Internal Medicine

Aviation medicine by John Ernsting; P F King

By John Ernsting; P F King

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This fluid movement from interstitium to blood vessel can increase circulating fluid volume by several hundred millilitres. 1 kPa), with a mean pressure of about 15 mmHg (2 kPa). This pressure is only about 10 mmHg above left atrial pressure, but this pressure difference is enough to drive the cardiac output through the pulmonary circulation because pulmonary vascular resistance is less than one-sixth of systemic vascular resistance. Autoregulation does not occur in the pulmonary circulation, where holding flow constant would be unhelpful.

This is known as skeletal muscle pumping. Venous return to the heart is also increased during inspiration, when the fall in intrathoracic pressure helps to suck blood back to the heart. (a) Fluid exchange in the capillaries: the Starling principle Capillaries are the exchange vessels where fluids, gases, nutrients and products of metabolism move between the blood and the interstitium. 2). The main force driving fluid out of the capillaries is the hydrostatic pressure difference between the capillary and the interstitium.

The natural stimuli that provoke these responses vary with species and individual, depending on the emotional significance of the stimulus. A telephone ringing in a quiet room may be a mild alerting stimulus to one individual or an intense stimulus to someone awaiting bad news. In experiments on humans, mental arithmetic often proves to be an effective stimulus. Hypoxia also activates the defence areas of the brain, probably secondary to peripheral chemoreceptor stimulation. It is probably the mechanism of the repeated awakening from sleep that occurs during hypoxic episodes in patients with obstructive sleep apnoea and it may be involved in the development of the chronic hypertension that is common in these patients.

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