Altitude Physiology Student Handout.doc

8/19/2019 Altitude Physiology Student Handout.doc

1/69

United States Army School of Aviation MedicineFort Rucker, Alabama

JANUARY 1 !

LESSON PLAN

TITLE: A"#$#U%& '(YS$)")*Y

F$"& NUM+&R -./. . &.AA.A0.A%.A&. -23/4-2

'R)')N&N# F)R #($S "&SS)N '"AN $S

United States Army School of Aviation Medicine A##N M00S2(AF Fort Rucker, Alabama 5 5-2/444

0


2/69

F)R&$*N %$S0")SUR& R&S#R$0#$)NS #he materials contained in thislesson 6lan have been revie7ed by the instructor.trainin8develo6er and determined to be 6ublic domain materials9 #his6roduct is releasable to military students from all re:uestin8forei8n countries 7ithout restrictions9

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6/69

A;$A#$)N M&%$0$N& N.A &rnstin8, John9 1 3,+utter7orth

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R)+&R# J9 ;)""MU#(0'# Robert G+obG ;ollmuth 0'# 0, Atmos6hericsSection 1 JAN !

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7/69

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8/69

S&0#$)N $$ 2 $N#R)%U0#$)N

Method of $nstruction 0)9 $nstructor to student ratio is 1 /9

#ime of $nstruction 444/ minutes

Media /mm Slides 12- . ''# Slides 12

M)#$;A#)R

N)#&S Use it 6ara6hrase it, or develo6 one of your o7n9 &nsure themotivator 8ains the students attention, states the need for

trainin8, and eH6lains the terminal learnin8 obEective9

IMan is not 6hysiolo8ically e:ui66ed for eH6osure to hi8haltitudes9 #o co6e, man must rely on 6reventive measures and, insome cases, life2su66ort e:ui6ment9 Althou8h Army aviation

6rimarily involves rotary27in8 aircraft flyin8 atrelatively lo7 altitudes, aircre7s may still encounteraltitude2associated 6roblems9 #hese may cause hy6oHia,hy6erventilation, and tra66ed 8as disorders9 +y understandin8 thecharacteristics of the atmos6here, aircre7s are better6re6ared for the 6hysiolo8ical chan8es that occur 7ith altitudechan8es9 As altitude increases, barometric 6ressure decreasesDthe ascent and descent themselves can also affect the body9 $naddition, aircre7s need to understand the functions of thehuman circulatory and res6iratory systems9

#&RM$NA" "&ARN$N* )+J&0#$;& ?#")@

N)#& Read, or have one of the students read, the #") re:uirements9

At the com6letion of this lesson the student 7ill

A0#$)N Mana8e the 6hysiolo8ical effects of altitude9

0)N%$#$)N Bhile servin8 as an air cre7 member9

S#AN%AR% $n accordance 7ith AR /21, AR 342


9/69

IU6 to this 6oint in your trainin8 at the School of AviationMedicine, you have 8ained kno7led8e about aviation medicine and aviation6rotective e:ui6ment9 #oday, 7e build on your learnin8 by discussin8 theeffects of altitude on the human system9

S&0#$)N $$$ 2 'R&S&N#A#$)N

N)#& Read, or have one of your students read the &")9

A9 &NA+"$N* "&ARN$N* )+J&0#$;& ?&")@ K 1

A0#$)N Select the 6hysiolo8ical Lone lethal to humans9

0)N%$#$)N *iven a list of the 6hysiolo8ical Lones of the atmos6here9

S#AN%AR% $AB FM 12 41 and FM


10/69

19 +oundary bet7een tro6os6here and stratos6here9

-9 $t has a stable tem6erature and varies in 7idth9

9 %omain of hi8h 7inds and hi8hest cirrus clouds9

39 *radually increases in altitude from the 6olarre8ions to the e:uator9

?c@ Stratos6here9

19 &Htends u67ard from the #ro6o6ause to about /4 milesfrom the earth s surface9

-9 0haracteriLed by constant ?2// 0@ tem6erature,absence of 7ater va6or and turbulence, cloudless, and has Eet streams9

9 )Lone layer at the to69

?d@ $onos6here9

N)#& #he s6ace shuttle orbits at 154 miles above the earth9

19 &Htends from the stratos6here to about 544 milesabove the earth s surface9

-9 Forms a shield around the earth and 6rotectsindividuals from ultraviolet radiation9

9 "ar8e electron density affects communications9

39 #em6erature increases to 1/44 ° 09

?e@ &Hos6here9

19 &Htends from the ionos6here to about 1,-44 milesabove the earth s surface9

-9 (y6othetically true s6ace9

c9 'hysiolo8ical Lones of the atmos6here9 Man cannot 6hysiolo8icallyada6t to all the 6hysical chan8es of tem6erature and 6ressure 7hich occur7ithin the various re8ions9 For this reason, the atmos6here is furtherdivided into three 6hysiolo8ical divisions9 #he 6rimary basis for these6hysiolo8ical Lones is the 6ressure chan8es 7hich take 6lace in the human

body9N)#& 'oint out that human factors, 6resented later, alters the

altitudes of the 6hysiolo8ical Lones9

?1@ &fficient Lone9

?a@ &Htends from sea level to 14,444 feet9

9


11/69

?b@ Most individuals are 6hysiolo8ically ada6ted to thisLone9

?c@ )Hy8en levels 7ithin this Lone are sufficient for anormal, healthy 6erson 7ithout the aid of 6rotective e:ui6ment9

?d@ +arometric 6ressure dro6s from !54mm.h8 to /- mm.h8 inthis Lone9

?-@ %eficient Lone9

?a@ &Htends from 14,444 feet to /4,444 feet9

?b@ Noticeable 6hysiolo8ical 6roblems, such as hy6oHichy6oHia and evolved 8as disorders, occur unless su66lemental oHy8en is used9

?c@ +arometric 6ressure dro6s from /- mm.h8 at 14,444 feet to

? @ S6ace e:uivalent Lone9

?a@ &Htends u67ard from /4,444 feet9

?b@ (uman system is essentially in s6ace9 Bithout anartificial atmos6heric environment, this Lone is lethal to humans and death7ill occur ra6idly9

d9 0om6osition of the atmos6here9 Atmos6here is a miHture of several8ases9

?1@ Nitro8en ?N-@ !


