RESPIRATION AND OXYGEN. Aerodoc

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1 RESPIRATION AND OXYGEN Aerodoc

2 Crash with B august 2005 NOTE: The same Boeing 737, 5B-DBY, Helios' Flight 522 departed Larnaca on a scheduled suffered 1 a hour loss and of cabin 23 minute pressure flight to on Athens, Greece. December After an 20, intermidiate 2004 during stop a there, flight it from was to have continued on to Prague, Czech Republic. Warsaw The fight, to cleared Larnaca. for. an Three en route passengers altitude of FL340, needed reportedly medical notified treatment Cypriotic after controllers landing that they had some problems with the air conditioning in Larnaca. system.. This incident The 737 was entered caused Greek by air a space leaking about door 10:30, seal but of efforts the right by air hand traffic rear door. controllers to contact the pilots were futile. Around 11:00 two Greek F-16 F fighter planes were scrambled from the Néa Anghialos air base. The F-16 F pilots reported that they were not able to observe the captain, while the first officer seemed to be unconscious. Apparently one or two other persons seemed to have entered the cockpit, attempting to control the plane. The F-F 16's continued to track the flight as it flew in a gradually descending holding pattern. That person then banked the plane away from Athens, lowering it first to 2,000 feet and then climbing back up to 7,000 feet before the plane apparently ran out of fuel and crashed in mountainous terrain some 40 km North of Athens. Aerodoc Why?

3 Why is oxygen important? Necessary for the production of energy in cells 20% of all oxygen is used by cells in brain Brain cells will die if they are deprived oxygen for over 2 minutes s. 37 Aerodoc

4 The Respiratory system Aerodoc

5 Airways consist of? Nose and mouth (warming, moistening, filtrating) Throat Trachea Bronchi Bronchioles Respiratory bronchioles Alveoli (gas exchange) s. 37 Aerodoc

6 s. 39 Aerodoc

7 Lung Gas Volume (male) Normal Tidal volume: 500 ml Normal IRV : 3000 ml Normal ERV : 1100 ml Normal RV : 1200 ml s. 38 Aerodoc 20-25% less in female

8 Gas exchange s. 38 Aerodoc

9 Transfer of oxygen and carbon dioxide When talking of tissue the diffusion i described by Fick s law: V gas ~ A / T D (P 1 -P 2 ) s. 41 Aerodoc

10 Diffusion of oxygen in lung 2 conditions: 1: normal P alv O 2 (103 mmhg) 2: low P alv O 2 (40 mmhg) = HYPOXI Aerodoc

11 Oxyhaemoglobin dissociations curve Aerodoc

12 Effect of Pco 2 Tissue Alv. Low Pco 2 => more oxygen attached to hemoglobin Aerodoc

13 Regulation of respiration CO 2 RC in Brain O 2 CO 2 Respiratory frequents normal 16 (12-20) breaths/min s. 37 Aerodoc

14 The standard atmosphere at MSL (ICAO) Pressure 1013,25 mbs(760 mmhg) Density 1225 g/m o Celsius Temp. decrease 1,98 o C/1.000 ft up to ft. Thereafter it remains constant at - 56,5 0 C to ft s. 40 Aerodoc

15 Pressure in atmosphere 8000 ft : ¾ MSL ft : ½ MSL ft : ¼ MSL s. 40 Aerodoc

16 Pressure Altitude Pressure 1 MSL Sea level ¾ MSL Cabin ¼ MSL Outside Altitude Aerodoc

17 How is the composition of the atmosphere? (up to ft) 21 % Oxygen 78 % Nitrogen 0,93 % Argon 0,03 % Carbon dioxide 0,04 % rare gases s. 40 Aerodoc

18 Gas Laws s. 41 Aerodoc

19 As atmospheric pressure decreases, the air tends to expand and get thinner The human body has several responses to changes in atmospheric pressure. P 1 x V 1 = P 2 x V 2 with constant T BOYLE S S LAW GAS EXPANSION FL 180 FL 250 FL 350 FL 430 s. 41 Aerodoc

