Extreme Final

Question 1

Cold Injuries

Answer 1

NFCI and FCI

Question 2

NFCI

Answer 2

Chilbaiin + Pernio -
Trenchfoot

Both damage local vasculature

but trenchfoot can be life altering and Cibain and pernio cause lesions

Question 3

FCI

Answer 3

Frost Nip - cell death of epidermis
Frost bite - crystallization of the cells within our vasculature

Forst bite can lead to free radicals on the influx of O2 during reprofusion

Question 4

States of Hypothermia

Answer 4

Mild 34-32 - increase blood pressure and max shivering

Moderate 32-29 - no more shivering - arythmiaas and unconsciousness

Severe <29 - decrease cardiac function and brain activity

Question 5

Cardiovascular Effects of Hyporthermia

Answer 5

Initially we get tachycardia then progresses to brady cardia @ 34ºC (505 reduced HR)

<30 = afib
<25 = asystole

Increase in cold = vasocantriction , blood goes central, increase blood pressure- BRADYcardia slows the HR to combat this

Question 6

Asytole - Not dead until Warm and Dead

Answer 6

As we get cold we decrease the amount of activation energy it takes for the enzymes to work. This means the metabolism is less while we are cold so the demands that it requires are also less. Therfore we can function with less blood supplying less nutrients.

Question 7

1 degree drop in temp = 2% drop in hematocrit

Increasing our Hemoconcentration Why

Answer 7

This is due to decrease in coagulation enzyme function of up to 40%

Caused by

Cold Induced Spleenic Contraction - increase is contraction of the spleen to put out RBC. we do this to hold onto as much oxygen as possible but this increases the thickness of the blood

Cold Induced Diueris - loose less than hlaf plasma volume due to this.

Question 8

Oxyhemoglobin Curve Respiratory in Cold

Answer 8

Decrease in temp makes hemoglobin hold onto oxygen more tightly, giving off less oxygen at the saem partial pressure.

We hold onto it to use it when it matters.

WE ARE STORING MORE OXYGEN .

Less oxygen giving to tissues + vasoconstriction ad low HR = ischemia - no oxygen

Question 9

Cold and Brain

Answer 9

decreased nueral transmission
paradoxical undressing (cold inuced vasodialation) + dimnished mental capacity makes them take off their clothes
stiffness/lack of reflexes
<32 = amnesia
loss of consciousness

Terminal burriowing behaviour - trying to tuck under something

Cold deaths more than heat deaths

Question 10

Steps to combat hypothermia

Answer 10

1. prevent further heat loss by getting them out
2. insulate ( space blanket0
3. sweet drink - glucose is anti freeze and

Question 11

Alcohol is a diuretic (COLD)

Answer 11

make us piss - lose heat - loose radiatiing fluid

Question 12

passive v active rewarming

Answer 12

passive is immediate
active - wait until they get back up to 34 degrees - dont want to lose more heat if they are still too cold

Question 13

DOnt exercise to warm up hypothermics why

Answer 13

exercise increases blood flow to periphery - loose heat to tissue and to enviroment and return cold blood

swewating - loose heat to evaporation

depletes energy - need energy to stay more

Question 14

DONT do these for hypothermics

Answer 14

• dont rub
• dont thaw

all increase risk of reprofusion injuries

Question 15

therapeutic hypothermia

Answer 15

droppinghte temperature for those with TBI or heart attacks -

reduce the metabolism = reduce the amount of blood needed in those areas

• cranial vasoconstiction to stop swelling and pressure
• supresses the inflamattory cascade and reprosuion radicals

Question 16

is it ever too cold too exercise ?

Answer 16

No, not if you can get back to warmth.

Question 17

Risk of Exercising in the cold

Answer 17

FCI - increased heat loss thorugh the elements but our body generates enough heat to combat this

Airway Damage - cold dry air irriatae alveoli inducing imflammaotyr cells (eicosanoid) - and when we exercise we increrase the rate of breathing so even riskier.

EIB

Cardiovascular Strain just from the cold - increase blood pressure and increase hearate then you add exercise casuing more strain

Slipping and not getting back home

Question 18

EIB

Answer 18

exercise induced bronchospasms

restriction of airflow formt he contration of bronchiotubes

less airflow means less oxyegn for exhcnage = less co2 removal

sympotoms - tight chest, dyspnea, wheezing, coughing

26% of non asthmatic people get this

EIB goes away when we stop running because we decrease the ventilation and can catch up to the amount of oxygen uptake.