12/69

Media /mm Slides !211 or ''# slides


13/69

09 &NA+"$N* "&ARN$N* )+J&0#$;& ?&")@ K

A0#$)N Select the com6onent of blood res6onsible for trans6ortin8 themaEority of oHy8en throu8hout the human system9

0)N%$#$)N *iven a list9



14/69

?a@ %iffer from R+0s in that they contain no hemo8lobin9

?b@ Main function is to fi8ht infection or inflammation9

? @ 'latelets ?#hrombocytes@22small irre8ular2sha6ed bodies6roduced by bone marro7 that aid in coa8ulatin8 the blood9

?3@ Red blood cells ?R+0s@9

?a@ (as an iron2containin8 com6ound, hemo8lobin, 7hich isres6onsible for the ) - u6take of these cells9

?b@ #rans6ort a66roHimately


15/69

?3@ Assists in maintainin8 body chemical balance9

c9 'rocesses of res6iration9

?1@ &Hternal res6iration 2 lun8s are ventilated durin8 inhalationand eHhalation and 8ases are transferred throu8h the lun8s in the bloodstream9

?-@ $nternal res6iration 2 8ases are trans6orted to and from bodytissues by the blood9 0hemical chan8es take 6lace 7ithin the tissue cells tometaboliLe the oHy8en9

d9 'hases of eHternal res6iration 2 the res6iratory cycle is aninvoluntary 6rocess that continues unless a conscious effort is made tocontrol it9

?1@ Active 6hase 2 inhalation9

?-@ 'assive 6hase 2 eHhalation9

N)#& 'ressure breathin8 causes a reversal of the active and 6assive6hases of res6iration9

N)#& 'ause for :uestions9

e9 0ontrol of res6iration9

?1@ 0ontrolled by the res6iratory centers in the 6ons and medullaoblon8ata ?lo7er brain@9

?-@ #he u6take of ) - and 0)- takes 6lace throu8h eHtensive chemicalchan8es in the hemo8lobin and 6lasma of the blood9

? @ $f the chemical 6ath7ays are disru6ted, the chemical balance of

the body chan8es9

?3@ Normal 6( level in the body is a66roHimately !93 ?sli8htlyalkaline@9

?/@ %urin8 res6iration, the 0)- elevates, the acidity levelincreases, and the 6( value lo7ers to less than !93

?5@ 0onversely, too little 0)- causes the blood to become morealkaline and the 6( value to rise9

?!@ Since the human body maintains e:uilibrium 7ithin narro7limits, any shift in the blood 6( and 0)- levels is sensed by the res6iratory

center of the brain9?


16/69

?-@ 'harynH9

?a@ +ack of the throat and is connected to oral and nasalcavities and the trachea9

?b@ 'rimarily humidifies and 7arms the air enterin8 theres6iratory system9

? @ #rachea ?IBind6i6e @9

?a@ #ube throu8h 7hich air moves do7n into the bronchi9

?b@ From here, air continues to move do7n throu8h the bronchiand increasin8ly smaller 6assa8es, or ducts, until it reaches the alveoli9

?c@ Additional res6onsibility of eH6ectoratin8 or s7allo7in8mucus moved there by cilia9

?3@ Alveoli9

?a@ Small sacs surrounded by a net7ork of ca6illaries9

N)#& #here are about 44 million alveoli in a 6air of human lun8s9

?b@ #he ca6illaries are so narro7 that red blood cells movethrou8h them in a sin8le file9

?c@ Actual 8aseous eHchan8e bet7een ) - and 0)- occurs here9

89 "a7 of 8aseous diffusion 2 this la7 states that a 8as moves from anarea of hi8h 6ressure to an area of lo7er 6ressure9

h9 +lood 8as eHchan8e9

?1@ Bhen ) - reaches the alveoli, it crosses a thin cellular barrierand moves into the ca6illary to reach the R+09 As the ) - enters the alveoli,it has a 6artial 6ressure ?')-@ of about 144mm.(89 Bithin the blood the ')-of the venous blood is about 34mm.(89 As the blood flo7s throu8h theca6illary the ) - moves from the area of hi8h 6ressure 7ithin the alveoli tothe area of lo7er 6ressure 7ithin the blood9 #hus ) - saturation of R+0s takes6lace9

?-@ 0)- diffuses from the blood to the alveoli in the same manner9#he '0)- in the venous blood is around 35mm.(8 in the alveoli9 As the bloodmoves throu8h the ca6illaries, the 0)- moves from the hi8h '0)- in theca6illaries to an area of lo7er '0)- in the alveoli9 #he 0)- is then eHhaled

durin8 the neHt 6assive 6hase of res6iration ?eHhalation@9N)#& #he eHchan8e of ) - and 0)- bet7een tissue and ca6illaries

occurs the same as it does bet7een the alveoli andca6illaries9

? @ #he amount of ) - transferred across the alveolar2ca6illarymembrane into the blood de6ends 6rimarily on the alveolar 6ressure of ) - inrelation to the venous 6ressure of ) - 9 ) - trans6ort in the blood is a 6ressurede6endent 6henomena9

15


17/69

?3@ #his 6ressure differential is critical to the cre7 memberbecause ) - saturation in the blood decreases as altitude increases due to thedecreasin8 6artial 6ressure of oHy8en in the atmos6here9

?/@ #his decrease in ) - saturation can lead to hy6oHia9

N)#& 0onduct a check on learnin8 and summariLe the learnin8ste6.activity9

N)#& 14 Minute break9

N)#& Revie7 the last hour9

&9 &NA+"$N* "&ARN$N* )+J&0#$;& ?&")@ K /

A0#$)N Match the ty6es of hy6oHia 7ith their res6ective causes9

0)N%$#$)N *iven a list of hy6oHia ty6es and a list of hy6oHia causes9



18/69

N)#& 0arbon monoHide is a very dan8erous chemical com6osition as itattacks the bodyQs blood and tissues simultaneously9

(emo8lobin has an affinity for 0) -44 times 8reater than ) - 9

?3@ (y6oHic hy6oHia 2 occurs 7hen there is insufficient ) - in theair that is breathed or 7hen conditions 6revent the diffusion of ) - from thelun8s to the blood stream9 #his is the ty6e that is most likely to beencountered at altitude9 $t is due to the reduction of the ')- at hi8haltitudes9 See the chart in 6ara8ra6h d under &") K-9

c9 Si8ns and sym6toms9

?1@ Sym6toms are observable by the individual air cre7 member inthemselves9 #hey vary from one 6erson to the neHt, and are therefore consid2ered subEective in nature9 &Ham6les include, but are not limited to thefollo7in8

