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Haemoglobin
Conjugated protein
Haem (iron-porphyrin compound) + globin (4 polypeptide chain complex)
Hb = 4O2
Normal Hb concentration = 15g/100ml
Oxygen Pathway:
Chemoreceptors
Central chemoreceptors are located in the medulla.
Sensitive to CO2
Rise in pCO2 / Fall in pH (more acidic)
Peripheral chemoreceptors located in the aorta and carotid arteries
Sensitive to O2
Fall in pO2
A rise in pCO2 or fall in pO2 will lead to an increase in rate and depth of breathing.
The Heart
4 chambered pump
2 atria, 2 ventricles
valves ensure one-way blood flow
Atria pump blood ventricles lungs (right ventricle) and rest of body (left
ventricle)
Contraction of ventricle = pulse
Blood & Pressure
Adults – 6L of blood
50% fluid (plasma) + 50% blood cells
Red Cells carry oxygen
White cells (5 types) attack foreign cells, produce antibodies, kill bacteria
Platelets are blood clotting
Normal Blood pressure 120/80 mmHg
Stroke Volume = amount of blood ejected each beat
Cardiac Output = Stroke volume x Heart Rate = SV x HR
Cardiac Output : 3-5 L/min
Arteries & Veins
Arteries take blood AWAY from the heart
High pressure blood
Elastic, muscular walls
Regulate blood pressure
Veins take blood to the heart
Low pressure blood
Inelastic
Contains valves for one-way flow
Capillaries allow diffusion in the tissues
Very thin walls
o Circulation
Arterial driving pressure
Venous return determines cardiac output
Non-return valves in veins helps blood get back to the hear to maintain CO
Negative intrathoracic pressure during inspiration
Peripheral muscle action
Baroreflex
Stretch receptors
Monitors and adjusts blood pressure
Fall in BP = less baroreflex activity Increase cardiac contractility + Increase HR +
Vasoconstriction
BP therefore rises
6-12 seconds to full activate
Hypoxia
o Hypoxia is the lack of suffiecient oxygen to meet the needs of the body tissues. The brain
weighs only 2% but is responsible for a 20% oxygen uptake. Hence, the earliest effects of
insufficient oxygen are the impairment of cerebral functions.
o As altitude increases, pressure decreases and above 10,000ft, there is insufficient oxygen to
maintain adequate cerebral function. It is hard to predict when hypoxia affects an individual
as each of us is different physically and mentally to pinpoint an exact measurement of
altitude where impairment may occur. Also, due to the nature of hypoxia, the pilot’s
judgement is unaware of its insidious effects.
o
o Factors causing hypoxia:
1. Altitude – the greater the altitude, the more rapid the onset
2. Time – longer time of exposure greater effect
3. Exercise – increases the demand for oxygen
4. Cold – energy is required to generate heat to overcome low temperature, and this increases
demand for oxygen
5. Illness – illness increases energy demands of the body
6. Fatigue – lowers the threshold for hypoxia symptoms
7. Drugs/Alcohol – depress brain functions reduce the tolerance of altitude
8. Smoking – produces carbon monoxide which binds to haemoglobin with a greater affinity
than oxygen, thus reducing the amount of haemoglobin available for oxygen transport.
Also, lung disease affects air sacs and makes it hard to breathe
Types of hypoxia
1. Hypoxic hypoxia
- Low partial pressure of oxygen in the arterial blood
- Most common : exposure to high altitude, low pressure and no supplement of oxygen
2. Anaemic Hypoxia
- Reduction of haemoglobin circulating the body
- Decreased red blood cell + excessive bleeding such as haemorrhages
- It effectively puts body at altitude before leaving ground and cockpit altitude gives boost to
more altitude.
3. Histotoxic Hypoxia
- Happens when the appropriate amount of oxygen is reaching the cells but there is a
disorder prohibiting the cells to utilise oxygen effectively
- Carbon monoxide poisoning : inhibits the ability of haemoglobin to release the oxygen
bound to it
- Excessive intake of alcohol
4. Stagnant Hypoxia
- Happens when blood fails to deliver oxygen to target tissues due to local restriction in the
flow of well-oxygenated blood
- Blood pooling peripheral vision loss and loss of ability to focus, can also cause blackouts
and unconsciousness
- Extreme rapid acceleration
Stages of hypoxia
All individuals who normally live around sea level will experience symptoms of hypoxia when
they are exposed to altitude of 10000ft +
Stages of hypoxia can be classified by performance decrement which is dependent upon altitude
and the oxygen saturation of blood.
Indifferent stage
Occurs when breathing air at altitude of 0-10,000ft arterial oxygen saturation is 98% to
87%.
