ALTITUDE PHYSIOLOGY WE ARE ADAPTED FOR LIFE AT SEA LEVEL AND LOW ALTITUDES 10,000 FEE AND BELOW. AS WE ASCEND INTO THE ATMOSPHERE THERE ARE LARGE AND SUDDEN PRESSURE CHANGES WHICH HAS AN ADVERSE AFFECT ON ARE BODIES. DEATH WILL RESULTS IF WE ARE NOT PROFIDED WITH A ENVORMENT SIMILAR TO THE GROUND LEVEL ATMOSPHERE FOR THESE RESONS IT’S ESSENTIAL THAT WE UNDERSTAND BASIC ATMOSPHERIC PHSIOLOGY AND THE LAWS THAT GOVERNS THE WORLD WE LIVE

TERMINAL LEARNING OBJECTIVE Action: Manage the physiological effects of altitude Condition: While performing as an aircrew member Standard: IAW AR 95-1, AR 40-8, FM 3-04.301, Fundamentals of Aerospace Medicine

ELO #1 ACTION: Identify the physiological zones and the physical divisions of the atmosphere. CONDITION: Given a list. STANDARD: IAW FM 3-04.301.

Physical Divisions of the Atmosphere 1200 miles EXOSPHERE 600 miles IONOSPHERE 50 miles STRATOSPHERE Tropopause ATMOSPHERE GASEOUS ENVELOPE SURROUNDING THE EARTH, WHICH INCLUDES A VAST MIXTURE OF GASES, TRACE QUANTITIES OF LIQUIDS AND SOLIDS AND ADDITION PRTECTS US FROM ULTRVIOLET RADIATION ATMOSPHERE STARTS AT THE EARH SURFACE AND EXTENTS TO 1,200 MILES AIRCRAFTS FLYS IN THE FIRST TWO LAYERS THE TROPOSHERE AND THE STRATOSHERE TROPOSPHERE CONTAINS WATER VAPOR WEATHER TUBULANCE AND THE JET STREAM EXTENDS FROM 30,000 AT THE POLES AND TO 60,000 FEET AT THE EQUATOR STRATOSPHERE EXTENDS UPWARD TO 50 MILES VOID OF WATER VAPOR AND TUBULANCETEMP RANGES FROM -49 TO -112 DEGRES THE OUTER LAYER IS CALLED THE IONOSPHERE AND EXOSPHERE IONOSPHERE EXTENDS FROM 50 MILES TO 600 MILES THIS LAYER ACT AS REFLECTOR FOR ELETROMAGNETIC ENERGY WAVES EXOSPHERE EXTENDS FROM 600 MILES TO 1,200 MILES AND GRADUALL BECOMES THE VACUUM OF SPACE THE OUTER EDGE OF EACH LAYER IS CALLED THE PAUSE THE TROPOPAUSE VARIES IN THICHNESS FROM A FEW FEET TO SEVERAL THOUSAND FEET IT INCREASES IN HIGHT AS IT LEAVES THE POLES AND APPROACHES THE EQUATOR TROPOSPHERE Sea level to flight level 300 - 600 depending on temperature, latitude and season. MOUNT EVEREST 29,028 FEET

Physiological Zones of the Atmosphere SPACE EQUIVALENT ZONE: 50,000 feet and above 63,000 ft 50,000 DEFICIENT ZONE: 10,000 to 50,000 feet 18,000 ft 10,000 1. EFFICIENT ZONE SEA LEVEL TO 10.000 FEET THIS IS THE ZONE THE HUMAN BODY IS ADAPTED TO LIFE ABOVE THIS ZONE REQUIRES CONSIDERABLE ACCLIMATIZATION 2. DEFICENT ZONE EXTENDS FROM 10,000 TO 50,000 FEET. BECAUSE OF REDUCED ATMOSPHERIC PRESSURE INADEQUATE OXGEN IS AVAILABLE. GAS EXPANDION DOUBLES AT 18,000 FEET AND OTHER EVOLVED GAS DISORDERS CAN OCCUR DECOMPRESSION SICKNESS (WHICH WE WILL TALK ABOUT LATER) 3. SPACE EQUIVALENT ZONE EXTENDS ABOVE 50,000 FEET. WE NEED PROTECTION IN A SEALED CABIN OR A FULL PRESSURE SUIT, THIS IS EXTREMELY HAZARDOUS TO THE HUMAN BODY 63,000 FEET ARMSTRONG LINE EFFICIENT ZONE: Sea level to 10,000 feet