?a@ Air hun8er or breathlessness9

?b@ A66rehension ?anHiety@9

?c@ Fati8ue9

?d@ Nausea9

?e@ (eadache9

?f@ %iLLiness9

?8@ (ot and cold flashes9

?h@ &u6horia9

?i@ +elli8erence ?an8er@9

?E@ +lurred vision9

?k@ #unnel vision9

?l@ Numbness9

?m@ #in8lin89

?n@ %enial9

N)#& &ach 6erson 7ill usually eH6erience similar sym6toms each time

hy6oHia occurs9 #his is 7hy the altitude chamber is aneHcellent trainin8 aid9

?-@ Si8ns are observable by the other air cre7 members andtherefore, are considered obEective in nature9 &Ham6les include but are notlimited to the follo7in8

?a@ $ncreased rate and de6th of breathin89

?b@ 0yanosis9

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19/69

?c@ Mental confusion9

?d@ 'oor Eud8ment9

?e@ "oss of muscle coordination9

?f@ Unconsciousness9

?8@ Slouchin89

d9 Sta8es of hy6oHia 2 indifferent, com6ensatory, disturbance, andcritical9

?1@ $ndifferent sta8e9

?a@ Altitude 2 sea level to 14,444 feet ?e:uivalent altitude7ith 144O ) - 2 3,444 to ,444 feet@ 7ith ambient barometric 6ressure9

?b@ Sym6tom 2 only si8nificant effect of mild hy6oHia in thissta8e is that ni8ht vision deteriorates at about 3,444 feet9 #he retina ofthe eye and the central nervous system have a 8reat re:uirement for oHy8en9#o be8in com6ensatin8 for this your heart and breathin8 rate increase atabout 3444 feet to im6rove circulation to brain and heart9

?c@ %ecrease of visual sensitivity of u6 to -

?-@ 0om6ensatory sta8e9 #he circulatory system, and to a lesserde8ree, the res6iratory system, 6rovide some defense a8ainst hy6oHia in thissta8e9 'ulse rate, systolic blood 6ressure, circulation rate, and cardiacout6ut increase9

?a@ Altitude2214,444 feet to 1/,444 feet ?e:uivalent altitude7ith 144O ) - 2 ,444 feet to 3-, 444 feet@ 7ith ambient barometric 6ressure9

?b@ Sym6toms9

19 $m6aired efficiency9

-9 %ro7siness99 'oor Eud8ment9

39 %ecreased coordination9

0AU#$)N Failure to reco8niLe sym6toms and take corrective actionmay result in an aircraft misha69

?c@ (emo8lobin saturation 2


20/69

? @ %isturbance sta8e9 $n this sta8e, the 6hysiolo8ical res6onsescan no lon8er com6ensate for the ) - deficiency9

?a@ Altitude 2 1/,444 feet to -4,444 feet ?e:uivalentaltitude 7ith 144O ) - 2 3-,444 feet to 33,


21/69

-9 0yanosis9

?d@ (emo8lobin saturation 2 5/2


22/69

?


23/69

#ime of $nstruction 441/

Media /mm Slides / 25! or ''# Slides 5 2!19

a9 (y6erventilation 2 %efinition 2 an eHcessive rate and de6th ofres6iration leadin8 to abnormal loss of 0)- from the blood9

b9 0auses9

?1@ &motions9

?a@ Fear9

?b@ A66rehension9

?c@ &Hcitement9

?-@ 'ressure breathin89

? @ (y6oHia9

c9 Sym6toms22similar to those of hy6oHia9

?1@ #in8lin8 sensations9

?-@ Muscle s6asms9

? @ (ot and cold sensations9

?3@ ;isual im6airment9

?/@ %iLLiness9

?5@ Unconsciousness9

d9 'hysiolo8y ?reason for sym6toms@9

?1@ Stores of 0)- ?necessary for 6ro6er 6( of the body@ arede6leted9

?-@ Alveolar 8ases are eHchan8ed more ra6idly durin8hy6erventilation thus lo7erin8 '0)- in the alveoli9

? @ 0)- from the blood diffuses ra6idly into the alveoli causin8the 6( of the blood to increase9

e9 Si8nificance of hy6erventilation9?1@ 0an inca6acitate a healthy cre7 member9

?-@ 0an be confused 7ith hy6oHia9

f9 'revention9

?1@ %on t 6anic ?easier said than done@9


24/69

?-@ 0ontrol rate and de6th of res6iration9

89 0orrective action9

?1@ Above 14,444 feet22assume hy6oHia and treat accordin8ly9

?a@ 144O ) - 22if available9

?b@ %escend to a safe altitude9

?-@ +elo7 14,444 feet22assume hy6erventilation and treataccordin8ly9 ;oluntary reduction in rate and de6th of res6iration9


N)#& 14 Minute break9

N)#& Revie7 the last hour9

&NA+"$N* "&ARN$N* )+J&0#$;& ?&")@ K !

A0#$)N $dentify the treatment of an ear or sinus tra66ed 8as dysbarism9

0)N%$#$)N *iven a list of treatments9



25/69


26/69

e9 Bith the increase in barometric 6ressure durin8descent, the 6ressure of the eHternal air is hi8her than the 6ressure in themiddle ear and the eardrum is forced in7ard9

f9 $f the 6ressure differential increasesa66reciably, it may be im6ossible to o6en the eustachian tube9 #he eardrumcould ru6ture because the eustachian tube cannot e:ualiLe the 6ressure9

-9 'revention9

a9 #he most common com6laint of cre7 members is theinability to ventilate the middle ear9

b9 #his inability fre:uently occurs 7hen theeustachian tube or its o6enin8 is s7ollen shut as the result of aninflammation or infection due to a head cold, sore throat, middle ear infec2tion, sinusitis, or tonsillitis9

c9 Unless absolutely necessary, cre7 members 7ithcolds or sore throats should not fly9

9 #reatments 2 same as sinus block9

?c@ Sinus blocks ?tra66ed 8as disorders of the @9

19 Mechanism9

a9 "ike the middle ear, sinuses can also tra6 8asdurin8 fli8ht9

b9 Sinuses are air2filled, relatively ri8id, bonycavities lined 7ith mucus membranes9

c9 Sinuses are connected 7ith the nose by means ofone or more small o6enin8s9

d9 $f the o6enin8s into the sinuses are normal, air6asses into and out of these cavities 7ithout difficulty and 6ressuree:ualiLes9

e9 $f these o6enin8s become obstructed it maybecome difficult or im6ossible to e:ualiLe the 6ressure9

