HIGH ALTITUDE

AND
DEEP SEA DIVING
 OBJECTIVES
At the end of the class the students should be able to:

• List the effects of acute exposure to high altitude

• To describe the mechanisms of physiological adaptation to high altitude

(acclimatization)

• Identify the effects of high partial pressures of gases on the body

• Identify the symptoms of decompression sickness (Dysbarism) and its

management
 SITUATION IN HIGH
ALTITUDE
• When one ascends to high altitude the composition of air
does not change. But because of a decrease in barometric
pressure, po2 in atmospheric air decreases proportionately.

This type of environment are faced by

• a) the permanent residents of high mountains
• b) the mountaineers
• c) the armed forces stationed at high altitude
• d) aviators
• Altitude is defined on the following scale
• High (8,000 - 12,000 feet [2,438 - 3,658 meters]),
• Very High (12,000 - 18,000 feet [3,658 - 5,487 meters]),
• and Extremely High (18,000+ feet [5,500+ meters]).
• Most people can go up to 8,000 feet (2,438 meters) with minimal
effect.

Altitude levels
• 1500 - 2500m Medium Altitude Adaptation is sufficient

• 2500 - 5300m High Altitude Acute adaptation is not sufficient

(AMS) - acclimatisation is necessary

• 5300 - 8848m Extreme Altitude Acclimatisation is not possible

 PO2 OF ALVELAR AIR AT DIFFERENT
ALTITUDES
ALTITUDE ABOVE BAROMETRIC PO2 OF PO2 OF
SEA LEVEL PRESSURE ENVIRONMENT ALVELAR AIR
(mm Hg) (mm Hg) (mm Hg)

0 ft 760 159 104

10,000 ft 523 110 67

20,000 ft 349 73 40

30,000 ft 226 47 21
 ACUTE EFFECTS OF HYPOXIA
(ACUTE MOUNTAIN SICKNESS)

• When a person residing at sea level ascends to high altitude over a

short period of time he shows the symptoms of exposure to hypoxia
•
• At elevations over 10,000 feet (3,048 meters), 75% of people will
have mild symptoms.

• The occurrence of Acute Mountain Sickness (AMS) is dependent

upon the elevation, the rate of ascent, and individual susceptibility.

• There are no specific factors such as age, sex, or physical condition

that correlate with susceptibility to altitude sickness. Some people get
it and some people don't, and some people are more susceptible than
others.
 SYMPTOMS OF
ACUTE MOUNTAIN SICKNESS
The symptoms of Acute mountain sickness are as follows:

• Above 10000 ft. --Headache, irritability, breathlessness, mental and muscle fatigue,
drowsiness, disorientation, euphoria & nausea.

Symptoms usually start 12-24 hours after arrival at altitude and begin to decrease in
severity about the third day as the body acclimatizes.
Symptoms tend to be worse at night and when respiratory drive is decreased.

• These symptoms progress to a stage of twitching or seizures above 18000 ft, and to
coma and death above 23000 ft.

• These symptoms are due to cerebral and pulmonary edema.

Symptoms of AMS

Headache
Fatigue

Nausea

Vomiting

Loss of appetite

Dizziness

Irritability

Disturbed Sleep
 HIGH ALTITUDE PULMONARY
EDEMA (HAPE)
• High Altitude Pulmonary Edema (HAPE) results from pulmonary edema.

• The fluid in the lungs prevents effective oxygen exchange.

• As the condition becomes more severe, the level of oxygen in the bloodstream
decreases, and this can lead to cyanosis, impaired cerebral function, and death.

• Symptoms include shortness of breath even at rest, "tightness in the chest," marked
fatigue, a feeling of impending suffocation at night, weakness, and a persistent
productive cough bringing up white, watery, or frothy fluid.

• The symptoms are releived by oxygen therapy or quickly bringing the subject back
to low altitude (2000 – 4000 ft).
 HIGH ALTITUDE CEREBRAL EDEMA
(HACE)
• HACE is the result cerebral edema.

• Symptoms can include headache, loss of coordination (ataxia),

weakness, and decreasing levels of consciousness including
disorientation, loss of memory, hallucinations, psychotic behavior,
and coma.

• It generally occurs after a week or more at high altitude. Severe

instances can lead to death if not treated quickly.

• Immediate descent is a necessary life-saving measure (2,000 - 4,000

feet [610-1,220 meters]).
 ACCLIMATIZATION
• When an individual ascends to high altitude
gradually and remain there for a longer period, it
brings about a number of physiological
compensations which help to reduce the effects of
hypoxia. These adaptive changes are called
acclimatization.
 PULMONARY COMPENSATION
• Hyperventilation : initially the ventillation increases about
65%. But within 3-4 days it increases upto 5 times.