Question 19

4 phases of cold water immersion

Answer 19

1. Cold shock - 0-2min
2. Muscle/ Swimming Failure (2-15min)
3. Hypothermia15-30
4. Post rescue collapse

Question 20

co,d water defined as

Answer 20

less than 25 degrees, worse effects at less than 15 degrees

Question 21

Cold Shock

Answer 21

when first immersed in the cold, we gasp

we increasse - vent rate and inspiratory volume

and we increase our heartrate form vasoconstriction

cold core and sucking in water to lungs are not good.

Gradual immersion can shorten the effects of cold shock once habituating , and increaseing our breath hold times

Question 22

Diving response

Answer 22

head first submersion triggers the trigeminal nerve in our face closing the epiglottis to protect against influx of water and cold air nto lungs

lessens the immediate cold shock and reduces our hr more than regualr cold shock

Question 23

People who will survie a boat sinking

Answer 23

fat people - more insulation and more buoynat save energy

women - more fat insulating

1. Insulation jacket floating thing
   Help position
2. Huddle
3. PDF
   4 Treading water

Question 24

survival tactic in water

Answer 24

if more than 800m assume huddle

if less than self rescue

Question 25

Post Rescue Collapse

Answer 25

Afterdrop causing loss of more heat even after out of the water due to blood flow and thermodynamics lose heat in blood and recool the core thermo - lose heat through migration through the tissues

Question 26

hihg altitude basics

Answer 26

less air particles less pressure exerted colder becasue less particles to warm up less pressrue in air casues less of a driving force of oxygen into us

Question 27

why decreased water vapour pressure in high altidue

Answer 27

cold climates hold lesss water and their are less particles in the air = less water vapour pressure

Question 28

respiratory response at altitude

Answer 28

increase tidal volume and breathing frequecy trying to increase the pressure of oxygen tidal volume - alwasy breath the saem amount but becasue less o2 we get less drive - low hypoxic drive breathing frequency - breathing faster expels co2 quicker to make rooom for oxygen

Question 29

respiratory alkalosis

Answer 29

at altitide the increased tidal volume and breathinf frequency makes us expel c02 much more, this takes hydrogen ions away nad makes our body become more basic

Question 30

oxyhemoglobin at altitude

Answer 30

because of low c02 in our blood we try to add mroe co2 with bicarbonate equation. when we have less c02 our body begins to hold onto oxygen more tightly (hemoglobin) allwoing us to store more 02 for later up and to the left

Question 31

Loss of blood volume at altitude why

Answer 31

- breathe out water - cold and altiitude induced diuresis loose blod volume we decrease edv and SV so we increase hr to maintain cariac output but we also see the blood more viscous because of increased hematocrit (good when its near the alveoli, more o2 carrying capacity)

Question 32

Altitidue iduced diuresis

Answer 32

- increase pressure in thorax cuases increase BP making us lower HR and piss more - also casue due to respiratory alkaloissi - getting too much bicarbonate so we reomve it thorugh urine

Question 33

V02 at altitude

Answer 33

hr x sv x a-v02 hr increases as we increase blood pressure sv decreases as we los volume of blood a-v o2 decreases as we old oxygen more tightly as we are becoming more cold and basic(harder to extract)

Question 34

enduracne sports in altitude

Answer 34

v02 is down in altidue becasue we have less oxygen supply/drive we begin to rely less on aerobic and more on anaerobic even thought aanaerobic doesnt use oxygen we still need to repay the systems that were used.

Question 35

lactate paradox

Answer 35

we increase reliance on our anaerobic metabolism during altitude. so we should see more lactate being produced inthose who are those who are native to the area but we dont

Question 36

metabolic changes at altitude

Answer 36

increased basal metabolic rate due to thyroid oroducing catachollmines and thyroid hormone from non shivering thrermogenies increased reliance on carbs since we rely more on anaerobic meatbaolism decreased appetite acutely casue we cant get food

Question 37

altitude response chornically to low oxygen

Answer 37

becuase of the decrease oxygen carrying capacity and and low 02 in blood, over time our body begins to increase epo (RBC) to tim more rbc fromt he liver to help increase 02 carrying capacity (increasing the a in a-v02 diff)

Question 38

AAS/AMS diagnosis

Answer 38

acute altitdue sickness 1. changed altitdues within the past 4 days 2. have a headeache 3. have one or moer of thease syptoms - loss of coordination - insomnia -GI distress etc starts at around 2500m 15-40% of people get it LAke Lois Questionaire 50A% of people get it at 4000m can avoid it if we ascend gradually 9 acclimate then climb ) combat with oxygen or descent

