TRANSPORT

PHYSIOLOGY
Dr Anwar Lewa SpBP M.Biomed
Objectives
• Describe the significance of gas laws
pertinent to the transport environment.
• Describe the stresses of flight and their
effects on transport teams and their
patients.
• Identify specific interventions to combat
the different stressors to the transport
team and their patients.
• Identify the signs and symptoms of
hypoxia.
• Identify appropriate interventions to
mitigate the adverse effects of barometric
pressure change in transport.
Flight Physiology Terms
• Ambient Pressure
– The pressure of existing and adjacent
environment
• Physiological Zone
– The area from sea level to 10K feet
• Cabin Altitude
– The altitude measured inside the
cabin of an aircraft
• Cruising altitude
– The actual, level-off altitude outside
the aircraft above sea level
Flight Physiology Terms
• Atmosphere
– The gaseous layer around the earth,
composed mainly of nitrogen and oxygen
• Altimeter
– An instrument used to measure aircraft
altitude
• Barometer
– An instrument used to measure atmospheric
pressure
• Barometric Pressure
– The pressure of the air in certain
environment, measured by a barometer
Boyle’s Law
• Statement of Law
– At a constant temperature, the
volume of a gas is inversely
proportional to it’s pressure.

• Example
– Trapped gas in the body
Dalton’s Law
• Statement of Law
– Total pressure of a mixture of gases
equals the sum of the partial pressure
of each gas in the mixture

• Example
– Hypoxia
Henry’s Law
• Statement of Law
– Gas dissolved in a liquid is directly
proportional to the weight of the gas
above the liquid.
• Example
– Soda can
– Decompression sickness
Charles’ Law
– Statement of Law
• The pressure of gas is directly
proportional to its temperature (volume
remains constant)

– Example
• Storage of oxygen containers
Graham’s Law
• Statement of Law
– A gas will diffuse from an area of high
concentration (or pressure) to an area
of low concentration.

• Example
– Gas exchange at the cellular level
Stresses of Transport
• Hypoxia
• Trapped Air
• Thermal changes
• Decreased Humidity
• Noise
• Vibration
• Fatigue
• Gravitational, acceleration/deceleration
forces
Hypoxia
An oxygen deficiency sufficient to
cause an impairment of function

• Causes
– Inadequate supply of oxygen
– Inadequate oxygen transport
capability
– Inability of body to use oxygen
Stages of Hypoxia
• Indifferent Stage
– Physiologic zone: 0 – 10 K feet
– Increased HR and RR
– Decrease in night vision @ around 5 K
Stages of Hypoxia
• Compensatory Stage
– 10 K – 15 K feet
– Increased HR, RR, BP, Respiration
Depth
– Drowsiness
– Poor judgement
– Impaired coordination
– Impaired efficiency
Stages of Hypoxia
• Disturbance Stage
– 15 K – 20 K feet
– Characterized by
• Dizziness, sleepiness, tunnel vision,
cyanosis, slowed thinking and decreased
muscle coordination.
– Which can cause…
• Impaired flight control
• Impaired handwriting
• Impaired speech
• Decreased coordination
Stages of Hypoxia
• Critical Stage
– 20 K - 30 K feet
– Mental confusion and incapacitation
– Unconsciousness
– Circulatory failure
– Cardiovascular collapse
– Death
Types of Hypoxia
• Hypoxic Hypoxia
• Anemic Hypoxia
• Stagnant Hypoxia
• Histotoxic Hypoxia
Hypoxic Hypoxia
• Deficiency in alveolar oxygen
exchange.
• Causes
– Reduction of pO2 in inspired air
– Ineffective gas exchange in an area of
the lung
• Result
– Inadequate oxygen supply in arterial
blood
Hypoxic Hypoxia

Altitude Pressure Oxygen

sea level 760mmHg 160mmHg
1000 ft. 732 132
8000 ft. 564 118
18000 ft. 380 80
34000 ft. 187 39