20 Where in the body can Boyle s law give rise to problems? Aerodoc

21 Aeromedical problems in relation til Boyle s s law Barotrauma in middle ear Barotrauma in sinus Aerodontalgia Barotrauma of the Gastro-Intestinal Tract s. 41 Aerodoc

22 Ear Block If you fly with a cold these passages can swell up enough to block the passage of air, especially when you are trying to get air in to equalize pressure on descent. Leads to a painful ear or sinus block! Do Not Fly with a Cold! Aerodoc

23 DALTON S S LAW states that? The total pressure of the gas mixture is equal to the sum of its partial pressure. P t = P 1 + P P n s. 41 Aerodoc

24 What is the Aeromedical problems in relation to Dalton s law? Oxygen in alveoli Hypoxia and decreased night vision (pressure in eye) Aerodoc

25 HENRY s LAW At equilibrium the amount of gas dissolved in a liquid is proportional to the gas pressure s. 41 Aerodoc

26 What is the Aeromedical problems in relation til Henry s law? Decompression sickness & bends s. 41 Aerodoc

27 CHARLE S S LAW The volume of a fixed mass of gas held at a constant pressure varies directly with the absolute temperature s. 41 Aerodoc

28 Alveolar gases when breathing air (Daltons law in practice) P alv alv O 2 = P insp O 2 P alv CO 2 ( F inspo2 + (1 - F inspo2 )/R ) Aerodoc Correction factor because of nitrogen in inspired and alveolar gas

29 Normal atmospheric pressure at sea level is 760 mm Hg As you go up in altitude, atmospheric pressure decreases. Pressure s. 41 Aerodoc 100% OXYGEN UNDER PRESSURE NEEDED 100% oxygen SUPL. OXYGEN NEEDED Press Alt in mm Hg Thou. Ft SEA LEVEL

30 Alveolar air The partial pressure of oxygen in lung is less than atmospheric air because of CO 2 + H 2 O (normal 103 mmhg) The minimum partial pressure of oxygen in alveoli for normal operations is 55 mmhg s. 42 Aerodoc

31 The gases in the lung Constituents Partial pressure (mmhg) Oxygen Nitrogen Water vapor Carbon dioxide Atmospheric Air 160 (21%) Alveolar air MSL 103 (14%) (5,3%) Alveolar air ft 55 (Limit for human activity) s. 42 Aerodoc

32 Environmental Requirements As altitude increases, available oxygen decreases STRATOSPHERE TROPOPAUSE of Oxygen 100% OXYGEN UNDER PRESSURE NEEDED Press Alt in mm Hg Thou. Ft Mt Everest 29,028 ft TROPOSPHERE Andes 100% OXYGEN Mt Whitney OXYGEN NEEDED Highest Human Habitation...18,000 ft Aerodoc SEA 760LEVEL 0

33 Thresholds of oxygen requirements Up to ft - air only (P alv O 2 decreases to 55 mmhg) ft - oxygen/air mixture (P alv O 2 = 103 mmhg) ft - 100% oxygen (P alv O 2 decreases to 55 mmhg) Above ft % oxygen under pressure s. 43 Aerodoc

34 How can people live permanently at ft.? Aerodoc

35 HYPOXIC HYPOXIA (Shortage of oxygen in lung) The most important reason to hypoxic hypoxia in aviation is altitude s. 43 Aerodoc

36 Saturation of hemoglobin with altitude 87 Sea level ft ft s. 43 Aerodoc

37 What is the symptoms of HYPOXIA? Aerodoc

38 Gaston Tissandier Balloon flight in 1875 to 8600 m s. 43 Aerodoc

39 Environmental Requirements Lack of oxygen will affect the brain and cause fatigue, sleepiness, headache, dizziness, blurred vision and will eventually cause you to lose consciousness. Oxygen HYP 10,000 MSL XIA Aerodoc