• Decreased PO2 causes hyperventilation through its

stimulatory action on the peripheral chemoreceptors.

• Resultant hyperventilation causes increased elimination of

large quantities of CO2 and PCO2 of arterial blood falls
causing respiratory alkalosis.
↓ PCO2 and ↓[H+] inhibit respiratory centre & opposes the stimulatory
effect of hypoxia.

But in subsequent 3 - 4 days. Alkalosis is reduced due to

• Renal compensation and

• A reduction of [HCO3-] in CSF and brain tissue.

Thus the opposition to stimulatory effects of hypoxia is withdrawn and
ventilation increases.
• ↑ Diffusing capacity of pulmonary membrane : there is
a substantial increase of blood volume in lungs, expanding
the pulmonary capillary surface area. Similarly, increased
ventilation expands the alveolar surface.

Therefore the surface area of diffusing membrane

increases causing more efficient diffusion of gases
between lung and blood.
 HEMATOLOGICAL COMPENSATION

• Hypoxia is the most important stimulus for the ↑ secretion of

Erythropoeitin from renal tissue.

• Hence within a few weeks of stay at high altitude, the RBC count and
Hb conc. rises substantially. This enables to carry additional quantities
of O2 to the tissues in spite of less saturation of Hb.

• ↑ 2,3 DPG : an increase in 2,3 DPG shifts the O2 dissociation

curve to the right, reducing the affinity of Hb to oxygen and facilitating
the release of more O2 in the tissues.

.
 CVS COMPENSATION
• ↑ Cardiac output : cardiac output increases immediately
when a person ascends to high altitude. But it slowly
comes back to normal as blood hematocrit increases.

• ↑ Tissue vascularity: there is an increase of capillaries in

all the tissues of the body particularly in cardiac and
skeletal muscles.
 NATURAL ACCLIMATIZATION OF
THE NATIVES
Natives living in high altitude are superior to the
best acclimatized low landers. The principal
adaptive changes include:

• Chest size greatly increased and body size

somewhat decreased resulting a high ratio of
ventilatory capacity to body mass.
• Heart is hypertrophied. Specially the right side of heart is
larger to provide high pulmonary arterial pressure to feed a
greatly expanded pulmonary capillary system.

• Polycythemic.

• The tissue vascularity is higher.

• The tissues contain more mitochondria and myoglobin.

 PHYSIOLOGY OF DEEP SEA DIVING

• Sea divers and caisson workers are exposed to high ambient pressure.

• For every 33 ft column of sea water 1 atmosphere of atmospheric

pressure is increased. Thus :

• At 33ft – 2 atmosphere,
66ft – 3 atmosphere,
99ft – 4 atmosphere,
200 ft – 7 atmosphere &
300 ft– 10 atmosphere.
 NITROGEN NARCOSIS
• With high atmospheric pressure equally high pressure is required to
inflate the lungs. Breathing air at high pressure for one hour or more
causes a large amount of N2 to get dissolved in plasma and body fat.

• N2 has narcotic effect like other gas anesthetics. The dissolved N2 in

the lipids of cell membrane of nurones alters ionic permeability and
reduces neuronal excitability. The symptoms are similar to alcohol
intoxication.

• Symptoms of N2 narcosis: symptoms include euphoria, clumsiness,

impairment of intellectual functions, drowsiness.
 DECOMPRESSION SICKNESS
( DYSBARISM )
After spending one hour or more in deep water below the
sea, when a person ascent rapidly to the surface of sea, N2
escapes from dissolved state and forms gas bubbles.

These bubbles block many blood vessels and cause

ischemia and necrosis of the surrounding tissue.

The resulting pain typically involves limbs near joint and is

known as bends. It can also occur in the chest, lung or
brain.
Decompression sickness causes

• Pain in joints and muscles of arm and leg,

• Dizziness and temporary paralysis,

• Unconciousness,

• Dyspnoea, pulmonary edema and

• Occasionally death
 HOW TO AVOID DECOMPRESSION
SICKNESS?
• Decreasing the rate of ascent
for example a person who spent 60 minutes at a depth of
200 ft should ascend to the sea surface in 5 hours.

• After rapid ascent the diver is put in a pressurized tank and

the pressure of the tank is gradually reduced to normal
atmospheric pressure using same time schedule.

• Inhaling helium oxygen mixture, instead of air.

 SUMMARY & REVISION

• ACUTE MOUNTAIN SICKNESS

• COMPENSATORY MECANISMS OF
ACCLIMATIZATION

• NITROGEN NARCOSIS

• DECOMPRESSION SICKNESS