Composition of the Air 78 % Nitrogen (N2) 21 % Oxygen (O2) 1 % Other 1. NITROGEN MOST PLENTIFUL GAS IN THE ATMOSPHERE BUILING BLOCKS OF LIVE, BUT NOT USED BY THE HUMAN BODY BUT IT SATURATES THE BODY TISSUES AND CELLS WHICH MAY CAUSE EVOLED GAS DISORDERS AT HIGH ALTITUDES. 2. OXYEN SECOND MOST PENTIFUL GAS THE HUMAN BODY OXGEN IS NECESSARY FOR METABOLISM 3. OTHER GASES 1% .03% OF THOSE GASES CONTAIN CO2 THIS GAS IS ESSENTAIL IN CONTROLLING RESPIRATION. AND INERT GASES SUCH AS NEON AND HELIUM

Questions ???

ELO #1 Check On Learning Atmosphere Physiological Zones of the Atmosphere Composition of the air

ELO #2 ACTION: Select the correct barometric pressure at sea level. CONDITION: Given a list. STANDARD: IAW FM 3-04.301

Sea Level Pressure lbs Scale Barometer / Altimeter 14.7 PSI 760 mm Hg OR 29.92 in. Hg ATMOSPHERIC (BAROMETRIC) PRESSURE THE MEASUREMENT OF PRESSURE EXERTED ON THE EARTH SURFACE FROM GASES AND WATER IN THE ATMOSPHERE THE WEIGHT OF THE ATMOSPHERE CAN BE MEASURED IN POUNDS PER SQUARE INCH (PSI) INCHES OF MERCURY (in Hg) MILLI METER OF MERCURY (mm Hg) SEA LEVEL STANDARD PRESSURE IS 760 mm Hg AT 18,000 FEET IT REDUCED TO 380 OR 1/2 29.92 in Hg (WHERE HAVE YOU SEEN THIS MEASUREMENT) ANSER ALTIMETER lbs Scale Barometer / Altimeter

PERCENT COMPOSITION OF THE ATMOSPHERE REMAINS CONSTANT BUT PRESSURE DECREASES WITH ALTITUDE AS WE GO UP IN ALITIUDE THE % OF NITROGEN AND OXGEN REMANS THE SAME AS ON THE EARTH SURFACE ,BUT THE PRESSURE OR PARTIAL PRESSURE DECRECREASE CAUSING THE OXGEN MOLECULES TO SPREAD OUT SO THERE ARE FEWER OXGEN MOLECULES TO BREATH

SIGNIFICANT PRESSURE ALTITUDES 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 Pressure (Dalton’s Law) 21% O2 78% N2 760 mm Hg 1% Other 95 --- 190 --- 380 --- 523 --- 760 --- 760 mm Hg THIS IS PRETTY MUCH A PICHURE OF WHAT WE HAVE BEEN TALKING ABOUT

(Dalton’s Law) The pressure exerted by a mixture of gases is equal to the sum of the partial pressures of each gas in the mixture. IN OTHER WORDS IF THE AS AMBIENT ALTITUDE INCREASESE THE PARTIAL PRESSURE OF OXGEN DECREASES BUT THE % OF STAY THE SAME PARTIAL PRESSURE OF OXGEN AT SEA LEVEL IS 21 % @760 mm Hg PARTIAL PRESSURE OF OXGEN AT 18,000 FEET IS 21% @ 360 mm Hg ½ EARH ATMOPHERE Pt = P1 + P2 + ...+ Pn

(Oxygen) P1=F1 X P. 160mm=21% X 760mm. Pt = P1 + P2 + ...+ Pn THIS IS A FORMLA YOU CAN DO IN YOU SPARE TIME IT’S ALSO IN FM 3-04.301 160mm IS THE PRESSURE INSIDE THE LUNGS Pt = P1 + P2 + ...+ Pn

(Oxygen) 63,000 ft P1=F1 X P. 10mm=21% X 47mm. Pt = P1 + P2 + ...+ Pn

Questions!!

Check on Learning #2 Atmospherics (barometric) pressure Dalton’s Law of partial pressure

ELO #3 ACTION: Identify the components of the circulatory system that transport oxygen throughout the human body. CONDITION: Given a list. STANDARD: IAW FM 3-04.301.