-9 'revention 2 avoid flyin8 7ith a cold or con8estion9

9 #reatment ?ear.sinus block@9

a9 Sto6 descent of aircraft and attem6t to clear byvalsalva9

b9 $f the condition is not cleared, climb toaltitude until cleared by 6ressure chan8e or valsalva9

c9 Reduce rate of descent and e:ualiLe ear.sinusfre:uently durin8 descent9

25


27/69

N)#& &H6lain valsalva and FrenLel techni:ues9

?d@ +arodontal8ia ?tra66ed 8as disorders of the teeth@9

19 Mechanism 2 chan8e in barometric 6ressure can cause atoothache9

&=AM'"& Air may be tra66ed in the tooth by recent dental 7ork9 Airunder the fillin8 material 7ill eH6and durin8 ascent causin8

6ain9

-9 'revention22avoid flyin8 follo7in8 dental restorationor 7hen in need of restoration9

9 #reatment 2 descent usually brin8s relief9

39 Referred 6ain9

a9 Nerve endin8s for sinuses and the u66er teethare in close 6roHimity in the maHilla9

b9 )n occasion, the sinuses 7ill block but the 6ain7ill be referred to the u66er teeth9

c9 0ondition must be treated as a sinus block9


&NA+"$N* "&ARN$N* )+J&0#$;& ?&")@ K <

A0#$)N $dentify the ty6e of evolved 8as dysbarism 7hich occurs in bodyEoints9

0)N%$#$)N *iven a list of evolved 8as dysbarism9



28/69

?a@ $nert 8ases in body tissues ?6rinci6ally N-@ are in6ressure e:uilibrium 7ith the same 8ases in the atmos6here9

?b@ Bhen barometric 6ressure decreases, the 6artial 6ressuresof atmos6heric 8ases decrease 6ro6ortionally, leavin8 the tissues tem6orarilysu6ersaturated9

?c@ Res6ondin8 to the su6ersaturatin8, the body attem6ts toestablish a ne7 e:uilibrium by trans6ortin8 the eHcess 8as volume in thevenous blood to the lun8s9

?d@ (o7ever, this is an inefficient system of removal andcould lead to an evolved 8as disorder9

? @ #he four ty6es of evolved 8as disorders9

BARN$N* &volved 8as disorders are considered serious and medicaltreatment.advice must be sou8ht immediately9

?a@ +ends9

19 )ccurs 7hen the N- bubbles become tra66ed in theEoints9 At the onset of bends, 6ain may be mild but it can become dee6,8na7in8, 6enetratin8, and eventually intolerable9

-9 Severe 6ain can cause loss of muscular 6o7er of theeHtremity involved and, if allo7ed to continue, may result in bodily colla6se9

9 #he lar8er Eoints, such as the knee or shoulder, aremost fre:uently affected9 #he hands, 7rists, and ankles are also commonsites9

39 $t may occur in several Eoints simultaneously and7orsen 7ith movement9

?b@ 'arathesia ?cree6s.tin8les@9

19 #in8lin8 and itchin8 sensations on the surface of theskin are the 6rimary sym6toms of 6arathesia9 $t is caused by N- bubblesformin8 alon8 the nerve tracts leadin8 to the affected areas9

-9 A mottled red rash may a66ear on the skin9

?c@ 0hokes9

19 Sym6toms occurrin8 in the thoraH are 6robably causedby innumerable small N- bubbles that block the smaller 6ulmonary vessels9

-9 At first, a burnin8 sensation is noted under thesternum9 As the condition 6ro8resses, the 6ain becomes stabbin8 7ith dee6inhalation9 #he sensation in the chest is similar to 7hat one eH6eriencesafter com6letin8 a 144 yard dash9 Short breaths are necessary to avoiddistress9

27


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9 #here is an uncontrollable desire to cou8h, but thecou8h is ineffective and non6roductive9

39 Finally, there is a sensation of suffocationDbreathin8 becomes more shallo7 and the skin has a bluish coloration9

?d@ 0NS disorder9

19 $n rare cases 7hen aircre7s are eH6osed to hi8haltitude, sym6toms may indicate that the brain or the s6inal cord is affectedby N- bubble formation9

-9 #he most common sym6toms are visual disturbances7hich vary from blind s6ots to the flashin8 or flickerin8 of a steady li8ht9

9 )ther sym6toms may be a dull2to2severe headache,6artial 6aralysis, the inability to hear or s6eak, and the loss oforientation9

39 'aresthesia, or one2sided numbness and tin8lin8, mayalso occur9

?3@ $nfluential factors 2 evolved 8as disorders do not ha66en toeveryone 7ho flies9 0ertain factors tend to increase the chance of evolved8as 6roblems and reduce the altitude at 7hich 6roblems can occur9

?a@ Rate of ascent 2 the more ra6id the rate of ascent, the8reater the chance that evolved 8as disorders 7ill occurD the body does nothave time to ada6t to the 6ressure chan8es9

?b@ Altitude 2 belo7 -/,444 feet sym6toms are less likely tooccurD above -/,444 feet they are more likely to occur9

?c@ +ody fat 2 fat has a hi8her N- content than other bodytissues9 )besity 6redis6oses and individual to %0S / timnes 8reater than ahealthy individual9

?d@ A8e 2 evidence su88ests that individuals in their mid2thirties are more susce6tible than those in their early t7enties9

?e@ &Hercise 2 6hysical eHertion durin8 fli8ht lo7ers thealtitude at 7hich evolved 8as disorders occur9

?f@ %uration of eH6osure 2 the lon8er the eH6osure,es6ecially above -4,444 feet, the more likely that evolved 8as disorders 7illoccur9

?8@ Re6eated eH6osure 2 the more often individuals areeH6osed to altitude above 1


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?5@ #reatment9

?a@ %escend to 8round level9

?b@ 144O ) - 9

?c@ Seek medical advice.assistance9

?d@ 0om6ression thera6y9

?!@ Aircre7 restrictions9

?a@ Accordin8 to AR 342


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S&0#$)N $; 2 SUMMARY

Method of $nstruction 0)9 $nstructor to student ratio 1 /

#ime of $nstruction 4414 minutes9

Media /mm Slides 2141 or ''# Slides 2144

19 R&;$&B.SUMMAR$ &9

-9 0(&0> )N "&ARN$N*

a9 Solicit student :uestions and eH6lanation9

b9 Cuestions and ans7ers9

CU&S#$)N Bhich of the 'hysiolo8ical ones of the atmos6here islethal to the human system