Question 39

HACE

Answer 39

swellling (liquid) in cranial cavity recognizing low 02 in the bloood so the body increases blood flow to the brain. increasees pressure in capillaries that can leak out fuid . increases blood into the brian and increases permeability of blood brain barrier whihc causes more blood allowed into brian swelling if not displaced with cerbro spinal fluid then we can get the full affects of HACE HACE SYMPTOMS ataxia,lethargy, confusion can progress to death becasue of the other sympotms of AAS and occurs around 4300 m

Question 40

HAPE

Answer 40

liquid in the lungs low 02 in the blood our body tells us to maximmizze the contat that it makes with the well aerated regions of the lungs, this vasoconstricts the poorly aerated regions of the lungs increasing the pressure ofblood their whihc can leak into to the lungs symptoms includ cchest tightness, coughing, confuison, blu elip s if there is pressrue on the capillaries it can casue endothelial damge which causes endothelyial dysfucntion which causes increased blood presssure and it will cycle or cause infection

Question 41

respiratory adaptations ot altitude

Answer 41

- inrease resting ventilattion at rest by 40 - iubmaximal vet will platuea at 50% higher

Question 42

blood adaptations to altitude

Answer 42

increase red blood cells increase plasma volmue - due to increasesing the hormine to conserve water when we stay there linger increase hemoglobin -oxygen carrying capacity

Question 43

muscle adaptations to altitude

Answer 43

- decrease muscle csa - decrease glycolyti and mitochondirial c enzymes (casue lsot muscle mass) - angiogenisis - to increase more 02

Question 44

cardiovascular adaptations to altitude

Answer 44

decrease v02 work capacity increased

Question 45

hard to tell if sea level or altidue traingn is benefical why

Answer 45

casue we increase all this stuff when you jsut train and becasue intensity and volume of trainng is reduced at altitidue and hard ot bring up equipmetn

Question 46

Increased perfomrance on gorund from Hypoxic envirometn

Answer 46

- increase HIF-1 (allows for more genes that increase epo and angiogeneissi and glucose transport to the cells) an idividual difference - increased epo - increase hyperventilatory response which causeses increase in looading of oxygen on the oxyhemoglobin curve - increased economy of movemtn since less particels in the air

Question 47

take into account when moving ot altitude

Answer 47

a;titude is calssified at 2000m or above have to deal withthe negative psychological and psyhiological effects of altitude 12-16 hr a day of traiing adn w can lose adaptations in 2 weeks takes long to see the adaptations

Question 48

live low train high

Answer 48

acute syptoms will occur in trianing casuing less of a traing stimulus buyt symptoms may be reduced

Question 49

live high train high

Answer 49

goes either way- cant accoutn for periodization

Question 50

live high train low

Answer 50

increased hypoxic effects when we are resting at altitiude and better trainng stimulus when we are trianing at low altitdue increased v02, epo, hemoglobin , perfomrance this is the best

Question 51

Hyper baric basics

Answer 51

air is compressable , water is not eery 10 m belwo sea levels is 1 atmoisphere of pressrue boyle law - increase in pressure is a result of decrease in volum eand decreease in volume increases pressure

Question 52

how do we combat the pressure compressing the air in us

Answer 52

we inspire dense air in order to push back against the pressurefrom the water until it is equal

Question 53

respiratory challeng to hyperbaric

Answer 53

increased dead space not participating in gas exchange so we need a respirator hihg dednsity of gases form the respoirator as pressure increases will dissolve reater into our tissue air temp we inhale is low os its hard to thermoregualte when we continuously are cooling

Question 54

henrys law

Answer 54

more pressure = more dissolved a gas into our tissue helium then nitrogen then oxygen

Question 55

lung colllapse/ squeeze

Answer 55

imncreasaeing outside pressrue as we descend increases pressure on the lungs which have lower relative pressure indie them, this will force the ari out of the lungsand close the lung to resiudual volume which can damge the alveoli at this spot

Question 56

mask squueze

Answer 56

putting a mask on outside of the water traps the atmospher air, this is lower than the pressure of water at certain levels and pressrue exerted onto the mask can ccasue rupturing of blood vessels in the eyes, to prevent this we canput the mask on outside of the water or breathe dense air from our nose inot the mask to equal pressure