Dark adaptation is affected at 5000ft visual sensitivity to the night is reduced by 10%
caused by mild oxygen starvation , hence the use of oxygen is required during night flight at
high altitudes.
Performance of new tasks may be impaired.
Slight increase in heart and breathing rates.
Compensatory Stage
10,000ft – 15,000ft
arterial oxygen saturation 87% to 80%
Cardiovascular and respiratory physiological responses provide protection against hypoxia
Effects on central nervous system become perceptible after a short time ; drowsiness,
decreased judgement and memory, difficulty performing tasks requiring mental alertness or
discrete motor movements.
Effects of prolonged flight at this altitude : persistent headache & excessive fatigue
12,000ft + ; short term memory loss
Worst case during climb 10k-15k ft : become hypoxic
Hypoxic : person gets fixated to a particular task, during focus, loses all surroundings
Loses judgement , decrease psychomotor skill, difficulty in simple tasks
Sum up these reactions aviator loses sense of time and surroundings, spends the last
moments of consciousness in a meaningless task
15000ft + will cause lost of consciousness and death
Disturbance stage
15,000ft – 20,000ft
Arterial oxygen saturation 65% to 60%
Mental performance deteriorates , confusion, dizziness occurs in few mins
Total incapacitation with loss of consciousness rapidly follows with little or no warning.
Alveolar gases
Dry air is composed of 21% oxygen, 78% nitrogen and 1% other gases. At the barometric
pressure of 760mmHg, partial pressure of oxygen would be 160mmHg. However, when a
gas is in contact with a liquid and is in equilibrium with the liquid , the partial pressure of
oxygen will change.
Lungs & airways are always moist, air is rapidly saturated with water vapour in the upper
segments of the respiratory system. Therefore, typical mixture of alveolar gas : oxygen,
nitrogen, carbon dioxide, water vapour
At body temp, water vapour has a partial temperature of 47mmHg. Hence total pressure
remaining for the inspired gases is 713mmHg giving the partial pressure of oxygen to be
150mmHg.
As altitude increases, ambient pressure decreases but partial pressure of water vapour
remains as 47mmHg. This changes the composition of gases. For every part of air at an
increased altitude, oxygen count is relatively lesser than oxygen at sea level.
Oxygen Systems
For flights above 10,000ft a supplementary oxygen supply must available. It may consist of a
portable oxygen container and mask or a fixed installation adjacent to the crew and passengers.
Diluter Demand
Flight crew oxygen system : close-fitting mask with a regulator that supplies a flow of
oxygen according to cabin altitude.
Regulators are designed to provide an appropriate proportion of oxygen and air from a mix
of 0% oxygen and 100% cabin air at altitude below 8,000ft. It gradually increases the
proportion of oxygen until 33,000ft where 100% oxygen and 0% cabin air is delivered.
Oxygen is supplied at the rate of the user when they inhale. This reduces the amount of
oxygen required.
Pressure demand
Similar to diluter demand equipment
Oxygen is automatically supplied under slight pressure at cabin altitudes above 10,000ft
with full pressure breathing above 38,000ft.
Cabin Pressurisation
For prolonged flights operating above 10000ft, using oxygen masks is exhilarating and
inefficient. Another method to maintain adequate supply of partial pressure of oxygen is to
pressurise the aircraft cabin to ensure the cabin altitude remains below 10,000ft, irrespective of
the actual altitude of the aircraft.
Cabin air supple is provided by tapping bleed air from the aircraft engine or by using an
independent compressor, and the pressure within the cabin is controlled by an outflow valve.
Maintaining the cabin at sea level pressure would require a very strong and thus heavy
structure for the fuselage affects weight and fuel economy.
Normal individuals can tolerate altitudes of up to 10000ft but this is not true for elderly or the
diseased who are less tolerable to the effects of hypoxia. Hence pressurised cabins are to
maintain 6,000ft to compromise physiological needs of the crew and economical needs of
aircraft operator.
Rapid Decompression
If cabin pressure is suddenly lost during flight, pressure inside will equalise outside pressure of
air. Magnitude of the rate of decompression, physiological effects will be determined by:
Size of cabin rupture or number of lost windows
Aircraft altitude
Pressure differential between cabin and external environment.
Volume of cabin
Position of the rupture or lost window – venturi effect can lead to increase in cabin altitude
if cabin air is sucked out
The larger the rupture + smaller cabin + greater pressure differential between cabin and the
outside air more rapid the rate of decompression
Explosive decompression = extremely rapid loss of pressure .
When this occurs , mist will fill the cabin
A sudden equalisation of pressure = strong blast of air outwards from cabin opening. This may
cause loose items / humans to be sucked out. Therefore, flying at high altitude in pressurised
aircraft , seat belt must be used and also provides restraint during unexpected turbulence.