ANSB&R S6ace &:uivalent one9

CU&S#$)N Select the atmos6here in 7hich total atmos6heric 6ressureis reduced by P the 6ressure found at sea level9

ANSB&R 1


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S&0#$)N ; 2 S#U%&N# &;A"UA#$)N

19 #&S#$N* R&CU$R&M&N#S

a9 #he &")Qs for this lesson 7ill be tested durin8 your finaleHamination9

b9 Final eHamination 7ill be 'ass.Fail or *).N)9

c9 $&RB is 6resently restricted from the Altitude 0hamber so a 6racticaldemonstration is unavailable9

-9 F&&%+A0> R&CU$R&M&N#

a9 &ach student 7ill be 6rovided feedback concernin8 the mastery of thislesson 6lan #") as 6art of the 6re6aratory re:uirements of the finaleHamination9

b9 Remedial trainin8 is available by a66ointment9


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A''&N%$= A

A"#$#U%& '(YS$)")*Y

#RA$N$N* A$%S $N%&=

33


35/69

A''&N%$= AA"#$#U%& '(YS$)")*Y#RA$N$N* A$%S $N%&=

0ross2ReferenceNumber $% Number %escri6tion

/mm Slides

1 118758 Altitude physiology

2 199450 Terminal Learning Objective

3 105390 Physical divisions of atmosphere

4 165191 Physiological zones of atmosphere

5 105406 Composition of air

6 181425 Questions

7 105372 Sea level pressure

8 101564 Percentage of constant/pressuredecrease

9 057659 Significant pressure altitude

10 105413 Dalton's Law

11 181424 Summary

12 056417 Circulation

13 117174 Blood transport of O 2 & CO 2

14 105396 Respiration

15 103592 Function of respiratory system

16 056413 Phases of respiration

17 181425 Questions!

18 057684 Control of respiration

19 056414 Anatomy of respiratory system

20 056415 Law of gaseous diffusion

21 056416 Blood gas exchange

22 080761 O 2 transport in blood

23 173855 Correlation of (air)altitude/alveolar O 2


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24 173856 Correlation of (air)altitude/alveolar 100% O 2

25 181424 Summary

26 184535 Break

27 105400 Definition of hypoxia

28 114368 Types of hypoxia

29 105431 Hypemic hypoxia

30 102430 Stagnant hypoxia

31 105375 Histotoxic hypoxia

32 105389 Hypoxic hypoxia

33 071805 Effect of pressure on blood/O 2

saturation


35 056420 Hypoxia signs/symptoms


37 056421 Stages of hypoxia

38 076584 Indifferent stage

39 076582 Compensatory stage

40 182576 Caution

41 076583 Disturbance stage

42 062662 Sensory symptoms

43 062672 Mental symptoms

44 062661 Personality symptoms

45 062663 Performance symptoms

46 120209 Charles M. Armstrong

47 182576 Caution

48 062664 Signs/disturbance stage

49 076570 Critical stage

50 199451 Warning

51 062667 Factors modifying hypoxiasymptoms

35


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52 103596 Alcohol/smoking

53 102075 1 oz - 2,000 feet

54 105420 Expected performance time

55 199452 EPT following RD

56 062665 Prevention of hypoxia

57 062660 Treatment of hypoxia

58 181424 Summary

59 105360 Hyperventilation

60 118460 Causes of hyperventilation

61 105358 Symptoms of hyperventilation

62 080782 Reason for symptoms

63 120870 Significance ofhyperventilation

64 118729 Prevention of hyperventilation

65 080783 Corrective action

66 181424 Summary

67 184535 Break

68 080784 Dysbarism

69 057713 Definition of dysbarism

70 101566 Boyle and you

71 056430 Boyle's Law

72 056435 Gas expansion

73 105363 Middle ear

74 056432 Pressure effects/ear

75 086352 Normal ear drum

76 086349 Inflamed ear drum

77 086350 Infected ear drum

78 056433 The sinuses

79 121972 Treatment of ear/sinus block

80 056434 Barodontalgia


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81 181424 Summary

82 105398 Decompression sickness

83 056436 Henry's Law

84 056437 Evolved gas

85 182575 Warning

86 181425 Questions???

87 118757 Evolved gas factor

88 056439 Decompression sickness

89 105541 Restriction/SCUBA diving

90 187504 Conclusion

91 184535 Break

'o7er 'oint Slides ?''#@

1 4502-1 USASAM

2 4502-2 Altitude Physiology

3 4502-3 Terminal Learning Objective

4 4502-4 Physical divisions of atmosphere

5 4502-5 Physiological zones of atmosphere

6 4502-6 Composition of air

7 4502-7 Questions!

8 4502-8 Sea level pressure

9 4502-9 Percentage of constant/pressuredecrease

10 4502-10 Significant pressure altitude

11 4502-11 Dalton's Law

12 4502-12 Dalton’s definition

13 4502-13 Check on Learning

14 4502-14 Circulation

15 4502-15 Functions of the respiratory system

16 4502-16 Components of the respiratorysystem

17 4502-17 Blood transport of O 2 & CO 2

37


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18 4502-18 Respiration

19 4502-19 Function of respiratory system

20 4502-20 Phases of respiration

21 4502-21 Questions!

22 4502-22 Control of respiration

23 4502-23 Anatomy of respiratory system

24 4502-24 Law of gaseous diffusion

25 4502-25 Blood gas exchange

26 4502-26 O 2 transport in blood

27 4502-27 Correction of (air)altitude/alveolar O 2

28 4502-28 Correction of (air)altitude/alveolar 100% O 2

29 4502-29 Check on learning

30 4502-30 Take a Break

31 4502-31 Definition of hypoxia

32 4502-32 Types of hypoxia

33 4502-33 Hypemic hypoxia

34 4502-34 Stagnant hypoxia

35 4502-35 Histotoxic hypoxia

36 4502-36 Hypoxic hypoxia

37 4502-37 Effect of pressure on blood/O 2 saturation

38 4502-38 Questions!