CIRCULATION DIAGRAM OF THE HEART LUNGS AND THE CIRCULATORY SYSTEM

FUNCTIONS OF THE CIRCULATORY SYSTEM Oxygen and nutrient (fuel) transport to the cells. Transport of metabolic waste products to organ removal sites. Assists in temperature regulation. WE NEED OXGEN TO MAINTAIN LIFE, RESPIRATION IS HOW WE RECEIVE IT RESPIRATION IS THE PHYSICAL AND CHEMICAL PROCESS USED BY ORGANISM TO SUPPLY CELLS WITH O2 AND TO RMOVE WASTE SUCH AS C02

Components of the Circulatory System AIR IS TAKEN IN THOUGH THE NOSE OR MOUTH TRAVELS THROUGH THE TRACHEA OR WIND PIPE. IT THEN BRACHES OFF INTO THE LEFT AND RIGHT BRONCHI, THEN INTO THE LUNGS WERE THE BRONCHI FUTHER BRANCHES OF TO SMALLER BRONCHIOLES. THEY CONTINUE UNTILL THEY REACH THE ALVEOLI THIS IS WHERE THE OXGEN AND CARBON DIOXIDE EXCHANGE OCCURS IN THE RESPITORY SYSTEM OXGEN AND CO2 MOVES BETWEEN AIR AND BLOOD BY SIMPLE DIFFUSION HIGH PRESSURE MOVES TO LOW PRESSURE. WHEN THE BLOOD COME BACK TO THE LUNGS THE PARTIAL PRESSURE IS LOWER THAN THE INCOMING OXGEN PRESSURE CAUSING THE OXGEN TO FORCE THE CO2 MOLECULES OUT OF THE BLOOD INTO THE ALVEOLI REPLACING IT WITH THE OXGEN MOLECULES. WHEN WE BREATH OUT OR EXHALE WE ARE GETTING RID OF THE CO2. THE OXGENATED BLOOD IS THEN PUMP BY THE HEART TO ALL THE TISSUE IN THE BODY BY THE BLOOD VESSELS.

Blood transport of O2 and CO2 Plasma CO2 CO2 O2 CO2 O2 COMPONENTS OF THE BLOOD 10 PINTS OF BLOOD THE HEART PUMPS 5 PINTS A MIN 5% OF TOTAL BODY WIEGHT 55% OF THE BLOOD CONTAINS PLASMA, IT 90% WATER 10% SOLUTES RED BLOOD CELLS IS THE TRANSPORTATION OF 02 AND C02 THE HEMOGLOBIN IN THE RBC ARE RESPONSIBLE FOR THIS ACTIVITY 4 OXGEN TO 1 HEMOGLOBIN MOLECULES WHITE BLOOD CELLS FIGHT FOREIGH ORANISMS PLATELETS FORMED IN THE BONE MARROW ARE ESSENTIAL FOR BLOOD CLOTTING hemoglobin molecule O2 molecule Red Blood Cell

QUESTIONS?

Check on Learning #3 Functions of the circulatory systems Components of the circulatory systems

ELO #4 ACTION: Select the functions and types of respiration. CONDITION: Given a list. STANDARDS: IAW FM 3-04.301.

FUNCTIONS OF THE RESPIRATORY SYSTEM Intake of Oxygen [O2] Removal of Carbon Dioxide [CO2] Maintenance of body heat balance Maintenance of body acid base balance [pH]

Phases of Respiration Active Phase INHALATION Passive Phase EXHALATION Breathing in Breathing out Active Phase INHALATION Passive Phase EXHALATION 20

QUESTIONS

COMPONENTS OF THE RESPIRATORY SYSTEM Nasal/Oral pharynx Trachea Bronchiole Bronchi Alveolar Ducts Alveoli

Law of Gaseous Diffusion Gas molecules of higher pressure move in the direction of gas molecules of a lower pressure PO2 = 100mmHg PO2 = 40mmHg PO2 = 74mmHg PO2 = 66mmHg 24

Hemoglobin Saturation 75% Hemoglobin Saturation 98% Blood Gas Exchange Venous Capillary Hemoglobin Saturation 75% PCO2 = 46 mm PO2 = 40 mm Tissue Alveoli CO2 CO2 PO2 = 100 mm PO2 = 1 - 60 mm O2 PCO2 = 46 mm PCO2 = 40 mm O2 O2 O2 PCO2 = 40 mm PO2 = 100 mm Arterial Capillary Hemoglobin Saturation 98% 25

Oxygen transport in the blood: dependent on the partial pressure of oxygen. pO2

Correction of Altitude, Alveolar O2, Hb saturation -------- ambient air -------- ALTITUDE BAROMETRIC ALVEOLAR HEMOGLOBIN (FEET) PRESSURE OXYGEN SATURATION (mmHg) ( PAO2) % (Hb) Sea level 760 104 97 10,000 523 67 90 20,000 349 40 70 30,000 226 21 20 40,000 141 6 5 50,000 87 1 1

Correction of Altitude, Alveolar O2, Hb saturation -------- 100% Oxygen -------- ALTITUDE BAROMETRIC ALVEOLAR HEMOGLOBIN (FEET) PRESSURE OXYGEN SATURATION (mmHg) ( PAO2) % (Hb) Sea level 760 673 100 10,000 523 436 100 20,000 349 262 100 30,000 226 139 99 40,000 141 58 87 50,000 87 16 15

Questions!!