• Reference Protocol:
– Atmospheric Pressure, Limits for Specific Disease
Processes
Hypoxic Hypoxia
• Treatment
– Supplemental 02
– Altitude restriction
– BIPAP
– Advanced airway management
– Fix problem
Anemic Hypoxia
• Reduction of 02 carrying capacity
– Decrease in circulating Hgb
– Reduction of functional / avail Hgb

• Treatment
– Maximize available 02
– Consider transfusion
Stagnant Hypoxia
• 02 deficiency secondary to poor
circulation
– Heart failure
– Hypovolemia
– Shock (any source)
• Treatment
– Maximize 02 supply
– Maximize 02 delivery
• Consider volume
• Consider pump
Histotoxic Hypoxia
• Inability to utilize 02 at cellular
level
– “Poisoned tissue”
• Causes
– Sepsis
– Alcohol
– Cyanide
– Carbon monoxide
• Treatment
– Cause specific
Trapped Air

• Expands with increase in altitude and

contracts on descent
• Trapped air will expand!
• Air expansion can cause rupture!
• One liter of gas at sea level will expand
to the equivalent of three liters of gas at
28,000 ft.
• Even with pressurization of the cabin
the body can act like a closed container.
Trapped Air

• Cranium
• Sinuses
• Ears
• GI Tract
• Thorax
• Medical
Devices
Trapped Air
– Middle ear
• Eustachian tube is far easier to open for
expanding gases than it is to open when
gas contracts. Therefore rupture is more
likely on descent when the eustachian
tube is blocked.
– Bowel gas, sinus and pleural space
gases
• Causing abdominal pain, increased
intracranial pressure and possible
pneumothorax
Trapped Air
• Pneumothorax
– Vent the chest!
• Bowel Obstruction
– NGT
– Vent to atmosphere or place on
suction
• Pneumocranium
– Lowest altitude possible
Trapped Air
• Colostomy
– BEWARE!
– Vent to atmosphere
• ETT cuff
– If high altitude for long periods of time
replace cuff air with saline or sterile H20
• IV Bags
– Remove all air prior to flight
• Glass Bottles
– Do not use!
• Air Splints / MAST Pants
– Monitor for increased pressure with altitude
Other Barometric Pressure Issues

• Dive Injuries
– Transported altitude < 1000 ft.
– Divers should be discouraged from
flying within 24 hours of dives > 66
feet.

• Dental work
– Should not fly within 24 hrs.
Thermal Changes
• Temperature decreases with
altitude
• Consider when “packaging” patient
• Consider flight crew dress
Decreased Humidity
• Decreased humidity with increased
altitude
– ETT’s plug more easily
– Corneas will dry out
– Dehydration
Noise
• Ear protection
• Cannot auscultate BS during flight
• Cannot auscultate BP during flight
• Creates acceleration of other
senses
Vibration
• Constant low vibration
– Traction devices must not have
hanging weights
– Diligent check of equipment settings
– Screws and bolts loosen over time
– Palpation of pulses
– Additional stress and fatigue on crew,
patient, and equipment
Fatigue
• Operational stressors
• Personal stressors

– D rugs
– E xhaustion
– A lcohol
– T obacco
– H ypoglycemia
Gravitational Forces
• Helicopter G forces are minimal,
fixed wing aircraft may experience
increased forces
• Maneuvering
– Visual Disturbances
– Disturbances in consciousness
• Acceleration/Deceleration
• CNS depressants and narcotics are
potentiated.
Key Points
Patient
• All patients receive supplemental 02!
• Assess and address all pulmonary needs
prior to departure
• Assess and address circulatory
deficiencies prior to flight
• Release trapped air
• NGTs should never be clamped
• Hematocrit should be > 21 and HGB
should be > 7
Crew
• Well rested
• Avoid smoking
• Remain in seat with restraints to avoid
vibration
• Avoid gas producing foods ( check on
your partner!)
• Avoid chewing gum on ascent
• Avoid flying with cold or ear infection
• Avoid effects of ETOH for 12 hours
before flight
Conclusion