medical aspects of air - travel the air pressure of the...

Medical aspects Medical aspects

of air of air -- traveltravel

Peter Felkai MD.Peter Felkai MD.PhPh.D..D.

associateassociate professorprofessor

head head of of departmentdepartment

TravelTravel MedicineMedicine ChairChair

AAttributes ttributes of of the cabin environment the cabin environment of of

commercial aircraftscommercial aircrafts

•• thethe air air pressurepressure of of thethe cabincabin at cruising altitudeat cruising altitude is is lowerlower thanthan on seaon sea ((groundground) ) level level –– reduced reduced air air pressurepressure

•• consequentlyconsequently,, the partialthe partial pressurepressure of of thethe oxygenoxygen is is muchmuch lowerlower, , thanthan onon seasea levellevel ((BoyleBoyle’’ss lawlaw) )

•• thethe humidityhumidity inin thethe cabinecabine is is muchmuch more more lowerlower thanthanonon the streetthe street

•• the number the number of air of air contaminating particulatescontaminating particulates of of thethecabinecabine are highare high

•• movement restrictionsmovement restrictions

•• high occupant density high occupant density ,, crowdcrowd

•• noisenoise, , vibrationvibration, , frekventfrekvent aa suddensudden elevatingelevating and and descending movementdescending movement

Peter Felkai: Travel Medicine

Triggering factor Consequence Symptoms

low cabin pressure lower PaO2, lower SaO2 dyspnoe, tachycardia

air conditioningsemi-fresh air-flow,

increased CO2

increased risk of airborne

infections, dyspnoe,

hypercapnia, fatique,

upper airway infections

rapid changes of altitude barotraumatooth ache, pain in the

body-cavities

movement of the aircraft vestibular dysfunction motion sickness

narrow sitting place, long

sitting position, immobility

disturbances in the blood-

microcirculation

DVT, increased risk of

host-to-host infections

check-in procedures,

congestion of passengerspsychosocial stress

air rage, fatique, nervous

breakdown

altitude above seaaltitude above sea –– level in meterlevel in meter

Parameter changesParameter changes ofof inhaledinhaled airair

relating to the altituderelating to the altitude

Biophysical changes during Biophysical changes during travel by travel by

commercial flcommercial flightight

values on sea level values on cruising speed

oxygen in the air 100% 60 – 70%

oxygen pressure (pO2)13 Kpa 8 Kpa

partial oxygen

pressure(PaO2)97% 85 – 90 %

inhaled air O2%

(FiO2%)21% 15%

hemoglobin

oxigénsaturation

(SaO2)

98% 78%

air extension0 25% ( 5 x dilatation)

humidity40 – 60% 5 – 15%


take offtake off landinglanding

Th

e air

pressu

reis

decrea

sing

Th

ea

ltitud

eis

incresin

g

0 m.

2,500 m.

10,000 m.

Pressure in Pressure in

cabincabin

Pressure outsidePressure outside

taxiway landingdescendingcruising

altitude

take -

offascending


Cabin pressure changeCabin pressure change

A shape of a bottle

at sea level. The

bottle was closed up

at cruising altitude.

BARODONTALGIA

1 Gingival Abscess - pain in

ascent

2 Root Abscess - pain in

ascent

3 Swollen Pulp due to a Cavity

or Dental Work - pain in

ascent

4 Swollen Maxillary Sinus -

pain in ascent or descent


Sea Level

5,500 m.

7,600 m.

9,200 m.

13,000 m.

1.0 x

2.2 x

3.0 x

5.0 x

9.5 x

..

�

�

�

�

�

expanding the air in

the body cavities


Barodontalgia can pose a

serious safety risk to divers,

submariners, pilots and

airline passengers*.


optimaloptimal

humidityhumidity

40 40 –– 60 %60 %

humidityhumidity inin thethe

cabincabin

20 20 –– 30 %30 %Contact lenses

became dry, therefore go for spectacles

onboardPeter Felkai: Travel Medicine

The The humidity humidity

percentage percentage

can can be be

controlled by controlled by

the pilotsthe pilots

Immobilisation can cause rheological disturbances and

deep vein thrombosis


DDecreasing ecreasing of of

space for the space for the

travelerstravelers’’ leg leg in in

the aircraft the aircraft

cabincabin ( ( inin inch )inch )


The The sharp bulge sharp bulge of of the the

popliteal veinpopliteal vein made made the the

circulation slowcirculation slow and and maymay

facilitate the development facilitate the development ofof

deep vein thrombosisdeep vein thrombosis

The air The air sicknesssickness

Dr. Felkai Péter: Utazásorvostan

PREVENTION OF AIR SICKNESS:

�Choosing a window seat with a view of the ground or

of lower clouds, such that motion can be detected.

� Choosing seats with the smoothest ride in regards to

pitch (the seats over the wings in an airplane)

�Sitting facing forward while focusing on distant

objects rather than trying to read or look at something

inside the airplane.

�Eating dry crackers, and eat normal portion. No

alcohol. Empty belly is more sensitive to the nausea.

�Use oxygene flow over the seat

�Use medications such as antivertiginoses

diphenhydramine

engine air- condition

the half of

the

expired

air is

bypassed

outside

air - filter

the half of

the expired

air is

recirculated

Cabin comfort –only for a few


Meningococcus infections

• 2 neighborough persons


TBC infections

• 8 persons around


SARS, H1N1 infections

• all passengers !


The seat of a SARS patient on the aircraft. During the travel to Hong Kong, he infected 22 travelmate. (Olsen SJ, Chang HL, Cheung TY, et al. Transmission of severe acute respiratory syndrome on aircraft. N Engl J Med 2003; 349,2416–2422 )

Dr. Carlo Urbani , who discovered and identified the SARS as

a highly contagious illnessHe lived 46 years.

Carlo Urbani was an Italiandoctor and microbiologist and

the first to identify severe acute respiratory syndromeas a new and dangerously contagious viral disease.

Although he himself became infected and died, his early warning to the World Health Organization (WHO) touched off a massive response that

helped save the lives ofmillions of people around the

world.

1956 - 2003

Travel related stress – air rage


Disruptive passenger incidents*

* Air Canada presentation: Safety Management Systems retr: 2014.03.

http://tc.gc.ca/eng/civilaviation/standards/sms-info-may2006-1869380-2772.htm

• newborns: in the first 2 days immediately after the

delivery, after one-week after birth if it’s necessary

(the airlines’ rules can be different)

• pregnancy: from 36th. week of pregnancy when the

labour is the first; from 32th. week of pregnancy

when the woman has already underwent a childbirth

• patient with communicable diseases

• patient with acut psychosis

• divers: within 24 hours of last ascent

• decompression injury

Contraindications of air - travel 1.


• Preexisting diseases:

acut angina pectoris, or/and effort angina,

anemia

dyspnea, shortness of breath, severe pulmonary diseases

• acute illnesses

incerased brain pressure ( due to trauma, infection or brain

accident)

acute myocardial infarction, acut coronaria syndrome

danger of air trapping: after operations or trauma (opening

the abdominal/thoracic cavity; craniofacial injuries, injury of

the eye, eye-opening operations; operation of the skull

pneumo/hemothorax


Contraindications of air - travel 2.

Thank you

for attention

medical aspects of air - travel the air pressure of the...

Documents