Safe Passage Astronaut Care for Exploration Missions (2001) / Chapter Skim
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Pages 117-136
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From page 117... ...
1. ae c Epson to initiate resusc~tation or determine end points is complex and must be based upon the best judgment of the medical command on the International Space Station (ISS)
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From page 118... ...
vrce-Isased medical triage system that contains guidelines for the management of individual and multiple casualties during space travel. ANESTHESIA AND PAIN MANAGEMENT During long-duration space missions, anesthesia and pain management may be required for unanticipated accidents (e.g., fractures of bones, lacerations, or blunt trauma)
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From page 119... ...
In the simulated atmosphere of microgravity, use of a laryngeal mask has been more successful (Keller et al., 20001. Anesthetics Although inhaled anesthetics, both volatile and gaseous, are extremely useful and helpful, they should not be considered for use in space travel at
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From page 120... ...
After conducting proper research on the effects of microgravity on the diffusion and nerve toxicities of local anesthetics, these will probably be the agents of choice. Health Care Opportunity 16.
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From page 121... ...
Physiological Responses to In jury The physiological alterations that accompany long-duration space missions may well affect homeostasis, wound healing, and resistance to infection, all of which are crucial for recovery from trauma or surgery. Any wound sets into motion a complex series of events under neurohumoral system control termed the "response to injury." The time course has been fairly well delineated in the normal Earth environment, and the routines of postoperative and postinjury care are based upon the assumptions implicit in this model of events (Greenfield, 19961.
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From page 122... ...
Although immediate control of bleeding in microgravity has been demonstrated to be achievable by conventional means, it is not known whether long-duration space missions may result in subtle alterations in blood coagulation activity (e.g., platelet dysfunction or hyperfibrinolysis) that might require additional hemostatic maneuvers or the use of topical hemostatic agents.
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From page 123... ...
Thus, in a mission beyond Earth orbit, transmission blackouts and delays will certainly limit its usefulness. Therefore, the roundtrip time lag (40 minutes or so once the mission is near Mars)
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From page 124... ...
A combination of computer-guided, robotic, and human handson expertise including crew medical officer training and proficiency in evolving, minimally invasive surgical techniques such as laparoscopy—will be necessary, backed by data in an onboard computer might provide the best solution for complex low-probability problems. Surgical Equipment What surgical equipment should be taken on a space mission beyond Earth orbit several decades from now?
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From page 125... ...
Technical Aspects of Surgery In a microgravity environment, special mechanical problems such as anchoring both the patient and the operating team, maintaining a sterile field, and controlling blood and body fluids can be anticipated (Kirkpatrick et al., 19971. The mechanics of both open and laparoscopic techniques have been explored during parabolic flight, and the feasibility of these techniques with suitable modifications has been demonstrated.
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From page 126... ...
A subarachnoid hemorrhage was managed by physicians in Antarctica, despite inadequate facilities, through ingenuity and innovation (Pardoe, 19651. Whether such a heroic effort could be undertaken or should be undertaken in the context of a space mission is doubtful, but it serves to show the human drive to preserve life, even against all odds.
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From page 127... ...
This is true for existing studies of both of preflight ground-based training and in-flight exercise. Similarly, little is known about whether preflight training or onboard exercise has a mitigating effect on the loss of bone mineral density or muscle mass.
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From page 128... ...
The needs for rehabilitation on board during protracted missions, be they ISS missions or missions beyond Earth orbit, must address the issues of maintenance of lean mass and bone mass and restoration of bone mineral density after trauma or disuse because of illness and maintenance of musculoskeletal system performance (both fine and gross motor)
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From page 129... ...
Restoration of function upon the return to Earth's gravity has been nearly complete in most instances, although full restoration of the bone mineral density that has been lost seems refractory to current treatments, which have mainly been exercise based. Nonpharmacological techniques for the stimulation of bone repair for example, the use of electrical stimulators or electromagnetic field generators have not been used.
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From page 130... ...
CATASTROPHIC ILLNESS, DEATH, AND END-OF-LIFE CONSIDERATIONS Guidelines for withdrawal of care and the provision of assistance to survivors should be developed for long-duration space missions. Resuscitative end point guidelines have been developed on Earth after years of experience and ethical discussion and have been limited to a few situations.
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From page 131... ...
Health Care Opportunity 18. Developing a mechanism for skill maintenance and retraining in psychomotor skills during long-ration space .
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From page 132... ...
Database During the space mission, routine surveillance of health measures should be conducted and all episodes of illness and injury should be recorded. Systematic record keeping with a computerized database will be necessary so that data can be accessed periodically and also used for identification of diagnostic and therapeutic errors and continued health care planning.
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From page 133... ...
Further opportunities will accrue as the field of space medicine continues to develop. As health care opportunities during space missions are explored, they will contribute substantially to the evidence base for the development of the appropriate means of management of medical events considered to be within the scope of care for long-duration space travel.
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From page 135... ...
· Investigators in engineering and biology should continue to explore together and embrace emerging technologies that incorporate appropriate advances in biotechnology, nanotechnology, space worthy medical devices, "smart" systems, medical informatics, information technology, and other areas to provide a safe and healthy environment for the space crew. · More partnerships in this area of integration of engineering and health sciences should be made with industry, academic institutions, and agencies of the federal government.
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From page 136... ...
and Dr. Jeff Jones, on-duty flight surgeons in Houston's Mission Control Center during the April 24, 2000, launch attempt of space shuttle Atlantis during mission STS-101.
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