Within the body cavities, free gases will expand and will be expelled wherever possible.
Decompression sickness
In addition to the gases trapped in the body cavities, a considerable volume (primarily
nitrogen) exists elsewhere within the body, not in normal gaseous state but in solution.
Visual Functions
Aimed at detecting 3 major components:
1. Light sense
2. Form Sense
3. Colour Sense
These are detected by the retina.
The crude image is then manipulated by the brain to produce a
recognisable image
Light Sense
Eye can function over wide range of light levels. Eg. From faint
starlight to bright sunlight on snow
Requires both rods and cones due to their photochemical reaction
which converts light energy into electrical energy
Three types of vision involved:
1. Scotopic vision
o Low light levels
o Night vision
o Mediated by Rods
2. Mesopic vision
o Intermediate light level
o Transitional stage (dawn, dusk, full moonlight)
o Mediated by Rods AND Cones
3. Photopic vision
o High light levels
o Day
o Mediated by cones
Form sense
Detection and recognition of objects
Involves varying levels of resolution and detail
Two types of vision involved: Focal , Ambient vision
Visual Acuity
Measured via standard eye chart at 6m away
Normal visual acuity 6/6 : subject sees 6m while rest of population
sees 6m
Poor vision 6/60
Subject sees 6m while rest of population sees 60m
Colour Perception
Cone (fovea) function
Blue,red,green ratio 1:10:10
Variation in proportion and saturation of these colours gives any other
colour
Peak spectral sensitivities:
Red cones 564nm
Blue cone 420nm
Green cone 534nm
Physiological blind spot
Caused by lack of rods and cones at optic disc
Covers 2-6 degrees of visual field
Sufficient to block 18 m object at 200m
Depth Perception
Binocular cues ( up to 200m):
Convergence – amount that the axes of the eyes converge to bring
visual target to each fovea
Stereopsis – the fusion of signals from slightly disparate retinal points,
measured in seconds of arc of disparity
Accommodation – if the eye observes a close object, the lens is
thickened and the pupil becomes larger, while to focus on a more
distant target, the lens flattens and the pupil becomes smaller
Monocular cues:
Retinal image/size constancy – comparison of the object from past
experience
Relative motion/motion parallax – near objects appear to move against
the oberserver’s motion, distant objects move in the same direction as
the observer’s motion
Obscuration – nearer objects appear to cover distant objects
Aerial perceptive
Overlap
Position in visual field
Atmospheric perspective – distant objects appear more blue and hazy
than near objects
Linear perspective – parallel lines converge at a distance
Perception time
Detect visualise,recognise : 1s
What to do? 2s
Muscle movement, change path 2.5s
Total time : at least 5s
Night vision
Function of the rods ( & therefore peripheral vision)
Visual acuity is less than during the day
Colour vision is poor
Night environment consists of degraded visual cues
Can be worsened by atmospheric conditions
Dark Adaptation:
The process by which the eyes adapt for optimal night visual acuity
under conditions of low ambient illumination
Rapid adjustments from dark to light
Slower adjustments from light to dark
Each eye adapts independently
30min -45min to fully adapt
depends on regeneration of photopigments in the rods and cones
5-7 min for cones
30-45 min for rods
full adapted cones give very poor night vision therefore, best when
rods are fully adapted
To minimise dark adaption time:
Avoid inhaling carbon monoxide from smoking /exhaust
Adjust instrument and lighting to low as possible
Avoid exposure to bright lights
Use supplementary oxygen at night flying above 5000ft
The night blind spot
At night, the fovea cannot be used for vision as it contains no rods
This region of the eye is effectively another blind spot
Each eye has 2 blind spots: The physiological blind spot ( optic disc )
and the night blind spot (fovea)
Using eyes at night
Awareness of limitations of eye
Rods need to be used
Looking off-centre ( not directly at an object) stimulates the peripheral
vision and rods
Keeping the eyes moving stimulates rods
Increases the chances of detecting an object ( stationary or moving)
Never fixate for more than 2-3 seconds
Insure a 15 degree overlap when scanning
This will counter the night blind spot
Maximise Night vision prior to flight
Balance diet
Plenty of rest
Avoid bright lights
Wear sunglasses
No smoking, alcohol, drugs
Maximise Night vision DURING flight:
Ensure complete dark adaption
Target acquisition and object detection can be maximise by :
Use off centre viewing ( 10 to 15degrees)
Keep gaze moving
Scan pattern needs practise
Exploit contrast if possible
Maintain clean visors/screens
Close one eye if flashed
Minimise cockpit lighting
Min external lighting
Use supplementary oxygen
Noise
Signs Symptoms:
1. Pallor
2. Cold sweats
3. Nausea
4. Vomiting
5. Hyperventilation & air hunger
6. Increased salivation, feeling of bodily warmth, light headed
7. Belching & flatulence
8. Sighing and yawning
9. Headache
10. Drowsiness and lethargy
