Transcript 노재훈2이상기압
이상기압 고도에 따른 기압, 산소분압 및 온도 고도(m) 0 500 1,000 2,000 3,000 4,000 5,000 6,000 7,000 8,000 9,000 11,000 15,000 20,000 기압(mmHg) 760 716 674 596 525 462 405 354 308 267 231 198 90.3 41.4 PO2 ,mmHg 103 61 (3-4주) 25 (11-12주) 109 0 기압비 1.00 0.94 0.89 0.78 0.69 0.61 0.53 0.47 0.41 0.35 0.30 0.26 0.12 0.05 1기압 = 760mmHg = 1013.25millibar, 109, 100% 산소 흡입시 온도(oC) 15.00 11.75 8.50 2.00 -4.49 -10.98 -17.47 -23.96 -30.45 -36.93 -43.41 -49.89 -56.50 -56.50 이상기압하에서의 작업 • 고기압 • 저기압 • 급격한 기압변동 고기압이 인체에 미치는 영향 • 기계적 장해 • 화학적 장해 기계적 장해 barotrauma ear squeeze sinus squeeze dental squeeze lung squeeze abdominal gas pain 화학적 장해 질소 마취작용(nitrogen narcosis) – 증상 – – 예방책 : helium diving의 장단점 martini rule 수심과 질소마취 증상과의 관계 수심(m) 증 상 30-45 현기증, 자신감의 증가, 세밀한 식별능력 소실, 다행증 45-60 명렁하고 상쾌한 기분, 다변증 60-75 자신의 안전에 대해 부주의, 웃음, 집중력 감소 90 우울상태, 명확한 사고의 소실, 신경-근의 협동작용 장해, 거동의 변동 105 의식소실 산소중독 산소분압 2기압(1550 mmHg) 이상 1. Visual disturbance Euphoria Nausea Twitching Incoordination Dizziness 2. Lorrain - Smith효과(만성형) Paul-Bert효과(급성형) 고압신경증후군 (High pressure nervous syndrome) – Tremor, convulsion, dizziness, nausea, vomiting – 15 ATA 급격한 기압변동에 의한 신체장해 • 감압병(decompression sickness) • 이압성 골괴사 감압병(decompression sickness) 동의어 A. 잠함병(caisson disease) B. 벤즈(bends) C. 초크스(chokes) D. 스테거즈(staggers) E. 공기 전색증(air embolism) – 유발요인 A. 운동 B. 손상 C. 한냉 D. 비만증 E. 이산화탄소 농도 F. 연령 G. 음주 – 임상증상 A. Type Ⅰ : 비교적 경한 형태로 통증을 수반하며 임파부종과 피부소양증이 나타나기도 한다. B. Type Ⅱ : 심한형태로 질식(chokes), 신경계 증상, 내이증상(staggers),복통, 흉통, 요통 동반 이압성 골괴사 (dysbaric osteonecrosis, aseptic bone necrosis) – 원인 기체성 기포, 지방성 색전 – 호발부위 대퇴골의 하단 골간부, 두부 경골의 상단 골간부 상완골의 두부, 경부 수심에 따른 압력과 증상 0m 10 20 30 1ATA 2 3 4 90 10 no decompression N2 narcosis O2 toxicity Hyperbaric Chamber Modified USN Table 5 Depth: 18msw., Atmosphere: air mix., Use: Treatment of CO poisoning. Comment: Can be extended if patient's condition indicates requirement for more prolonged treatment • 감압병의 예방 • 적성검사 비만자, 호흡기 질환자, 이비인후과 질환 자, 알콜중독자, 약물중독자, 골관절 질환자 – 작업시간 제한 – 단계적 감압 실시 – 반복 잠수 금지 – 헬륨 잠수 – 재가압 저기압에 의한 인체 장해 • 기계적 장해 • 저산소증(hypoxia) • 고산병 기계적 장해 – aerotitis media – aerosinusitis 저산소증(hypoxia) – 저산소환경에서 순화 호흡횟수 및 깊이 증가 → 호흡성 알카리증 → 맥박수, 심박출량 증가 → 적혈구수 증가, 혈색소량 증가, 혈액량 증가 – 3,000m → 3 ∼ 4주에 순화 6,000m → 11 ∼ 12주에 순화 Altitude Illnesses • • • • Acute Mountain Sickness (AMS High Altitude Pulmonary Edema (HAPE) High Altitude Cerebral Edema (HACE) Cheyne-Stokes Respirations 저기압 대책 순응 약물요법 가압 산소흡입 Preventing Acute Mountain Sickness Acute mountain sickness is caused by a lack of oxygen when traveling to higher elevations. This usually occurs in individuals exposed to an altitude over 7,000 feet (2,100 m) who have not had a chance to acclimate to the altitude before engaging in physical activities. Mountain climbers, trekkers, skiers, and travelers to the Andes or Himalayas are at greatest risk. While individual tolerance varies, symptoms usually appear in several hours, with those in poor physical condition being most susceptible. Headache, fatigue, shortness of breath, nausea, and poor appetite occur initially. Inability to sleep is also frequently reported. In more severe cases