ALTITUDE ALTITUDE PHYSIOLOGY PHYSIOLOGY
ALTITUDEALTITUDE
PHYSIOLOGYPHYSIOLOGY
OUTLINEOUTLINE
• The Atmosphere• Hypoxia
• Types• Stages
• Hyperventilation• Trapped Gas Disorders• Evolved Gas Disorders
REFERENCESREFERENCES
FM 1-301, Aeromedical Training for Flight
Personnel, May 1987
FM 1-204, Night Flight Techniques and
Procedures, October 1983
TROPOSPHERE
Sea level to flight level 300 - 600 depending on temperature, latitude and season.
Physical DivisionsPhysical Divisions of the Atmosphere
STRATOSPHERE
IONOSPHERE
EXOSPHERE
MOUNT EVEREST 29,028 FEET
1200 miles
600 miles
50 miles
Tropopause
Physiological ZonesPhysiological Zones of the Atmosphere of the Atmosphere
EFFICIENT ZONE: SEA LEVEL TO 10,000 FEETEFFICIENT ZONE: SEA LEVEL TO 10,000 FEET
SPACE EQUIVALENT ZONE: 50,000 FEET AND ABOVESPACE EQUIVALENT ZONE: 50,000 FEET AND ABOVE
DEFICIENT ZONE: 10,000 TO 50,000 FEETDEFICIENT ZONE: 10,000 TO 50,000 FEET
10,000
50,000
78 % Nitrogen (N2)
21 % Oxygen (O2)
1 % Other
(.03 % CO2)
Composition of AirComposition of Air
14.7 PSI
Sea Level PressureSea Level Pressure
Scale
lbs
760 mm Hg
OR
29.92 in. Hg
Barometer / Altimeter
PERCENT COMPOSITION OF THE ATMOSPHERE REMAINS
CONSTANT
BUT PRESSURE
DECREASES
WITH ALTITUDE
SIGNIFICANT PRESSURE ALTITUDESSIGNIFICANT PRESSURE ALTITUDES
ALTITUDE PRESSURE
FEET mm/HG ATMOSPHERES
0 760 1
18,000 380 1/2
34,000 190 1/4
48,000 95 1/8
63,000 47 1/16
Partial PressurePartial Pressure
(Dalton’s Law)(Dalton’s Law)760 mm Hg760 mm Hg
47 --- mm/Hg 95 ---190 ---380 ---523 ---760 ---
21%O2
78% N2
1% O
ther
The pressure exerted by a mixture of gases is equal to the sum of the partial pressures of
each gas in the mixture.
Pt = P1 + P2 + ...+ Pn
(Dalton’s Law)(Dalton’s Law)
HypoxiaHypoxia
State of oxygen [O2] deficiency in the blood cells
and tissues sufficient to cause impairment of
function.
Types of HypoxiaTypes of Hypoxia
Hypemic
Stagnant
Histotoxic
Hypoxic
HypemicHypemic HypoxiaHypoxia
Inability of the Inability of the blood to blood to
accept oxygen accept oxygen inin
adequate adequate amountsamounts
++
++++
++
++++
++
++++
++
++
++
++ ++++
Stagnant HypoxiaStagnant HypoxiaStagnant HypoxiaStagnant Hypoxia
ReducedReduced bloodbloodflowflow
Blood Blood movingmovingslowlyslowly
adequateadequateoxygenoxygen
Red blood cells Red blood cells not replenishing not replenishing
tissue needs tissue needs fast enoughfast enough
Red blood cellsRed blood cells retain oxygenretain oxygen
Inability of Inability of the the
cell to accept cell to accept or use or use oxygenoxygen
Histotoxic HypoxiaHistotoxic Hypoxia
Poisoned tissuePoisoned tissue
adequateadequateoxygenoxygen
Hypoxic HypoxiaHypoxic HypoxiaReduced Reduced
pOpO22
in the in the lungslungs(high (high
altitude)altitude)
Body tissueBody tissue
Red Red blood cellsblood cells
HypoxiaHypoxiaSymptomsSymptoms
Subjective: FeelSubjective: Feel
Air hunger Air hunger Hot and Cold FlashesHot and Cold Flashes
Apprehension Apprehension EuphoriaEuphoria
Fatigue Fatigue BelligerenceBelligerence
Nausea Nausea Blurred visionBlurred vision
Headache Headache NumbnessNumbness
Dizziness Dizziness Tingling Tingling
Denial Denial
Air hunger Air hunger Hot and Cold FlashesHot and Cold Flashes
Apprehension Apprehension EuphoriaEuphoria
Fatigue Fatigue BelligerenceBelligerence
Nausea Nausea Blurred visionBlurred vision
Headache Headache NumbnessNumbness
Dizziness Dizziness Tingling Tingling
Denial Denial
HypoxiaHypoxiaSignsSigns
Objective: SeeObjective: See
HyperventilationHyperventilation
CyanosisCyanosis
Mental confusionMental confusion
Poor JudgmentPoor Judgment
Lack of muscle coordinationLack of muscle coordination
Stages of HypoxiaStages of Hypoxia
Indifferent Stage
Compensatory Stage
Disturbance Stage
Critical Stage
Indifferent StageIndifferent Stage
Altitudes
Air: 0 - 10,000 FEET
Symptoms: decrease
in night vision @ 4000 feet
Compensatory StageCompensatory Stage
Altitudes
Air : 10,000 - 15,000 FEET
Symptoms: impaired efficiencydrowsinesspoor judgmentdecreased coordination
CAUTION!CAUTION!
