs
- pneumothorax
- air embolism - pneumomediastinum
Prevention of Trapped Gas
Problems Fly only when healthy See a doctor if ill Equalize pressures frequently on descent
Avoid gas producing foods, maintain
a healthy diet
Flight Environment GLARE Strong bright light from the sun above and reflected from the clouds below Health effect from UVa & UVb causing eyes irritation pterygium & cataract (long term) Effect pilot more than cabin crew
Noise & Vibration
Pa
200,000,000 140
20,000,000 Pneumatic road drill
Jet take-off 120
2,000,000
100
200,000
80
20,000
60
2000
40
Business office
dB
Heavy truck
Library Quiet woods
200
20
20
Acceptable Noise Levels.
No NIHL with 75 exposures.
- 80 dB(A)
OH&S limit of 85 dB(A) for 8 hour
working day (Daily Noise Dose). Aircrew exposures regularly exceed this.
Flight Environment Noise
Vibration
Communication Stress Fatigue Distraction Deafness (hearing loss) Vibro-acoustic Syndrome
Flight Environment HUMIDITY Human are comfortable with humidity around 60-70%; Cabin humidity could be as low as less than 30% Can cause throat & upper airway irritation prone to viral infection & make jet lag worse Dryness exacerbate chronic skin problems such as allergy, eczema, dandruff
HUMIDITY
Drinks more water or fluids
Avoid alcohol, too much coffee or tea
Flight Environment UNUSUAL MOTION Unexpected movements in all three axis which is not normally encounter on the ground confusion, stress and motion sickness. Long term worsen the effect of jet lag and fatigue easily Turbulence are health hazard for aircrew
Med-crew Environment CONFINED WORKING AREA Psychologically stressful: constantly avoiding obstacles; worse in claustrophobia Physically a safety hazard: can get injured easily especially during turbulence
Guidelines for Air and Ground Transport of Neonatal and Pediatriс Patients 4th Edition Aap Section On Transport Medicine (Author) all chapter instant download
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