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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%
Peter Felkai: Travel Medicine
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
Peter Felkai: Travel Medicine
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
Peter Felkai: Travel Medicine
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
Peter Felkai: Travel Medicine
Barodontalgia can pose a
serious safety risk to divers,
submariners, pilots and
airline passengers*.
Peter Felkai: Travel Medicine
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
Peter Felkai: Travel Medicine
DDecreasing ecreasing of of
space for the space for the
travelerstravelers’’ leg leg in in
the aircraft the aircraft
cabincabin ( ( inin inch )inch )
Peter Felkai: Travel Medicine
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
Peter Felkai: Travel Medicine
Meningococcus infections
• 2 neighborough persons
Peter Felkai: Travel Medicine
TBC infections
• 8 persons around
Peter Felkai: Travel Medicine
SARS, H1N1 infections
• all passengers !
Peter Felkai: Travel Medicine
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
Peter Felkai: Travel Medicine
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.
Peter Felkai: Travel Medicine
• 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
Peter Felkai: Travel Medicine
Contraindications of air - travel 2.
Thank you
for attention