Aviation medical

What is the checklist for evaluating pilot readiness to fly?

Illness, Medication, Stress, Alcohol, Fatigue, Emotions

How might flying while sick affect you?

Fevers and other symptoms can impact alertness, memory, breathing, or perception of space, or create ear/sinus blocks. Don’t fly while sick

How might medication affect your ability to fly, and what are the regulations on using meds before flight?

Some meds, prescription or over the counter, can cause sedation, and anything that depresses the nervous system can make you susceptible to hypoxia.

Regulations: you cannot operate an aircraft while using any drug that affect’s your faculties in any way contrary to safety.

This may look different to different people, so if trying a new medicine, figure out how it affects you and try it several times before going flying

How might stress affect you in flight?

It can occupy enough of your thoughts to make you less alert. It can also alter physical conditions like blood pressure or heart rate. Stress can be psychological like we typically think of, but can also be physical like too much noise or vibration, or physiological like fatigue. It can be acute or chronic, and chronic stress is more likely to be beyond your ability to cope with without performance decreases

What are the regulations around flying and alcohol?

Even a very small amount can have an effect, and effects can last for hours after alcohol has left the body. It makes you susceptible to hypoxia and disorientation.

You cannot fly within 8 hours of drinking, with a BAC of 0.04 or greater, or while under the influence of alcohol in any way including hangovers. You also cannot carry any passenger who appears to be intoxicated or under the influence of drugs

How can fatigue affect you in flight?

Can also be acute or chronic (chronic is when you don’t get enough chance to recover between instances of acute fatigue). It may degrade your attention, coordination, and communication

How might emotions affect you in flight?

upsetting events can reduce alertness and focus, and cause unneccesary risk taking. You shouldn’t fly after major life altering events

What is the general definition of hypoxia, and at what altitudes should you watch for it?

An oxygen deficiency due to lower air pressure at altitude. Can have effects at night as low as 5,000 ft, during the day not until 10,000-12,000

What are the symptoms of hypoxia?

Cyanosis (blue fingers and lips), drowsiness, lightheadedness or dizziness, feelings of euphoria, tingling or numbness of extremities, visual impairment, longer reaction time

What are the 4 types/causes of hypoxia?

Traditional/hypoxic hypoxia: insufficient oxygen reaching the body as a whole due to lower air pressure at altitude

Hypemic hypoxia: when blood cannot take up enough oxygen or transport it to cells, occurs due to CO poisoning, diseases, or blood loss like after donating blood

Stagnant hypoxia: blood in the lungs is not flowing to the tissues. Caused by G forces, or reduced circulation in cold temps

Histotoxic hypoxia: inability of cells to use the oxygen they get, caused by alcohol or drugs usually

How would you treat hypoxia if it happens in flight?

Descend to a lower altitude or give supplemental oxygen

At what altitudes is supplemental oxygen required?

Required between altitudes of 12,500-14,000 if that part of the flight is >30 mins

required for all flight crew at all times when above 14,000

required to be provided to all passengers/occupants above 15,000

What is hyperventilation, and what causes it?

excess rate and depth of breathing resulting in a loss of CO2 from the body.

Caused by stress, or higher altitudes, both of which may make people feel like they need to breathe faster

What are some of the symptoms that come with hyperventilation?

Lightheadedness, feeling suffocated, feeling drowsy, tingling or hot or cold sensation, muscle spasms, disorientation. May eventually lead to unconsciousness as the body tries to regulate breathing

These are similar to the symptoms of hypoxia, so make sure to check function of supplemental oxygen or other causes of hypoxia before treating

How might you treat hyperventilation if it happens in flight?

Consciously slow the rate of breathing, talk out loud, breathe into a paper bag. Falling unconscious is ok, the body will naturally bring the breathing rate back down.

What causes CO poisoning?

CO is a colorless, odorless gas that is naturally produces as part of the exhaust. Small aircraft heaters work by passing air over the manifold, if there are any cracks or incomplete seals, exhaust fumes can get in the cabin. Even small amounts of CO reduce ability to carry oxygen, resulting in hypemic hypoxia.

Smoking can also cause increased CO in the blood

What are some of the symptoms of CO poisoning?

Headache, blurry vision, drowsiness, muscle weakness

How would you prevent/treat CO poisoning in flight?

If you smell gas, assume CO is present and turn off the heater. Open the air vents. CO detectors in some aircraft will change color in the presence of CO. Avoid smoking before flying

What causes decompression sickness?

exposure to a rapid drop in pressure causing gasses in the blood like nitrogen to come out of solution and form gas bubbles. Flying in unpressurized aircraft at very high altitude or flying after scuba diving can cause it

Symptoms of decompression sickness

joint pain (the bends), itching, shortness of breath, neurologic symptoms like seizure or confusion

How would you treat decompression sickness in flight after it has happened?

Begin an emergency descent, give oxygen if you have it. Don’t move painful joints, seek specialized medical attention asap after landing

How would you prevent decompression sickness when flying after scuba diving?

Before a flight, wait 12 hours after a scuba dive that did not require controlled ascent or 24 hours after a dive that did require controlled ascent. If flying above 8,000ft, wait 24 hours after any dive

Causes of motion sickness

brain receiving conflicting messages about state of the body. Anxiety or stress may make it worse

Motion sickness symptoms

nausea, paleness, sweating, vomiting

Treatment of motion sickness? Why shouldn’t meds like dramamine be taken regularly?

Avoid turbulence, open air vents, focus vision on objects outside the aircraft, avoid unneccesary head movements. Meds can help, but do not take them regularly because they cause drowsiness

What are the causes of dehydration and heatstroke?

Critical loss of water and inability to regulate body temperature. Heat, wind, humidity, or drinks like coffee tea or alcohol can cause dehydration, and high altitude makes the body lose water faster.

symptoms of dehydration/heatstroke?

usually presents first as fatigue, may lead to headache cramps and dizziness, once it gets to heatstroke confusion and body collapse may occur

Prevention/treatment of dehydration/heatstroke

Drink at least 8 cups of water a day, don’t wait to be thirsty to drink. Limit intake of caffeine and alcohol. Keep the flight deck well ventilated

What happens in the middle ear and sinuses normally during flight?

As altitude increases, pressure decreases, and air in the middle ear and sinuses expands and is equalized through sinus openings or the ear Eustachian tube. On descent, the ear tube may not open automatically so you may have to equalize pressure by yawning/swallowing/plugging nose and blowing out

What causes sinus or middle ear problems in flight?

respiratory illnesses or allergies make congestion that plugs sinus/ear openings, making it difficult to equalize pressure and can block them entirely, causing ear drum injuries or infections

Symptoms of inflight middle ear/sinus issues

severe ear or sinus pain, loss of hearing, teeth aching, bloody nose

How to prevent middle ear and sinus issues in flight

do not fly while sick or having allergies. Even with medication, it may not be enough to prevent blockages, and meds have other effects that hinder flying performance

Hypothermia cause and symptoms

Inability for the body to produce heat faster than it is lost. Initially presents as shivering, then blood flow may be restricted to the extremities due to decreased circulation, finally fatigue confusion or disorientation, trouble talking, muscle stiffness, skin paleness

How to prevent/treat hypothermia in flight

Turn on the cabin heat. Wear layers and boots if flying in the cold, stay hydrated and eat before flying to keep metabolism up. If hypothermia does occur, get the person warm asap, apply warm blankets or heating pads, remove wet clothes, try to get them to drink warm drinks