39 4502-39 Hypoxia symptoms

40 4502-40 Hypoxia signs

41 4502-41 Stages of hypoxia

42 4502-42 Indifferent stage

43 4502-43 Compensatory stage

44 4502-44 Caution

45 4502-45 Disturbance stage


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46 4502-46 Sensory symptoms

47 4502-47 Mental symptoms

48 4502-48 Personality symptoms

49 502-49 Performance symptoms

50 4502-50 Charles M. Armstrong

51 4502-51 Caution

52 4502-52 Signs/disturbance stage

53 4502-53 Critical stage

54 502-54 Warning

55 4502-55 Factors modifying hypoxiasymptoms

56 4502-56 Alcohol/smoking

57 4502-57 1 oz - 2,000 feet

58 4502-58 Expected performance time

59 4502-59 EPT following RD

60 4502-60 Prevention of hypoxia

61 4502-61 Treatment of hypoxia


63 4502-63 Hyperventilation

64 4502-64 Causes of hyperventilation

65 4502-65 Symptoms of hyperventilation

66 4502-66 Reason for symptoms

67 4502-67 Significance ofhyperventilation

68 4502-68 Prevention of hyperventilation

69 4502-69 Corrective action


71 4502-71 Break

72 4502-72 Dysbarism

73 4502-73 Boyle’s law

74 4502-74 Gas expansion

39


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75 4502-75 Gastrointestinal

76 4502-76 Middle ear

77 4502-77 Pressure effect/ear

78 4502-78 Normal ear drum

79 4502-79 Inflamed ear drum

80 4502-80 Infected ear drum

81 4502-81 The sinuses

82 4502-82 Treatment of ear/sinus block

83 4502-83 Barodontalgia


85 4502-85 Decompression sickness

86 4502-86 Henry's Law

87 4502-87 Warning

88 4502-88 Evolved Gas

89 4502-89 Bends

90 4502-90 Parathesia

91 4502-91 Chokes

92 4502-92 CNS

93 4502-93 Evolved gas factor

94 4502-94 Decompression sickness prevention

95 4502-95 Decompression sickness treatment

96 4502-96 Restriction/SCUBA diving

97 4502-97 Summary

98 4502-98 Conclusion

99 4502-99 Break

100 4502-100 USASAM


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41


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44/69

A''&N%$= +A"#$#U%& '(YS$)")*Y #&S#

0ommand Authority, 0ontact USASAM #est 0ontrol )fficer, US Army School ofAviation Medicine, Fort Rucker A" 5 5-2/444

43


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A''&N%$= 0

A"#$#U%& '(YS$)")*Y

'RA0#$0A" &=&R0$S&


46/69

A''&N%$= 0A"#$#U%& '(YS$)")*Y'RA0#$0A" &=&R0$S&

#here is no 6ractical eHercise associated 7ith this block of instruction9

45


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48/69

6roduct is releasable to military students from all re:uestin8forei8n countries 7ithout restrictions9

47


49/69

January 1 !

A"#$#U%& '(YS$)")*Y

#&RM$NA" "&ARN$N* )+J&0#$;& ?#")@

At the com6letion of this lesson the student 7ill

A0#$)N Mana8e the 6hysiolo8ical effects of altitude9

0)N%$#$)N Bhile servin8 as an air cre7 member9

S#AN%AR% $n accordance 7ith AR /21, AR 342


50/69


51/69

?c@ )Hy8en levels 7ithin this Lone are sufficient for anormal, healthy 6erson 7ithout the aid of 6rotective e:ui6ment9

?d@ +arometric 6ressure dro6s from !54mm.h8 to /- mm.h8 inthis Lone9

?-@ %eficient Lone9

?a@ &Htends from 14,444 feet to /4,444 feet9

?b@ Noticeable 6hysiolo8ical 6roblems, such as hy6oHichy6oHia and evolved 8as disorders, occur unless su66lemental oHy8en is used9

?c@ +arometric 6ressure dro6s from /- mm.h8 at 14,444 feet to

? @ S6ace e:uivalent Lone9

?a@ &Htends u67ard from /4,444 feet9

?b@ (uman system is essentially in s6ace9 Bithout anartificial atmos6heric environment, this Lone is lethal to humans and death7ill occur ra6idly9

d9 0om6osition of the atmos6here9 Atmos6here is a miHture of several8ases9

?1@ Nitro8en ?N-@ !


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d9 Standard sea level atmos6heric 6ressure is !54mm.(89 At 1


53/69

? @ Assists in tem6erature re8ulation9

c9 0om6onents of circulatory system9

?1@ Arteries 2 vessels that move blood from the heart to the bodytissue9

?-@ ;eins 2 vessels that return blood to the heart9

? @ 0a6illaries9

?a@ 0onnect arteries to veins9

?b@ 0ontact most tissues of the body transferrin8 ) - , 0)-,nutrients, and 7aste 6roducts bet7een the cells and blood9

d9 0om6onents and functions of blood 2 Makes u6 a66roHimately /O oftotal body 7ei8ht and is com6osed of some 3/O cells and //O 6lasma9

?1@ 'lasma //O of 7hole blood9

?a@ Fluid 6art of the blood com6osed mainly of salt, 7ater,and 6roteins9

?b@ )ne of its im6ortant functions is to trans6ort 0)- in theblood9

?-@ Bhite blood cells ?B+0s@9

?a@ %iffer from R+0s in that they contain no hemo8lobin9

?b@ Main function is to fi8ht infection or inflammation9

? @ 'latelets ?#hrombocytes@22small irre8ular2sha6ed bodies6roduced by bone marro7 that aid in coa8ulatin8 the blood9

?3@ Red blood cells ?R+0s@9

?a@ (as an iron2containin8 com6ound, hemo8lobin, 7hich isres6onsible for the ) - u6take of these cells9

?b@ #rans6ort a66roHimately


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A0#$)N Select the active 6hase of eHternal res6iration9

0)N%$#$)N *iven a list9



55/69

?5@ 0onversely, too little 0)- causes the blood to become morealkaline and the 6( value to rise9

?!@ Since the human body maintains e:uilibrium 7ithin narro7limits, any shift in the blood 6( and 0)- levels is sensed by the res6iratorycenter of the brain9

?


