CFRN
What is the worst stressor in transport?
Vibration. Physical effects on crew & patient plus affects ECG and increases ETCO2. Increase
padding to decrease vibration
Gravitational forces cause what?
Pooling of blood
Negative impacts on transport
Fatigue
Dehydration
Cold, high, & dry
What stressor impacts physical assessment most?
Noise
Vision Impairment
Night vision affected as early as 5000 feet MSL
Avoid inside light and use supplemental O2
Most common reason for patient death during flight?
Cardiac tamponade
Tension pneumothorax
Hypovolemia
Fuel vapors cause what?
Eye irritation
AMS
Nausea
Flicker Vertigo
Sunlight through wind milling propeller can cause seizures. Cover patient's eyes to prevent.
Occurs @ 4-20Hz
,Barotitis Media
Obstruction of eustachian tubes cause pain, tinnitus, vertigo on descent. Ask the patient to yawn
or swallow.
Barogastralgia
Unclamp NG/OG tube during ascent to relieve pressure
Barodontalgia/aerodontalgia
Warm compresses to relieve dental pain on ascent
What happens to an untreated PTX during ascent?
Any untreated PTX will expand on ascent and may needle needle decompression or chest tube
placement Boyle's law
Barosinusitis
Obstruction of the sinus passages may cause pain or epistaxis on ascent. Use valsalva
maneuver to equate pressure
Boyle's "Balloon" Law
Temperature is constant Trapped gas expands with altitude (your pressure will decrease with
altitude) i.e. air splints, chest tubes, ET cuff pressure, hollow organs (insert NG/OG), increase
IVF rate, IABP purge
-insert chest tube for rotor wing
-no air transport for pneumocephalus air in the cranial cavity
-bi-valve a cast that is < 7 days old
-no air splints
Henry's Law "Heineken" Law
N2 bubbles cause decompression sickness "the bends" The amount of gas dissolved in a
solution is directly proportional to the pressure of gas over a solution. The more concentrated
the gas that comes in contact with a liquid is the more that gas will be dissolved in the liquid or if
,the partial pressure is twice as high twice as many molecules will hit the surface of the liquid
which is then captured in the solution based on the solubility
Charles "Centigrade" Law
Charles is cold For every 1000 ft you ascend (go up) your temperature decreases 2 degrees
Celcius or for every 150m you go up temp decreases 1 degree Celcius An increase in altitude
leads to a decrease in temperature. Gas expands as temperature increases and gas decreases
and temp decreases
Dalton's "Gang" Law
More O2 required at higher altitude (altitude hypoxia) because it moves molecules further apart
The total pressure of a gas mixture is the sum of the partial pressure of all gases. Gases:
Oxygen 21%
Nitrogen: 78%
Trace 1% at all levels, but further apart as you ascend (Dalton's disperse) When pressure of
gases changes (your altitude) each component of gas does not change in other words as the
aircraft ascends gas expansion causes the available oxygen to decrease because the
molecules are further apart
Gay-Lussac's Law "Charle's Brother"
Pressure in O2 tanks (changes PSI) decreases as temperature drops and increases with heat.
At a given mass and constant volume of gas the pressure exerted on the side of the container is
directly proportional to the to its absolute temperature
Graham's Law
Diffusion rate of gas through a liquid is related to solubility of the gas (Graham=gray matter)
Combined Gas Law (Boyle's, Charles, Gay-Lussac)
The ratio of the product of pressure and volume and the absolute temperature of a gas is equal
to a constant
Atmosphere Zones
0ft 760mmHg=1 atm 18,000ft=380mmHg=1/2 atm; 34,000ft=190mmHg =/4 atm; 48,000
ft=95mmHg= 1/8 ATM physiologic sea level to 10,000ft
physiologic deficient 10-50,000ft (oxygen of pressurization required to survive), space
equivalent, space
, Water Pressure
0 is 1 ATM or 14.7 psi
33 ft below surface 2 ATM 29.2 psi
66 ft below surface 3 ATM 44.1 psi 99 below surface 4 ATM 58.8 psi 132ft below surface 5 ATM
73.5 psi
Divers Alert Network (DAN)
24 hr hotline for diving related questions 919-684-9111 or diversalertnetwork.org
Air Gas Embolism (AGE) d/t Boyle's Law
inexperienced diver breath holding compressed air during ascent forces air through alveoli into
the skin in the chest & neck. Greatest pressure difference @ <4 feet depth just below the
surface. May result in a PTX or ischemia from air embolus.
Tx: transport in pressurized cabin or <1000 feet MSL in rotor wing to immediate HBO
Decompression Sickness Henry's Law
Decompression sickness 1-painful joints, mottled skin, itching "cutis marmorata"
Decompression sickness 2-neurologic stroke-like symptoms, AMS syncope, dizziness
Bends
Limb/joint pain from N2 bubbles under the skin
Chokes
Chest pain & respiratory distress (sensation from suffocation) from N2 gas bubbles in the
pulmonary vessels
Creeps
Paresthesia, tingling and itching from N2 bubbles under the skin
Staggers
Neurologic disturbances as N2 comes out of the blood and forms gas bubbles
Treatment for bends, creeps, and staggers
Ground transport preferred for all DCS illnesses
Administer O2
Possible HBO therapy
What is the worst stressor in transport?
