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Basic Aeromedical
Transport
Presented at: ACEM Workshop
By: Sutuspun Kay Kajornboon,
M.D., Dip. Av. Med. (UK)
Director, Civil Aeromedical Center, BMC
Date: 2011
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TROPOSPHERE
Fromsealevelto FL 300-600 Dependingon temperature
Temperature Lapse Rate1.98oC / 1,000 ft.Water Vapor : Seasons & Weather,
Turbulance
Most Flying occurs
Dr. Sutuspun Kajornboon
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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
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Physiological impact of decreased atmospheric
pressure
Decrease of Total Pressure
Evolved Gas Problem
*Decompression
sickness
Decrease of Atmospheric Pressure
Decrease of Partial
Pressure
Trapped Gas Problem
*Ear Barotrauma
*Sinus Barotrauma*Gastrointestinal gas
expansion
*Barodentalgia
*Etc.: pneumothorax,
peumomediastinum
Hypoxia
Dr. Sutuspun Kajornboon
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mm Hg0
200 400 600 760
80k
70k
60k
40k
30k
20k10k
50k
Feet
Change of Pressure with Altitude
1/2
1/4
1/10
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Partial Pressure
Air at Sea Level
O2 = 21% pO2 = 160 mm Hg
N2 = 78% pN2 = 593 mm Hg
Other = 1% = 7 mm Hg
Total = 100% = 760 mm Hg
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Partial Pressure
Air at 10,000 ft.
O2 = 21% pO2 = 110 mm Hg
N2 = 78% pN2 = 408 mm Hg
Other=1% = 5 mm Hg
Total=100% =523 mm Hg
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Partial pressures in mm Hg at sea level
103
570
40
47
Alveolar air
Carbon dioxide
Water vapour
Oxygen
Nitrogen
160
593
Atmospheric air
Oxygen
Nitrogen
0
760
Other 7
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Alveolar Gases
10,000 ft
523 mm Hg
55O2
381N2
40
47
CO2
H2O
Sea level
760mm Hg
103O2
570N2
40
47
CO2
H2O
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Alveolar Gases
10,000 ft
523 mm Hg
55O2
381N2
40
47
CO2
H2O
Sea level
760 mm Hg
103O2
570N2
40
47
CO2
H2O
18,000 ft
380 mm Hg
Air
39O2
264N2
30
47
CO2
H2O
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Symptoms and Signs
Performance Effects
personality change
loss of judgement loss of self-criticism
euphoria
loss of short term memorymental incoordination
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Symptoms and Signs
Physical Effects
muscular incoordination
sensory loss - vision
- touch
hot flushes
cyanosishyperventilation
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Symptoms and Signs
Late Effects
semi-consciousnessunconsciousness
death
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Times of Useful Consciousness
Alt i tude TUC
FL 180 20 - 30 min
FL 220 10 minFL 250 3 - 5 min
FL 300 1 - 2 min
FL 350 30 - 60 secFL 400 15 - 30 sec
FL 430 9 - 12 sec
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Factors Affecting Tolerance to
Hypoxia - I altitude
time
rate of ascent
exercise
cold illness
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Factors Affecting Tolerance to
Hypoxia - I I fatigue
drugs and alcohol
smoking
stress and workload
physical fitness hangover
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TR PPED G S
DISORDERS
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80k
34k
18k
0
53k
4 x
1 x
10 x
Gas Expansion at Altitude
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The M iddle Ear
Eardrum
Eustachian tube
Inner earOuter ear
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Gas Expansion in
the Ear - Climb
Pressure in the
middle ear is
greater than theoutsides pressure.
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Gas Contraction in
the Ear - Descent
Pressure in the middle
ear is less than the
outsides pressure.
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Acute Baroti tis Media
Eardrum
Eustachian tube
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BAROTITIS MEDIA
An acute/chronic traumatic inflammation
caused by pressure difference between
the air in the middle ear and that of thesurrounding atmosphere.
Symptoms: pain, deafness, tinnitus and
occasionally, vertigo.
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Prevention
Equalized pressure by:
Chewing action or moving jaw side to
side
Yawning or swallowing
Valsalva
Do not fly with a cold.
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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 )
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The Sinuses
Frontal sinus
Maxillary sinus
Ethmoidal sinuses
Sphenoidal sinus
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Barosinusitis Media
Signs: fullness around the eyes area to
sharp stabbing pain
: trace of blood with nasal discharge
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Treatment & Prevention
Seek treatment for URI/Sinusitis
Do a valsalva maneuver for relief
Use antihistamine nasal spray
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Intestinal Gas Expansion
Sea Level = 1.0 Liter
10,000 ft. = 1.5 Liter
30.000 ft. = 4.0 Liter
40,000 ft. = 7.0 Liter
50,000 ft. = 17.0 Liter
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Gas Expansion in
the Stomach
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Gas Expansion in
the Large Bowel
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Gas Expansion in
the Small Bowel
?
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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
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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)
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Gas Expansion in the Lungs
- pneumothorax
- air embolism
- pneumomediastinum
Prevention of Trapped Gas
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Prevention of Trapped Gas
Problems
Fly only when healthy
See a doctor if ill
Equalize pressures frequently on
descent
Avoid gas producing foods, maintaina healthy diet
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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
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Noise & Vibration
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Acceptable Noise Levels.
No NIHL with 75 -80 dB(A)exposures.
OH&S limit of 85 dB(A) for 8 hour
working day (Daily Noise Dose). Aircrew exposures regularly exceed this.
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Flight Environment
Noise
Communication
Stress
Fatigue Distraction
Deafness (hearing loss)
Vibro-acoustic Syndrome
Vibration
Pain threshold
Stress
Fatigue Motion Sickness
Speech problem
Hyperventilation
Soft tissue injury (backpain)
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Flight Environment HUMIDITY
Human are comfortable with humidityaround 60-70%; Cabin humidity could be as
low as less than 30% Can cause throat & upper airway irritation
prone to viral infection & make jet lagworse
Dryness exacerbate chronic skin problemssuch as allergy, eczema, dandruff
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HUMIDITY
Drinks more water or fluids
Avoid alcohol, too muchcoffee or tea
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Flight Environment UNUSUAL MOTION
Unexpected movements in all three axiswhich is not normally encounter on theground confusion, stress and motionsickness.
Long term worsen the effect of jet lag
and fatigue easily Turbulence are health hazard for aircrew
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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
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Thank you for your attention