thinking and judgement may become impaired. An uncommon but potentially fatal complication called high altitude pulmonary edema, caused by fluid build-up in the lungs, can also occur. Gary P. Barnas, MD Associate Professor General Internal Medicine The symptoms of acute mountain sickness can be prevented or minimized by gradually ascending (less than 500 meters/day)over several days to give your body a chance to acclimate to the higher altitude. Taking the prescription medication Diamox (acetazolamide) 250 mg three times a day has been shown to speed up the acclimatization process and can be taken shortly before and during the ascent. Do not take this medication if you are allergic to sulfa drugs. This medication is a mild diuretic and may work by changing the body's acid-base balance and stimulating breathing. Dexamethasone 8 mg once a day has also been shown to be effective. However, this steroid medication may have more adverse effects. Once symptoms occur, they usually improve over several days without treatment. However, if they become severe, they can be relieved with the administration of oxygen or descent to a lower altitude. Gary P. Barnas, MD Prevention of Altitude Illnesses Prevention of altitude illnesses falls into two categories, proper acclimatization and preventive medications. Below are a few basic guidelines for proper acclimatization. •If possible, don't fly or drive to high altitude. Start below 10,000 feet (3,048 meters) and walk up. •If you do fly or drive, do not over-exert yourself or move higher for the first 24 hours. •If you go above 10,000 feet (3,048 meters), only increase your altitude by 1,000 feet (305 meters) per day and for every 3,000 feet (915 meters) of elevation gained, take a rest day. •"Climb High and sleep low." This is the maxim used by climbers. You can climb more than 1,000 feet (305 meters) in a day as long as you come back down and sleep at a lower altitude. •If you begin to show symptoms of moderate altitude illness, don't go higher until symptoms decrease ("Don't go up until symptoms go down"). If symptoms increase, go down, down, down! •Keep in mind that different people will acclimatize at different rates. Make sure all of your party is properly acclimatized before going higher. •Stay properly hydrated. Acclimatization is often accompanied by fluid loss, so you need to drink lots of fluids to remain properly hydrated (at least 3-4 quarts per day). Urine output should be copious and clear. •Take it easy; don't over-exert yourself when you first get up to altitude. Light activity during the day is better than sleeping because respiration decreases during sleep, exacerbating the symptoms. •Avoid tobacco and alcohol and other depressant drugs including, barbiturates, tranquilizers, and sleeping pills. These depressants further decrease the respiratory drive during sleep resulting in a worsening of the symptoms. •Eat a high carbohydrate diet (more than 70% of your calories from carbohydrates) while at altitude. •The acclimatization process is inhibited by dehydration, over-exertion, and alcohol and other depressant drugs.