Vibration. Physical effects on crew & patient plus affects ECG and increases ETCO2. Increase
padding to decrease vibration
Gravitational forces cause what?
Pooling of blood
Negative impacts on transport
Fatigue
Dehydration
Cold, high, & dry
What stressor impacts physical assessment most?
Noise
Vision Impairment
Night vision affected as early as 5000 feet MSL
Avoid inside light and use supplemental O2
Most common reason for patient death during flight?
Cardiac tamponade
Tension pneumothorax
Hypovolemia
Fuel vapors cause what?
Eye irritation
AMS
Nausea
Flicker Vertigo
Sunlight through wind milling propeller can cause seizures. Cover patient's eyes to prevent.
Occurs @ 4-20Hz
,Barotitis Media
Obstruction of eustachian tubes cause pain, tinnitus, vertigo on descent. Ask the patient to yawn
or swallow.
Barogastralgia
Unclamp NG/OG tube during ascent to relieve pressure
Barodontalgia/aerodontalgia
Warm compresses to relieve dental pain on ascent
What happens to an untreated PTX during ascent?
Any untreated PTX will expand on ascent and may needle needle decompression or chest tube
placement Boyle's law
Barosinusitis
Obstruction of the sinus passages may cause pain or epistaxis on ascent. Use valsalva
maneuver to equate pressure
Boyle's "Balloon" Law
Temperature is constant Trapped gas expands with altitude (your pressure will decrease with
altitude) i.e. air splints, chest tubes, ET cuff pressure, hollow organs (insert NG/OG), increase
IVF rate, IABP purge
-insert chest tube for rotor wing
-no air transport for pneumocephalus air in the cranial cavity
-bi-valve a cast that is < 7 days old
-no air splints
Henry's Law "Heineken" Law
N2 bubbles cause decompression sickness "the bends" The amount of gas dissolved in a
solution is directly proportional to the pressure of gas over a solution. The more concentrated
the gas that comes in contact with a liquid is the more that gas will be dissolved in the liquid or if
,the partial pressure is twice as high twice as many molecules will hit the surface of the liquid
which is then captured in the solution based on the solubility
Charles "Centigrade" Law
Charles is cold For every 1000 ft you ascend (go up) your temperature decreases 2 degrees
Celcius or for every 150m you go up temp decreases 1 degree Celcius An increase in altitude
leads to a decrease in temperature. Gas expands as temperature increases and gas decreases
and temp decreases
Dalton's "Gang" Law
More O2 required at higher altitude (altitude hypoxia) because it moves molecules further apart
The total pressure of a gas mixture is the sum of the partial pressure of all gases. Gases:
Oxygen 21%
Nitrogen: 78%
Trace 1% at all levels, but further apart as you ascend (Dalton's disperse) When pressure of
gases changes (your altitude) each component of gas does not change in other words as the
aircraft ascends gas expansion causes the available oxygen to decrease because the
molecules are further apart
Gay-Lussac's Law "Charle's Brother"
Pressure in O2 tanks (changes PSI) decreases as temperature drops and increases with heat.
At a given mass and constant volume of gas the pressure exerted on the side of the container is
directly proportional to the to its absolute temperature
Graham's Law
Diffusion rate of gas through a liquid is related to solubility of the gas (Graham=gray matter)
Combined Gas Law (Boyle's, Charles, Gay-Lussac)
The ratio of the product of pressure and volume and the absolute temperature of a gas is equal
to a constant
Atmosphere Zones
0ft 760mmHg=1 atm 18,000ft=380mmHg=1/2 atm; 34,000ft=190mmHg =/4 atm; 48,000
ft=95mmHg= 1/8 ATM physiologic sea level to 10,000ft
physiologic deficient 10-50,000ft (oxygen of pressurization required to survive), space
equivalent, space
, Water Pressure
0 is 1 ATM or 14.7 psi
33 ft below surface 2 ATM 29.2 psi
66 ft below surface 3 ATM 44.1 psi 99 below surface 4 ATM 58.8 psi 132ft below surface 5 ATM
73.5 psi
Divers Alert Network (DAN)
24 hr hotline for diving related questions 919-684-9111 or diversalertnetwork.org
Air Gas Embolism (AGE) d/t Boyle's Law
inexperienced diver breath holding compressed air during ascent forces air through alveoli into
the skin in the chest & neck. Greatest pressure difference @ <4 feet depth just below the
surface. May result in a PTX or ischemia from air embolus.
Tx: transport in pressurized cabin or <1000 feet MSL in rotor wing to immediate HBO
Decompression Sickness Henry's Law
Decompression sickness 1-painful joints, mottled skin, itching "cutis marmorata"
Decompression sickness 2-neurologic stroke-like symptoms, AMS syncope, dizziness
Bends
Limb/joint pain from N2 bubbles under the skin
Chokes
Chest pain & respiratory distress (sensation from suffocation) from N2 gas bubbles in the
pulmonary vessels
Creeps
Paresthesia, tingling and itching from N2 bubbles under the skin
Staggers
Neurologic disturbances as N2 comes out of the blood and forms gas bubbles
Treatment for bends, creeps, and staggers
Ground transport preferred for all DCS illnesses
Administer O2
Possible HBO therapy