40 Symptoms (subjective) Air hunger Apprehension / scared Fatigue Nausea Headache Dizziness Hot and Cold flashes Euphoria/Personality Change Aggressive Blurred vision (color/peripheral Tunnel vision Formication Tingling Hypoxia Signs (objective) UNCONSCIOUSNESS Hyperventilation Cyanosis Mental confusion (Short memory > ft) Impaired judgment (>12000 ft) Muscle incoordination DEATH (within minutes) s. 43 Aerodoc

41 Which factors determining the severity of and the susceptibility to hypoxic hypoxia? Altitude Time Workload Extremes of temperature (heat/cold) Illness Fatigue Alcohol Drug s. 45 Aerodoc

42 Relative incidence of the causes of 397 cases of hypoxia in flight in a military air force Cause of hypoxia Failure of oxygen supply Failure of oxygen regulator Regulator off Inadvertent break of connection in host between regulator and mask Hose defect or failure Inadequate seal of mask to face Malfunction of mask valves Decompression of pressure cabin Toxic fumes giving rise to hypoxia Others Relative incidence (%) Aerodoc

43 Treatment What to do in the air? OXYGEN + Descend to safe level s. 44 Aerodoc

44 ANAEMIC HYPOXIA (Decreased ability of the blood to carry oxygen) The most important reason to this is CARBON MONOXIDE POISONING s. 46 Aerodoc

45 Smoking Increases the amount of carbon monoxide in blood leading to decreased OXYGEN CARRIAGE Aerodoc

46 20 cigarettes a day will have a raised CO-haemoglobin by 7% This equates to a reduction in oxygen carrying capacity of ft. With normal cockpit altitude of ft this will give the smoker an altitude up to ft with resulting Anaemic hypoxia s. 46 Aerodoc

47 Aerodoc

48 Effect of smoking 20 cigarettes Aerodoc

49 Aerodoc

50 Smoking can lead to? Lung cancer Breathing problems (COLD) Circulatory problems Reduced tolerance of G forces Increased risk of heart attack Increased level of adrenaline Addiction Degradation of night vision (20%) Aerodoc

51 IF YOU SMOKE STOP IF YOU DON T T SMOKE DON T T START Aerodoc

52 What can you do to prevent Hypoxia? - Ensure you now your own symptoms of hypoxia - Ensure supply of oxygen is available (>10000 ft.) - Ensure crew can use it correct (oxygen drill) - Ensure passengers are briefed - Stop smoking - Fly only if fit - Ensure cabin heater is checked and serviceable s. 44 Aerodoc

53 Environmental Requirements A pilot must be able to recognize when problems are due to lack of oxygen Altitude chamber training helps aircrew to discover their own hypoxia symptoms Oxygen Aerodoc

54 Hypoxia in Altitude Chamber Aerodoc

55 4 stages/zones of hypoxia 1 The indifferent stage/zone: GL ft - dark adaption decreases - performance of new tasks impaired - slight increase in heart and breathing rates The compensatory stage/zone: ft ft - increase in heart and breathing rate - increase in blood pressure - drowsiness - decreased judgement and memory (short) - difficulty in performing tasks requiring mental alertness - difficulty in performing very small movements s. 44 Aerodoc

56 4 stages/zones of hypoxia 2 The Disturbance stage/zone ft - euphoria - dizziness - sleepiness - headache - fatigue - intellectual impairment - memory impairment - severe impaired motor performance - loss of judgement - grayout and tunnel vision s. 42 Aerodoc

57 4 stages/zones of hypoxia 3 The critical stage/zone ft - Mental performance deteriorates rapidly - Confusion and dizziness occurs within a few minutes - Total incapacitation with loss of consciousness with little or no warning s. 44 Aerodoc

58 Mean value of gas tensions after acute exposure to breathing air at altitude Partial pressure (mmhg) Altitude (ft) O2 insp. O2 alv. O2 art. Critical line Aerodoc