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?-@ 0)- diffuses from the blood to the alveoli in the same manner9#he '0)- in the venous blood is around 35mm.(8 in the alveoli9 As the bloodmoves throu8h the ca6illaries, the 0)- moves from the hi8h '0)- in theca6illaries to an area of lo7er '0)- in the alveoli9 #he 0)- is then eHhaleddurin8 the neHt 6assive 6hase of res6iration ?eHhalation@9

N)#& #he eHchan8e of ) - and 0)- bet7een tissue and ca6illariesoccurs the same as it does bet7een the alveoli and

ca6illaries9

? @ #he amount of ) - transferred across the alveolar2ca6illarymembrane into the blood de6ends 6rimarily on the alveolar 6ressure of ) - inrelation to the venous 6ressure of ) - 9 ) - trans6ort in the blood is a 6ressurede6endent 6henomena9

?3@ #his 6ressure differential is critical to the cre7 memberbecause ) - saturation in the blood decreases as altitude increases due to thedecreasin8 6artial 6ressure of oHy8en in the atmos6here9

?/@ #his decrease in ) - saturation can lead to hy6oHia9

&9 &NA+"$N* "&ARN$N* )+J&0#$;& ?&")@ K /

A0#$)N Match the ty6es of hy6oHia 7ith their res6ective causes9

0)N%$#$)N *iven a list of hy6oHia ty6es and a list of hy6oHia causes9



57/69

?3@ (y6oHic hy6oHia 2 occurs 7hen there is insufficient ) - in theair that is breathed or 7hen conditions 6revent the diffusion of ) - from thelun8s to the blood stream9 #his is the ty6e that is most likely to beencountered at altitude9 $t is due to the reduction of the ')- at hi8haltitudes9 See the chart in 6ara8ra6h d under &") K-9

c9 Si8ns and sym6toms9

?1@ Sym6toms are observable by the individual air cre7 member inthemselves9 #hey vary from one 6erson to the neHt, and are therefore consid2ered subEective in nature9 &Ham6les include, but are not limited to thefollo7in8

?a@ Air hun8er or breathlessness9

?b@ A66rehension ?anHiety@9

?c@ Fati8ue9

?d@ Nausea9

?e@ (eadache9

?f@ %iLLiness9

?8@ (ot and cold flashes9

?h@ &u6horia9

?i@ +elli8erence ?an8er@9

?E@ +lurred vision9

?k@ #unnel vision9

?l@ Numbness9

?m@ #in8lin89

?n@ %enial9

N)#& &ach 6erson 7ill usually eH6erience similar sym6toms each timehy6oHia occurs9 #his is 7hy the altitude chamber is an

eHcellent trainin8 aid9

?-@ Si8ns are observable by the other air cre7 members andtherefore, are considered obEective in nature9 &Ham6les include but are notlimited to the follo7in8

?a@ $ncreased rate and de6th of breathin89

?b@ 0yanosis9

?c@ Mental confusion9


58/69

?d@ 'oor Eud8ment9

?e@ "oss of muscle coordination9

?f@ Unconsciousness9

?8@ Slouchin89

d9 Sta8es of hy6oHia 2 indifferent, com6ensatory, disturbance, andcritical9

?1@ $ndifferent sta8e9

?a@ Altitude 2 sea level to 14,444 feet ?e:uivalent altitude7ith 144O ) - 2 3,444 to ,444 feet@ 7ith ambient barometric 6ressure9

?b@ Sym6tom 2 only si8nificant effect of mild hy6oHia in thissta8e is that ni8ht vision deteriorates at about 3,444 feet9 #he retina ofthe eye and the central nervous system have a 8reat re:uirement for oHy8en9#o be8in com6ensatin8 for this your heart and breathin8 rate increase atabout 3444 feet to im6rove circulation to brain and heart9

?c@ %ecrease of visual sensitivity of u6 to -

?-@ 0om6ensatory sta8e9 #he circulatory system, and to a lesserde8ree, the res6iratory system, 6rovide some defense a8ainst hy6oHia in this

sta8e9 'ulse rate, systolic blood 6ressure, circulation rate, and cardiacout6ut increase9

?a@ Altitude2214,444 feet to 1/,444 feet ?e:uivalent altitude7ith 144O ) - 2 ,444 feet to 3-, 444 feet@ 7ith ambient barometric 6ressure9

?b@ Sym6toms9

19 $m6aired efficiency9

-9 %ro7siness9

9 'oor Eud8ment9

39 %ecreased coordination9

0AU#$)N Failure to reco8niLe sym6toms and take corrective actionmay result in an aircraft misha69

?c@ (emo8lobin saturation 2

? @ %isturbance sta8e9 $n this sta8e, the 6hysiolo8ical res6onsescan no lon8er com6ensate for the ) - deficiency9

57


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?a@ Altitude 2 1/,444 feet to -4,444 feet ?e:uivalentaltitude 7ith 144O ) - 2 3-,444 feet to 33,


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?3@ 0ritical sta8e9 Bithin to / minutes, Eud8ment andcoordination deteriorate9

?a@ Altitude 2 -4,444 feet and above ?e:uivalent altitude7ith 144O ) - 2 33,


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f9 &H6ected 'erformance #ime ?&'#@ 2 #he time a cre7 member has fromthe interru6tion of the ) - su66ly to the time 7hen the ability to takecorrective action is lost9

?1@ #he &'# varies 7ith the altitude at 7hich the individual isflyin89

A"#$#U%& &'#

F" /44 T Above 21- secondsF" 3 4 21- secondsF" 344 1/2-4 secondsF" /4 4254 secondsF" 44 12- minutesF" -


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?c@ &Hcitement9

?-@ 'ressure breathin89

? @ (y6oHia9

c9 Sym6toms22similar to those of hy6oHia9

?1@ #in8lin8 sensations9

?-@ Muscle s6asms9

? @ (ot and cold sensations9

?3@ ;isual im6airment9

?/@ %iLLiness9

?5@ Unconsciousness9

d9 'hysiolo8y ?reason for sym6toms@9

?1@ Stores of 0)- ?necessary for 6ro6er 6( of the body@ arede6leted9

?-@ Alveolar 8ases are eHchan8ed more ra6idly durin8hy6erventilation thus lo7erin8 '0)- in the alveoli9

? @ 0)- from the blood diffuses ra6idly into the alveoli causin8the 6( of the blood to increase9

e9 Si8nificance of hy6erventilation9

?1@ 0an inca6acitate a healthy cre7 member9

?-@ 0an be confused 7ith hy6oHia9

f9 'revention9

?1@ %on t 6anic ?easier said than done@9

?-@ 0ontrol rate and de6th of res6iration9

89 0orrective action9

?1@ Above 14,444 feet22assume hy6oHia and treat accordin8ly9

?a@ 144O ) - 22if available9

?b@ %escend to a safe altitude9

?-@ +elo7 14,444 feet22assume hy6erventilation and treataccordin8ly9 ;oluntary reduction in rate and de6th of res6iration9

&NA+"$N* "&ARN$N* )+J&0#$;& ?&")@ K !