Failure to recognize symptoms and Failure to recognize symptoms and take corrective action may result in take corrective action may result in
an aircraft mishapan aircraft mishap
Disturbance StageDisturbance Stage
Altitudes
Air: 15,000 - 20,000 FEET
Disturbance StageDisturbance Stagesymptomssymptoms
Sensory Vision
Touch & pain
Hearing
Disturbance StageDisturbance Stagesymptoms
Mental Memory Judgment Reliability Understanding
Disturbance StageDisturbance Stagesymptomssymptoms
Personality Happy Drunk
versus the
Mean Drunk
Disturbance StageDisturbance Stagesymptomssymptoms
Performance Coordination Flight Control Speech Handwriting
put back on oxygen
Time off Oxygen
1 minute1 minute
2 minutes2 minutes
3 minutes3 minutes
4 minutes4 minutes
5 minutes5 minutes
6 minutes6 minutes
CAUTION!CAUTION!CAUTION!CAUTION!
Failure to recognize symptoms Failure to recognize symptoms and take corrective action may and take corrective action may
result in an aircraft mishapresult in an aircraft mishap
Disturbance StageDisturbance Stage
Signs Hyperventilation
Cyanosis
Critical StageCritical Stage
Altitudes
Air: 20,000 FEET and above
Symptoms: loss of consciousnessconvulsions
death
WARNING!WARNING!
When hemoglobin saturation falls toWhen hemoglobin saturation falls to
serious cellular dysfunction occurs; serious cellular dysfunction occurs;
and if prolonged, can cause deathand if prolonged, can cause death
WARNING!
65%65%
Factors modifying hypoxia Factors modifying hypoxia symptomssymptoms
Pressure altitude Rate of ascent
Time at altitude
Temperature
Physical activity Individual factors Physical fitness Self-imposed stresses
Alcohol
it’s a no brainer!it’s a no brainer!
Tobacco
keep keep self imposed stressesself imposed stresses out of the aircraft out of the aircraft
Drugs
ExhaustionHypoglycemia
2000 feet
2000 feet
BBUUZZZZ
1 ounce =
1 ounce =
alcoholalcohol
Expected Performance TimesExpected Performance TimesExpected Performance TimesExpected Performance Times
FL 430 & above 9-12 seconds
FL 400 15 - 20 seconds
FL 350 30 - 60 seconds
FL 300 1 - 2 minutes
FL 280 2 1/2 - 3 minutes
FL 250 3 - 5 minutes
FL 220 8 - 10 minutes
FL 180 20 - 30 minutes
Expected performance time for a crew member Expected performance time for a crew member flying in a pressurized cabin is reduced flying in a pressurized cabin is reduced
approximately one-half following approximately one-half following loss of pressurization such loss of pressurization such
as in a:as in a:
RDRDrapid decompression rapid decompression
HypoxiaHypoxia
Prevention
limit time at altitude
breathing oxygen
pressurized cabin
HypoxiaHypoxia
Treatment
oxygen
descend to a safe altitude
HyperventilationHyperventilationdefinitiondefinition
an excessive rate and depth of respiration leading to the abnormal
loss of CO2 from the blood.