Check on learning #4 Functions of the respiratory systems Phases of the respiratory systems

10 Minutes Take a break!

ELO #5 ACTION: Match the type of hypoxia with their respective causes. CONDITION: Given a list of hypoxia types and a list of hypoxia causes. STANDARDS: IAW FM 3-04.301.

Hypoxia State of oxygen [O2] deficiency in the blood cells and tissues sufficient to cause impairment of function.

Types of Hypoxia Hypemic Stagnant Histotoxic Hypoxic

Inability of the blood to accept oxygen in Hypemic Hypoxia Inability of the blood to accept oxygen in adequate amounts + + + + + + + + + + + + + + +

Stagnant Hypoxia Reduced blood flow Adequate oxygen Blood moving slowly Red blood cells not replenishing tissue needs fast enough

Histotoxic Hypoxia Inability of the cell to accept or use oxygen Adequate oxygen Red blood cells retain oxygen Poisoned tissue

Hypoxic Hypoxia Reduced pO2 in the lungs (high altitude) Red blood cells Body tissue

QUESTIONS ?

Hypoxia Symptoms what you feel (subjective) Air hunger Apprehension Fatigue Nausea Headache Dizziness Denial Hot & Cold Flashes Euphoria Belligerence Blurred Vision Numbness Tingling

Hypoxia Signs what we see in you (objective) Hyperventilation Cyanosis Mental confusion Poor Judgment Lack of muscle coordination

Stages of Hypoxia Indifferent Stage Compensatory Stage Disturbance Stage Critical Stage

Indifferent Stage Altitudes: Air: 0 - 10,000 feet 100% O2: 34,000 - 39,000 feet Symptoms: decrease in night vision @ 4000 feet acuity color perception

Compensatory Stage Altitudes: Air: 10,000 - 15,000 feet 100% O2: 39,000 - 42,000 feet Symptoms: impaired efficiency, drowsiness, poor judgment and decreased coordination

Failure to recognize your result in an aircraft mishap. CAUTION!!!! Failure to recognize your signs and symptoms may result in an aircraft mishap.

Disturbance Stage Altitudes Air: 15,000 - 20,000 FEET 100% O2: 42,000 - 44,800 FEET

Disturbance Stage symptoms Mental Memory Judgment Reliability Understanding

Disturbance Stage symptoms Personality Happy Drunk versus the Mean Drunk

Disturbance Stage symptoms Performance Coordination Flight Control Speech Handwriting

Disturbance Stage symptoms Sensory Vision Touch & pain Hearing

CAUTION!!!! FAILURE TO RECOGNIZE THESE SIGNS AND SYMPTOMS MAY RESULT IN A AIRCRAFT MISHAP.

Disturbance Stage Signs Hyperventilation Cyanosis

Critical Stage Altitudes Air: 20,000 feet and above 100% O2: 44,800 feet and above Signs: loss of consciousness, convulsions and death

65% WARNING! When hemoglobin saturation falls below serious cellular dysfunction occurs; and if prolonged, can cause death 65% WARNING!

Factors modifying hypoxia symptoms Pressure altitude Rate of ascent Time at altitude Temperature Physical activity Individual factors Physical fitness Self-imposed stresses

DEATH Drugs Exhaustion Alcohol Tobacco Hypoglycemia keep self imposed stresses out of the aircraft

Expected 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

RD Rapid Decompression Expected performance time for a crew member flying in a pressurized cabin is reduced approximately one-half following loss of pressurization such as in a: RD Rapid Decompression

Hypoxia Prevention Limit time at altitude 100% O2

Hypoxia Treatment 100% O2 Descend to a safe altitude

Questions ????

Check on Learning #5 Hypoxia types/stages Causes of hypoxia Signs/Symptoms Treatment of hypoxia

ELO #6 ACTION: Select the symptoms of hyperventilation. CONDITION: Given a list. STANDARD: IAW FM 3-04.301 and Fundamentals of Aerospace Medicine.

Hyperventilation (definition) An excessive rate and depth of respiration leading to the abnormal loss of CO2 from the blood.