Question 57

pneumo thorax

Answer 57

when the plural sack ruptures as we decreas the pressure exerted from the water onto our lungs but happen to have too much high dense gases in our lungs at the wrong time, we can have pressrue from the lungs expand outwrds (greater than that of the water around us) and burst the like a ballon, this will get rid of the suction from the plural sack to the lung and influx ocygen here, oxygen here cancreate air embolisms which are bubbbles which may be move to ither areas of the blood in the body to reduce this we breath out whil ewe are ascending to reduce pressrue in the lungs

Question 58

hood squuze

Answer 58

increase pressrue durig descent from the outside into or low pressrue ear canals can rupture tympanic membranes this can affect heearing, balance and orientation which are senses that are needed to get out of riskyy enviorments get rid of this will the valsva manuever or, swallowing

Question 59

aerotitis

Answer 59

hihg pressrue outside onto low pressrue ear inflammes the middle ear

Question 60

aerosinitus

Answer 60

during ascnet, ikf we get air trapped in our sinuses from the high pressrue enviroment/ gases due to cloggred onose or something, we can iexert pressrue from the sinus on the mucous lined walls of the causing immflamaition or capillary ruptrue in the sinus

Question 61

On gassing

Answer 61

increasing the pressure in our lungs throuhg high desnity gasses, casues the gases in the lungs to absorb into the blood/tissues

Question 62

ON Gassing Problems

Answer 62

Inert Gas Narcosis and Oxygen toxicicyt

Question 63

Inerert gas narcosis

Answer 63

when too much nitrogen absorbs into our blood, cna be reversed, vcausng euphoroia, imparired judgement, loss of consciousness noticed @ 100 ft with compressed air ffeeling mildly intoxicated high pressrue more absorbs (henry)

Question 64

HPNS

Answer 64

HiHg Pressure Nervous Syndrome occurs in descent greater than 400 ft dizziness trauma cause vomiting muscle twitching stomach cramps ususally we want to take out nitrgogen because of the narcosis effect but in the case of HPNS we add 5-10% nitrogen back into the mix in order to combat the effects of Narcotic

Question 65

COmbat On Gassing

Answer 65

decreasey of the gas in order to allow for less dissolving into our tissues to elimiante narcosis notriox shallow heliox deep trimix very deeps dont need c02 casue we produced the co2 into the tank

Question 66

Oxygen toxicity

Answer 66

too much oxygen can suck up electron create super oxicdce anion which leads to the creating of freee radical swhich abosorb electrons from other tissues /decreaing cellular function

Question 67

Off Gassing

Answer 67

reducing hte pressure reduces the gases that are dissolved in the tissue low pressure in the lungs will have the gas in the tissue move to the lungs decreaseing ambient presssrue so high pressure has to go somewhere

Question 68

Off Gassing Problems

Answer 68

the bends pneumonia thorax aerosinitus

Question 69

fst and slow tissues

Answer 69

take on and left off gasses quicker or slower if its slow tissue then we need to stay their longer for the gases to absorb

Question 70

the bends (decompression sickness)

Answer 70

when we increase ascent too wuickly the gases in our blood and tissues need to go somehwere as they will now be high pressure and the enviroment will be low, gases from the tissues push into the apillaries and can create bubbles that block block from going downstream (ischemic tissues) the bubblecan also irritate the tissues insode the capillary and casue leakage and imflammation (wbc cause clottign = blockage)

Question 71

determinants of the bends

Answer 71

depth - deep mor on gassing time - time more the time ascent rate - too fast multiple dives - residual gasses no fully gone

Question 72

How would treat decompression sickness?

Answer 72

Recompress them in a hyperbaric chamber @ 60 ft of sea water fsw. and can use pure oxygen without the risk of oxygen toxicicity since the pressure (60 ft ) is much less than deep dives so lower risk of oxygen toxicicity ( less drive of oxygen dissolving into blood)

Question 73

G- Forces

Answer 73

force of gravity or acceleration on the body high gravity. Gx - anteroposterior Gy - horizontal Gz - vertical

Question 74

Positive G z responses

Answer 74

- head to foot blood rushing from head to foot, we increase our heart rate and force in order to get cirulated blood around the body - increase vascular tone in head to keep blood there without being able to get blood back to the head, we can loose vision and begin to go unconscious (GLOC) slwly narrow tunnel vission to the point of GLOC greyout then blackout

Question 75

negative Gz forces

Answer 75

foot to head too much blood goes to the head, less blood out of the head and we can get red out where the capillaries fill with blood and we cant see then we can also go unconscious becasue the blood that there is pooling but not doing gas exchange