Earliest symptom is epigastric discomfortnauseaavalanche
phenomenonmultiple symptom signsvomit
Contributing factors:
o Age
o Sex : females more likely to suffer 1.7:1
o Anxiety
o Mental activity
o Aircraft/environmental factors : control dynamics
o Individual variation
Management approach
o MEDICAL:
o History : motion stimulus : provocation, frequency, severity
Risk factors: susceptibility factors, anxiety,stress
o Clinical examination : evidence of other disease processes
o MANAGEMENT :
o Behavioural
Minimise head movement
Lie down
Close eyes
Keep mind occupied
Stay in stable part of aircraft
View horizon
o Adaptation: the more you fly the less likely you are to be motion sick
o Medications:
Central anticholinergics ( scopolamine (kwells), atropine,
cinnarizine,promethazine from avomine or phenergen)
o Sympathomimetics ( ephedrine, pseudoephedrine,amphetamines)
o Others ( calcium channel blockers, phenytoin)
o Densitisation:
o Used by most air forces
o Program of frequet motion stimulation with a nauseogenic stimulus
(coriolis)
o May be supplemented by flying phase
o Leads to adaptation to motion stimuli
o Desensities individual to motion effects
o 85% success rate
o must go back to flying immediately
Noise
Oculogravic illusion
o When aircraft accelerates and there is a backward rotation of the
resultant force vector, the pilot may experience a pitch up illusion.
Accompanied by apparent upward movement and displacement of
objects, such as line of lights.
Auto-kinesis
o In the dark, static light will have motion when stared at for several
seconds & will increase in movement if it becomes the prime focus
o At night, shift the gaze to not stare at single light source
Illusion of level flight ( false horizon)
o In absence of clearly defined horizon, the pilot may choose mistakenly
another pt of line as a reference. Eg. Flying parallel to a sloping cloud
bank instead of earth’s surface
The landing errors
o The visual approach and landing of an aircraft requires the pilot to
perceive and respond to a number of visual cues. When flying a 3
degree approach, the angle between the horizon and the visual impact
point on the runway is also 3 degree. Thus the approach is flown using
suitable control inputs to maintain a constant angle subtended at the
horizon.
o Large aircraft: touchdown pt will be shot of the visual aiming pt
o Visual texture in the peripheral field will assist final judgement of
height and speed.
o Surface feature and atmospheric conditions can create illusions of
incorrect height and distance from runway. Can be avoided by
approach angle guidance lights
Ground lighting illusions
o Lights along a straight path such as a road or lights on moving vehicles
can be mistaken for runaway lights
o Bright runway where few lights illuminate the surrounding terrain may
create the illusion of there being less distance to the runway threshold.
o Flying over terrain which has few lights to provide height cutes may
lead to a lower than normal approach being flown.
Atmospheric condition
o Haze, mist or fog can lead to refraction of light illusion of greater
height or greater distance from runway
o Penetrating mist or fog illusion of pitch up may cause pilot to
steepen the approach
o Rain on windscreenrefraction of light illusion of greater height or
distance pilot makes shallower than normal approach rain also
gives blooming effect to perception of runway lights gives perception
that approach is faster and runway is closer than it actually is.
Runway and terrain slope illusion
o Unsloping runway or terrain illusion that aircraft is higher altitude
and runway is shorter lower than normal approach
o Runways which slopes down have opposite effect
Runway width illusion
o Approaching a narrow runway aircraft may seem higher lower
approach than normal.
o Approaching wider runway aircraft seems lower higher approach
than normal landing beyond runway threshold
Featureless terrain ( black hole)
o Absence of ground features – eg. Land over water, darkened areas,
terrain with snow creates illusion that aircraft is at higher altitude
than reality leading to lower approach.
o Landing at night at aerodome with no surrounding lights pilots face
black hole excessively low approach with risk of undershooting
runway . Cause: runway edge light is only visible cue and there is
nothing to provide dimension of scale leading to false perception of
distance and angle.
Prevention of disorientation:
o Illusions can be overcome by believing instruments>sensations
o Never continue flying in bad weather conditions unless suitably
qualified in instrument flying
o In poor visibility : do not mix instrument flying with visual flying ,
constant switching may lead to disorientation
o Never fly into dusk or darkness unless very competent with
instruments
o Avoid sudden head movements in flight, especially when manoeuvring
o Ensure outside visual reference are used they are reliable fixed pts on
earth’s surface
o Do not fly with cold or other illness
o Do not drink alcohol within 12 hrs of take off
o Do not fly when tired
o Maintain practice and proficiency in instrument flying