61


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A0#$)N $dentify the treatment of an ear or sinus tra66ed 8as dysbarism9

0)N%$#$)N *iven a list of treatments9



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c9 %escent to a lo7er altitude ?if 6ain 6ersists@9

?b@ &ar blocks ?tra66ed 8as disorders of the middle ear@9

19 Mechanism9

a9 As the barometric 6ressure is reduced durin8ascent, the eH6andin8 air in the middle ear is intermittently released throu8hthe eustachian tube9

b9 As the inside 6ressure increases, the eardrumbul8es until an eHcess 6ressure of a66roHimately 1- to 1/mm.(8 is reached9

c9 At this time, a small bubble of air is forcedout of the middle ear and the eardrum resumes its normal 6osition9

d9 %urin8 ascent, the chan8e in 6ressure 7ithin theear may not occur automatically9

e9 Bith the increase in barometric 6ressure durin8descent, the 6ressure of the eHternal air is hi8her than the 6ressure in themiddle ear and the eardrum is forced in7ard9

f9 $f the 6ressure differential increasesa66reciably, it may be im6ossible to o6en the eustachian tube9 #he eardrumcould ru6ture because the eustachian tube cannot e:ualiLe the 6ressure9

-9 'revention9

a9 #he most common com6laint of cre7 members is theinability to ventilate the middle ear9

b9 #his inability fre:uently occurs 7hen theeustachian tube or its o6enin8 is s7ollen shut as the result of aninflammation or infection due to a head cold, sore throat, middle ear infec2tion, sinusitis, or tonsillitis9

c9 Unless absolutely necessary, cre7 members 7ithcolds or sore throats should not fly9

9 #reatments 2 same as sinus block9

?c@ Sinus blocks ?tra66ed 8as disorders of the @9

19 Mechanism9

a9 "ike the middle ear, sinuses can also tra6 8asdurin8 fli8ht9

b9 Sinuses are air2filled, relatively ri8id, bonycavities lined 7ith mucus membranes9

c9 Sinuses are connected 7ith the nose by means ofone or more small o6enin8s9

63


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d9 $f the o6enin8s into the sinuses are normal, air6asses into and out of these cavities 7ithout difficulty and 6ressuree:ualiLes9

e9 $f these o6enin8s become obstructed it maybecome difficult or im6ossible to e:ualiLe the 6ressure9

-9 'revention 2 avoid flyin8 7ith a cold or con8estion9

9 #reatment ?ear.sinus block@9

a9 Sto6 descent of aircraft and attem6t to clear byvalsalva9

b9 $f the condition is not cleared, climb toaltitude until cleared by 6ressure chan8e or valsalva9

c9 Reduce rate of descent and e:ualiLe ear.sinusfre:uently durin8 descent9

?d@ +arodontal8ia ?tra66ed 8as disorders of the teeth@9

19 Mechanism 2 chan8e in barometric 6ressure can cause atoothache9

&=AM'"& Air may be tra66ed in the tooth by recent dental 7ork9 Airunder the fillin8 material 7ill eH6and durin8 ascent causin8

6ain9

-9 'revention22avoid flyin8 follo7in8 dental restorationor 7hen in need of restoration9

9 #reatment 2 descent usually brin8s relief9

39 Referred 6ain9

a9 Nerve endin8s for sinuses and the u66er teethare in close 6roHimity in the maHilla9

b9 )n occasion, the sinuses 7ill block but the 6ain7ill be referred to the u66er teeth9

c9 0ondition must be treated as a sinus block9

(9 &NA+"$N* "&ARN$N* )+J&0#$;& ?&")@ K <

A0#$)N $dentify the ty6e of evolved 8as dysbarism 7hich occurs in bodyEoints9

0)N%$#$)N *iven a list of evolved 8as dysbarism9



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-9 At first, a burnin8 sensation is noted under thesternum9 As the condition 6ro8resses, the 6ain becomes stabbin8 7ith dee6inhalation9 #he sensation in the chest is similar to 7hat one eH6eriencesafter com6letin8 a 144 yard dash9 Short breaths are necessary to avoiddistress9

9 #here is an uncontrollable desire to cou8h, but thecou8h is ineffective and non6roductive9

39 Finally, there is a sensation of suffocationDbreathin8 becomes more shallo7 and the skin has a bluish coloration9

?d@ 0NS disorder9

19 $n rare cases 7hen aircre7s are eH6osed to hi8haltitude, sym6toms may indicate that the brain or the s6inal cord is affectedby N- bubble formation9

-9 #he most common sym6toms are visual disturbances7hich vary from blind s6ots to the flashin8 or flickerin8 of a steady li8ht9

9 )ther sym6toms may be a dull2to2severe headache,6artial 6aralysis, the inability to hear or s6eak, and the loss oforientation9

39 'aresthesia, or one2sided numbness and tin8lin8, mayalso occur9

?3@ $nfluential factors 2 evolved 8as disorders do not ha66en toeveryone 7ho flies9 0ertain factors tend to increase the chance of evolved8as 6roblems and reduce the altitude at 7hich 6roblems can occur9

?a@ Rate of ascent 2 the more ra6id the rate of ascent, the8reater the chance that evolved 8as disorders 7ill occurD the body does nothave time to ada6t to the 6ressure chan8es9

?b@ Altitude 2 belo7 -/,444 feet sym6toms are less likely tooccurD above -/,444 feet they are more likely to occur9

?c@ +ody fat 2 fat has a hi8her nitro8en content than otherbody tissues9 )besity 6redis6oses and individual to %0S / times 8reater thana healthy individual9

?d@ A8e 2 evidence su88ests that individuals in their mid2thirties are more susce6tible than those in their early t7enties9

?e@ &Hercise 2 6hysical eHertion durin8 fli8ht lo7ers thealtitude at 7hich evolved 8as disorders occur9

?f@ %uration of eH6osure 2 the lon8er the eH6osure,es6ecially above -4,444 feet, the more likely that evolved 8as disorders 7illoccur9


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?8@ Re6eated eH6osure 2 the more often individuals areeH6osed to altitude above 1


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Altitude Physiology Student Handout.doc

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