Question 76

neurovestibular responses to microgravity

Answer 76

have fluid in our canals in the ear. in space we cant sense orientation with no gravity but after a few days we can be unconfused as what are eyes sees catches up with what are brain is senseing motion sicknesss is conflicting imformation of our senses 1. crista - semicircular canals - sense angular motion, not really effected in micro gravity 2. Maccula in the Saccules - sense linear motion and as our bodies accelerate in the linear direction otoliths embedded in the fluid of the ear canals get sent forward or backward triggeringthe hairs to sense this 70% of astronauts get the nausesa nd vomiting and disorientation but it onyl catches up with us in a few days so if the mission is shrot than we cant really do a lot of productive stuff

Question 77

cardiovascular responses to micro gravity

Answer 77

in micro gravity fluid is not pulled down to the legs but floats throught the body dispersing around, this can fill sinuses which can cause a headache and will generally make our faces puffy Micro gravity induced diuresis - the shifting of fluid causes the kidney to get rid of excess fluid so we piss so plasma volume decreases ,, kidney also reduces epo and wbc making most astronauts anemic as early as 4 days ( 15% plassma loss ion 3 months exposure can cause 22% loss of blood volume we dont get as thirsty

Question 78

myocardial tissue resposne to micro gravity

Answer 78

since we are losing blood volume and we are also reducing the amount of work the heart has to do to fight gravity, we decrease the cost of moving which detrains the heart making it smaller and weaker

Question 79

cardiovascular when we return to earth

Answer 79

orthostatic intolerance and presyncope since we have a reduced cardiac work in space and reducesblood volume then we add gravity pulling pulling down the blood back to our legs orthosttic intolerance- when we cant commabt the effects of gravity when we stand ( getting light headed when we stand up) presyncope - reduced blood pressure casuing light headed ness dizziness feeling faint addd on top of it the suits trying to cool us off so we lose mroe fluid

Question 80

how to combat return to earth cardiac effects

Answer 80

Low body negative pressure- putting our legs in a vaccum to drive the pressrue out adn from the upper body down to the legs orthostatic intolerance can be combatted with lots of fluid and salt because water follows salt in order to drive up blood volume or cool them down to vasoconstrict adn drive blood back up centrally / g suit - increases pressure int he legs to drive blood back up centrally

Question 81

respiratory in space

Answer 81

space is a vaccum so we neeed to mek artificaila pressure in the space station this can casue high pressrue inside and no pressure outside meaning decrompression sickness wehn we go outside thats why we pressurize the suits or else the suits would be stiff, but if we can add pressure in them we can maintain mobility and to combat the decompression sickness they use pure O2 because the pressure is low so no need for oxygen, any pressure will be enough to drive oxygen into the blood eliminating the risk of inert gas narcosis

Question 82

thermoregulation in space

Answer 82

hot when facing the sun and freezign when not facing the sun no atmosphere so increasesd heat transfer from thermal radition and fluid loss (hot in space suit for vasodialation adn fluid loss) fromt he space suit it over cools we are protected by the earths magnetic field low earth orbit

Question 83

muscle in space

Answer 83

muscles atrophy because we arent using them 5% a week in atrophy 30% decrease in myotcytes lose slow fibres lose actin more than myosin lose structural proteins more relaince on muscle glycognen thatn fat metabolism all lead to lack of endurance and fatigue

Question 84

bone in space

Answer 84

wiehgt bearing bones lose much less arms still used to fly around so we see only 1-2% loss a motnth 0.3% calcium kidney stones may occur because as we lose the calcium in our ou rbone it has to go somwhere so it goes to the blood increasing blood ca concentration ultimatley leading to increase output to kidney and kidney sotne formation (also due chewed up bone by osteoclasts)

Question 85

direct and indirect effects of radiation in space

Answer 85

direct effects - radiation changing dna and cellular componetns that we need for survival indirect - hihg chance of breaking down water into hydroxylz that can create free radicals which can casue tissue damage

Question 86

risk to radiation depends on

Answer 86

type of radiation, dose , energy , dose rate, absorbed dose liver is low risk eyes are high risk kidneys spleen gall moderate risk best defences is to limit duration adn amoun t of exposre

Question 87

RADS and exposure to low dose radiation

Answer 87

radiation absorbed dose space close to 200 rads genetic - radiation changing ameetes and sex cell s somatic - radiation carcinogenic effects in utero. - mutation in fetus