Emotional (fear, apprehension, excitement)
Pressure breathing
Physical stress
Hypoxia
HyperventilationHyperventilationCausesCauses
HyperventilationHyperventilation SymptomsSymptoms
tingling sensations muscle spasms hot and cold sensations visual impairment dizziness unconsciousness
HyperventilationHyperventilation reason for symptomsreason for symptoms::
loss of carbon dioxide [CO2]
shift in pH balance
HyperventilationHyperventilationsignificancesignificance
incapacitation of an otherwise outstanding, healthy aviator.
confusion with hypoxia
Don’t Panic
Control your breathing
HyperventilationHyperventilationpreventionprevention
Check your oxygen equipment - it may be hypoxia
above 10,000 feet
possible hypoxia
below 10,000 feetprobable hyperventilation
HyperventilationHyperventilationcorrective actioncorrective action
DysbarismDysbarism
syndrome resulting from the effects, syndrome resulting from the effects, excluding hypoxia, of a pressure excluding hypoxia, of a pressure differential between the ambient differential between the ambient
barometric pressure and the barometric pressure and the pressure of gases within the bodypressure of gases within the body
Boyle’s LawBoyle’s Law
The volume of a gas is inversely proportional to its
pressure; temperature remaining constant.
DRY GAS EXPANSIONWET GAS EXPANSION1.8X 2.0X16,000
2.5X 25,000 3.0X
34,,000 5.0X
43,000
4.0X
9.5X6.0X
Gas Expansion
Watch your diet, don’t eat too fast Avoid soda and large amounts of water just
prior to going to altitude
Don’t chew gum during ascent
Keep regular bowel habits; eat your fiber
Gas ExpansionGas Expansionprevention of abdominal gas painsprevention of abdominal gas pains
Middle Ear
Opening to throatOpening to throatEustachian tubeEustachian tube
External earMiddle ear
Ear drum
Semicircular canal Cochlea Auditory nerve
Middle Ear Cavity
Eustachian Tube
Atmospheric Pressure
Tympanic Membrane
External Ear
Middle Ear Cavity
Eustachian TubeBlocked / Infected
Tympanic Membrane
External EarAtmospheric Pressure
Pressure EffectPressure Effect
Ear Block
Clear
Normal tympanic membrane (ear drum)Normal tympanic membrane (ear drum) Inflamed ear drumInflamed ear drum
Infected ear drumInfected ear drum
Frontals
Ethmoids
MaxillarySphenoids
The SinusesThe Sinuses
Treatment of an Sinus/Ear Block Treatment of an Sinus/Ear Block
1.1. Stop the descent of the aircraft and attempt Stop the descent of the aircraft and attempt to clear by valsalva. to clear by valsalva.
22. If unable to clear, climb back to altitude until . If unable to clear, climb back to altitude until clear by pressure or valsalva.clear by pressure or valsalva.
33. Descend slowly and clear ear frequently . Descend slowly and clear ear frequently during descent.during descent.
BarodontalgiaBarodontalgia
Tooth pain due to:
Gum abscess: dull pain on ascent Inflamed pulp: sharp pain on ascent
Inflamed maxillary sinus: pain primarily on descent
Decompression Decompression SicknessSickness
Henry’s LawHenry’s Law
The amount of gas dissolved in solution is directly proportional to the pressure of the gas over the solution
WARNIN
G
WARNIN
G
Evolved gas disorders are considered serious
and medical treatment and advice
must be sought immediately.
Evolved Gas DisordersEvolved Gas Disorders
The BendsThe Bends
ParesthesiaParesthesia
The ChokesThe Chokes
Central Nervous System-CNSCentral Nervous System-CNS
Evolved Gas DisordersEvolved Gas Disorders
N2 bubbles become trapped in the joints. Onset is mild, but eventually painful!
The BendsThe Bends
Evolved Gas DisordersEvolved Gas Disorders
ParesthesiaParesthesia N2 bubbles form along nerve tracts. Tingling and itchy sensation and possibly a mottled red rash.
Evolved Gas DisordersEvolved Gas Disorders
The ChokesThe Chokes N2 bubbles block smaller pulmonary vessels. Burning sensation in sternum. Uncontrollable desire to cough. Sense of suffocation ensues.
Evolved Gas DisordersEvolved Gas Disorders
CNSCNS N2 bubbles affect spinal cord. Visual disturbances, paralysis, one sided tingling.
Evolved gas factorsEvolved gas factors
Rate of ascent
Altitude
Body fat content Age
Exercise
Duration of exposure
Repeated exposure
Descend
100% Oxygen
Decompression SicknessDecompression Sicknesstreatmenttreatment
Land at nearest location where qualified medical assistance is available.
Compression greater than 1 atmosphere (absolute).
Scuba Divers Beware!Scuba Divers Beware!
24 Hour restriction
24 Hour restriction
between diving and flying!!!!!
between diving and flying!!!!!
or be bent!or be bent!
?QUESTIONS?
QUESTIONS?