Hyperventilation (causes) Emotional (fear, anxiety, apprehension) Pressure breathing Hypoxia

Hyperventilation Symptoms tingling sensations muscle spasms hot and cold sensations visual impairment dizziness unconsciousness

Hyperventilation reason for symptoms: loss of carbon dioxide [CO2] shift in pH balance

Hyperventilation significance incapacitation of an otherwise outstanding, healthy air crewmember confusion with hypoxia

(distinguishing factors) Hyperventilation (distinguishing factors) above 10,000 feet possible hypoxia below 10,000 feet probably hyperventilation

Hyperventilation (corrective actions) Don’t Panic Control your breathing Check your oxygen equipment - it may be hypoxia

Questions!!!!

Check on Learning #6 Hyperventilation Causes of hyperventilation Treatment of hyperventilation

Let’s take 10 minutes a break

ELO #7 ACTION: Select the causes and treatment of an ear, sinus and tooth trapped gas dysbarism. CONDITION: Given a list. STANDARD: IAW FM 3-04.301.

Dysbarism Syndrome resulting from the effects, excluding hypoxia, of a pressure differential between the ambient barometric pressure and the pressure of gases within the body.

Boyle’s Law The volume of a gas is inversely proportional to its pressure; temperature remaining constant.

Gas Expansion 43,000 9.5X 6.0X 4.0X 34,000 5.0X 2.5X 3.0X 25,000 1.8X 18,000 2.0X DRY GAS EXPANSION WET GAS EXPANSION

Gas Expansion (prevention of gas pain) 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 77

Anatomy of the Ear Eustachian tube Cochlea Semicircular canal Auditory nerve Ear drum Middle ear External ear Eustachian tube Opening to throat 78

Pressure Effect Clear Ear Block Middle Ear Cavity Tympanic Membrane Atmospheric Pressure Clear External Ear Eustachian Tube Middle Ear Cavity Tympanic Membrane Atmospheric Pressure Ear Block External Ear Eustachian Tube Blocked / Infected

The Sinuses Frontal Ethmoid Maxillary Sphenoid

Treatment of an Sinus/Ear Block Stop the descent of the aircraft and attempt to clear by valsalva. If unable to clear, climb back to altitude until clear by pressure or valsalva. Descend slowly and clear ear frequently during descent.

Barodontalgia Tooth pain due to: Gum abscess: dull pain on ascent Inflamed pulp: sharp pain on ascent Inflamed maxillary sinus: pain primarily on descent 86

TREATMENT of Barodontaliga Descend aircraft/chamber to sea level. Seek dental help

Questions Questions

Check on Learning #7 Trapped gas dysbarism Treatment of ear and sinus dysbarisms Treatment of tooth pain

ELO #8 ACTION: Identify the types and treatments of evolved gas dysbarsims, which occurs with altitude. CONDITIONS: Given a list. STANDARD: IAW FM 3-04.301 and Fundamentals of Aerospace Medicine

Decompression Sickness (evolved gas dysbarism) Results due to the reduction in atmospheric pressure. As pressure decreases, gases dissolved in body fluids are released as bubbles.

Henry’s Law The amount of gas dissolved in solution is directly proportional to the pressure of the gas over the solution.

must be sought immediately. WARNING Evolved gas disorders are considered serious and medical treatment and advice must be sought immediately.

Evolved Gas Disorders The Bends Paresthesia The Chokes Central Nervous System-CNS

Evolved Gas Disorders The Bends N2 bubbles become trapped in the joints. Onset is mild, but eventually painful!

Evolved Gas Disorders Paresthesia N2 bubbles form along nerve tracts. Tingling and itchy sensation and possibly a mottled red rash.

Evolved Gas Disorders The Chokes N2 bubbles block smaller pulmonary vessels. Burning sensation in sternum. Uncontrollable desire to cough. Sense of suffocation ensues.

Evolved Gas Disorders CNS N2 bubbles affect spinal cord. Visual disturbances, paralysis, one sided tingling.

Evolved gas factors Rate of ascent Exercise Altitude Body fat content Age Exercise Duration of exposure Repeated exposure

Decompression Sickness prevention Denitrogenation Denitrogenation Maintain cabin pressurization

Decompression Sickness treatment Descend 100% Oxygen Land at nearest location where qualified medical assistance is available. Compression greater than 1 atmosphere (absolute).

24 Hour restriction between diving and flying!!!!! Scuba Divers Beware! 24 Hour restriction between diving and flying!!!!!

QUESTIONS 95

Check on Learning #8 Evolved gas dysbarism Four types of DCS Treatment 95

CONCLUSION