59 THE CABIN Aerodoc

60 Cabin Pressurisation Pressure 1 MSL Sea level ¾ MSL Cabin ( ft) ¼ MSL Outside Altitude s. 49 Aerodoc

61 Cabin Altitude Ascent 500 ft/min. s. 49 Aerodoc Descent 300 ft/min

62 Cabin decompression (FL over 25) Hypoxia Cold Decompression sickness s. 49 Aerodoc

63 Effect of rapid descent with large defect in cabin NOTE venturi effect s. 49 Aerodoc

64 Effect of rapid descent with small defect in cabin Aerodoc

65 Decompression Remember the Venturi effect (+ P 5000ft ) Too high pressure in lung Limit for lung damage ( mmhg) Safe limit (< 50 mmhg) Aerodoc

66 Alveolar gases during rapid decompression s. 49 Aerodoc

67 TUC Time of useful consciousness Altitude (ft) Progressive decompression Sitting About 40 min 10 min 5 min 1,5 min 45 sec. 25 sec. 18 sec. Moderate activity About 30 min 5 min 3 min 45 sec. 30 sec. 18 sec. 12 sec. Rapid decompressi on min 3 min 2 min 30 sec. 20 sec. 12 sec. 12 sec. s. 47 Aerodoc

68 Time of useful consciousness induced by rapid decompression in relation to the high altitude From ft From 8000 ft Aerodoc

69 TUC will depend on? Individual fitness Workload Smoking Overweight or Obesity Type of decompression s. 47 Aerodoc

70 Remember! TUC is the time of useful consciousness but the EPT (Effective Performance Time) might be less. EPT above ft is approximately seconds s. 47 Aerodoc

71 Crew protection It is very important that crew members individually take on their oxygen masks and check flow before helping other members of the crew or passengers. Remember TUC and EPT. The aircraft must descend rapidly to safe altitude s. 50 Aerodoc

72 HYPERVENTILATION Hyperventilation CO 2 H 2 CO 2 ph O 2 release from hemoglobin s. 48 Aerodoc

73 The symptoms of hyperventilation is? Dizziness/ feeling of unreality Tingling Visual disturbances Hot or cold sensations Anxiety Loss of muscular co-ordination ordination and impaired performance Increased heart rate Spasms Loss of consciousness s. 48 Aerodoc

74 Hyperventilation - causes Hypoxia (must always be ruled out) Anxiety Motion sickness Shock Vibrations Heat High g-forcesg Pressure Breathing s. 48 Aerodoc

75 Hyperventilation Hypoxi? DO NOT ASSUME HYPERVENTILATION IF IT COULD BE HYPOXIA Altitude > ft always presume hypoxia at first s. 49 Aerodoc

76 REMEMBER Hyperventilation unconsciousness recovery Hypoxia unconsciousness death s. 49 Aerodoc

77 DECOMPRESSION SICKNESS What is that? s. 50 Aerodoc

78 Decompression sickness (Henry s s law) Air bubbles can form in the body if you go to high enough altitudes These bubbles are made of nitrogen and usually dissolve as you descend. s. 50 Aerodoc

79 Decompression Sickness. What is the symptoms? Bubbles that do not dissolve can get trapped in the joints and cause pain (Bends( Bends) and in skin causing (Creeps) If they form in the blood they can go to the lungs causing (Chokes( Chokes) and to the brain causing serious neurologic symptoms (Staggers) s. 50 Aerodoc

80 What can increase the risk of DCS? Hypoxia Cold Age Excess body mass / obsesity Aerodoc

81 Decompression Sickness Prevention Prebreathing 100% oxygen for at least an hour before high altitude flights can decrease the amount of nitrogen in the body and decrease the chance of getting decompression sickness. Pressurized cabins or, if necessary, pressure suits can be used. s. 50 Aerodoc

82 Decompression Sickness Treatment Decompression sickness can often be successfully treated in a hyperbaric chamber which dilutes out the nitrogen with high pressure concentrated oxygen s. 51 Aerodoc Hyperbaric Chamber, Brooks AFB, TX

83 Flying and diving Do not fly within 12 hours of swimming using compressed air and avoid flying for 24 hours if a depth of 30 ft has been exceeded Why is SCUBA diving a problem? s. 51 Aerodoc

84 Crash with B august 2005 Why? Aerodoc

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