Aviat Space Envir Md
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Aviat Space Envir Md · Jan 2008
Aeromedical evacuation of patients with pneumocephalus: outcomes in 21 cases.
Aeromedical evacuation of patients with posttraumatic and/or post-surgical pneumocephalus has often been regarded with great concern. The expansion of intracranial air with increasing altitude can theoretically result in tension pneumocephalus, with potentially fatal results. This concern is primarily based on extremely rare case reports and theoretical models rather than any significant clinical experience. We report the outcomes of a series of 21 patients with posttraumatic and/or post-craniotomy pneumocephalus who underwent long-range air evacuation from a combat theater in military aircraft. ⋯ We conclude that pneumocephalus in the head-injured and/or craniotomy patient is not likely by itself to be an absolute contraindication to air evacuation. The mechanism causing pneumocephalus, its time course, progression, and the rate of altitude change are likely more important factors in determining its clinical significance. More clinical experience is required to better assess the safety of aeromedical evacuation of these patients, but this small series suggests that it is not as dangerous as previously thought.
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Aviat Space Envir Md · Dec 2007
Tactile cueing effects on performance in simulated aerial combat with high acceleration.
Recent evidence indicates that vibrotactile displays can potentially reduce the risk of sensory and cognitive overload. Before these displays can be introduced in super agile aircraft, it must be ascertained that vibratory stimuli can be sensed and interpreted by pilots subjected to high G loads. ⋯ This study is the first to show that tactile display information is perceivable and useful in hypergravity (up to +9 Gz). The results show that the tactile display can capture attention at threat pop-up and improve threat awareness for threats in the back, even in the presence of high-end visual displays. It is expected that the added value of tactile displays may further increase after formal training and in situations of unexpected target pop-up.
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Aviat Space Envir Md · Dec 2007
Practice GuidelineEmergency medical kit for commercial airlines: an update.
In 1998, the Air Transport Medicine (ATM) Committee of the Aerospace Medical Association (AsMA) made its first recommendations concerning medical kits for commercial airlines. These were updated in 2002 and the ATM has continued to monitor medical kit usage, as well as pharmaceutical developments, and a further revision is now needed. This has taken into account ongoing work of the International Civil Aviation Organization and recommendations of the International Air Transport Association in the field of passenger and crew health. Based on the above, the Committee proposes the following update to its 2002 recommendations.
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Aviat Space Envir Md · Dec 2007
Oxygen administration, cerebral blood flow velocity, and dynamic cerebral autoregulation.
Hyperoxia is reported to decrease steady-state cerebral blood flow (CBF). In addition, dynamic cerebral autoregulation would be altered. Hyperoxia may improve dynamic cerebral autoregulation, contrary to hypoxia. However, no previous studies have examined changes in steady-state CBF velocity (CBFV) and alterations of dynamic cerebral autoregulation during acute exposure to hyperoxia. We, therefore, evaluated dynamic cerebral autoregulation simultaneously with steady-state CBFV during stepwise hyperoxia under oxygen administration. ⋯ These results suggest that hyperoxemia and hypocapnia reduce steady-state CBFV and increase cerebral vascular resistance during oxygen administration. This reduction in steady-state CBFV occurs even during mild hyperoxia < or = 40% O2 and becomes obvious at 70% O2 with hypocapnia. However, dynamic cerebral autoregulation may remain unchanged during hyperoxia, even with apparent changes in steady-state CBFV.
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Aviat Space Envir Md · Nov 2007
Medical histories of 61 aviation accident pilots with postmortem SSRI antidepressant residues.
Selective serotonin reuptake inhibitor (SSRI) antidepressants are popularly prescribed, but these drugs are not currently approved for use by U.S. civilian aviators. In a 2003 study, the presence of 4 SSRIs--citalopram, fluoxetine, paroxetine, and sertraline-was reported in 61 pilot fatalities of civil aviation accidents that occurred during 1990-2001. However, it was not known whether these pilots had disqualifying psychological conditions, including depression, and had properly reported the use of the antidepressants. ⋯ These findings reconfirm that SSRIs were used by the aviators but were not reported in their last aeromedical examinations.