space medicine: past, present and future · polk space medicine: past, present and future j.d....
TRANSCRIPT
![Page 1: Space Medicine: Past, Present and Future · Polk Space Medicine: Past, Present and Future J.D. Polk, DO, MS, MMM, CPE, FACOEP . Deputy Chief Medical Officer . Chief, Space Medicine](https://reader035.vdocuments.us/reader035/viewer/2022070721/5ee168f0ad6a402d666c4dd1/html5/thumbnails/1.jpg)
Polk
Space Medicine: Past, Present and Future
J.D. Polk, DO, MS, MMM, CPE, FACOEP Deputy Chief Medical Officer
Chief, Space Medicine NASA Johnson Space Center
10/17/2011
![Page 2: Space Medicine: Past, Present and Future · Polk Space Medicine: Past, Present and Future J.D. Polk, DO, MS, MMM, CPE, FACOEP . Deputy Chief Medical Officer . Chief, Space Medicine](https://reader035.vdocuments.us/reader035/viewer/2022070721/5ee168f0ad6a402d666c4dd1/html5/thumbnails/2.jpg)
10/17/2011 Polk
![Page 3: Space Medicine: Past, Present and Future · Polk Space Medicine: Past, Present and Future J.D. Polk, DO, MS, MMM, CPE, FACOEP . Deputy Chief Medical Officer . Chief, Space Medicine](https://reader035.vdocuments.us/reader035/viewer/2022070721/5ee168f0ad6a402d666c4dd1/html5/thumbnails/3.jpg)
10/17/2011 Polk
![Page 4: Space Medicine: Past, Present and Future · Polk Space Medicine: Past, Present and Future J.D. Polk, DO, MS, MMM, CPE, FACOEP . Deputy Chief Medical Officer . Chief, Space Medicine](https://reader035.vdocuments.us/reader035/viewer/2022070721/5ee168f0ad6a402d666c4dd1/html5/thumbnails/4.jpg)
10/17/2011 Polk
![Page 5: Space Medicine: Past, Present and Future · Polk Space Medicine: Past, Present and Future J.D. Polk, DO, MS, MMM, CPE, FACOEP . Deputy Chief Medical Officer . Chief, Space Medicine](https://reader035.vdocuments.us/reader035/viewer/2022070721/5ee168f0ad6a402d666c4dd1/html5/thumbnails/5.jpg)
10/17/2011 Polk
Don’t stand here during launch
![Page 6: Space Medicine: Past, Present and Future · Polk Space Medicine: Past, Present and Future J.D. Polk, DO, MS, MMM, CPE, FACOEP . Deputy Chief Medical Officer . Chief, Space Medicine](https://reader035.vdocuments.us/reader035/viewer/2022070721/5ee168f0ad6a402d666c4dd1/html5/thumbnails/6.jpg)
10/17/2011 Polk
![Page 7: Space Medicine: Past, Present and Future · Polk Space Medicine: Past, Present and Future J.D. Polk, DO, MS, MMM, CPE, FACOEP . Deputy Chief Medical Officer . Chief, Space Medicine](https://reader035.vdocuments.us/reader035/viewer/2022070721/5ee168f0ad6a402d666c4dd1/html5/thumbnails/7.jpg)
10/17/2011 Polk
Space Motion Sickness (SMS) or Space Adaptation Syndrome
Pho
to N
AS
A
![Page 8: Space Medicine: Past, Present and Future · Polk Space Medicine: Past, Present and Future J.D. Polk, DO, MS, MMM, CPE, FACOEP . Deputy Chief Medical Officer . Chief, Space Medicine](https://reader035.vdocuments.us/reader035/viewer/2022070721/5ee168f0ad6a402d666c4dd1/html5/thumbnails/8.jpg)
• What is the problem? – Optic Disc Edema, Globe Flattening, Choroidal Folds, Hyperopic Shifts and Raised
Intracranial Pressure has occurred in Astronauts During and After Long Duration Space Flight
Choroidal Folds
Visual-Intracranial Pressure
Optic Disc Edema Globe Flattening
10/17/2011 Polk
![Page 9: Space Medicine: Past, Present and Future · Polk Space Medicine: Past, Present and Future J.D. Polk, DO, MS, MMM, CPE, FACOEP . Deputy Chief Medical Officer . Chief, Space Medicine](https://reader035.vdocuments.us/reader035/viewer/2022070721/5ee168f0ad6a402d666c4dd1/html5/thumbnails/9.jpg)
Polk 10/17/2011
Panoptic Fundoscopy
![Page 10: Space Medicine: Past, Present and Future · Polk Space Medicine: Past, Present and Future J.D. Polk, DO, MS, MMM, CPE, FACOEP . Deputy Chief Medical Officer . Chief, Space Medicine](https://reader035.vdocuments.us/reader035/viewer/2022070721/5ee168f0ad6a402d666c4dd1/html5/thumbnails/10.jpg)
10/17/2011 Polk
![Page 11: Space Medicine: Past, Present and Future · Polk Space Medicine: Past, Present and Future J.D. Polk, DO, MS, MMM, CPE, FACOEP . Deputy Chief Medical Officer . Chief, Space Medicine](https://reader035.vdocuments.us/reader035/viewer/2022070721/5ee168f0ad6a402d666c4dd1/html5/thumbnails/11.jpg)
Increased Optic Nerve Sheath Diameter seen on-orbit
10/17/2011 Polk
![Page 12: Space Medicine: Past, Present and Future · Polk Space Medicine: Past, Present and Future J.D. Polk, DO, MS, MMM, CPE, FACOEP . Deputy Chief Medical Officer . Chief, Space Medicine](https://reader035.vdocuments.us/reader035/viewer/2022070721/5ee168f0ad6a402d666c4dd1/html5/thumbnails/12.jpg)
Flattening of Posterior Wall – most likely location of Choroidal Folds if any exist
Polk 10/17/2011
![Page 13: Space Medicine: Past, Present and Future · Polk Space Medicine: Past, Present and Future J.D. Polk, DO, MS, MMM, CPE, FACOEP . Deputy Chief Medical Officer . Chief, Space Medicine](https://reader035.vdocuments.us/reader035/viewer/2022070721/5ee168f0ad6a402d666c4dd1/html5/thumbnails/13.jpg)
Elevation of Optic Disc
Polk 10/17/2011
![Page 14: Space Medicine: Past, Present and Future · Polk Space Medicine: Past, Present and Future J.D. Polk, DO, MS, MMM, CPE, FACOEP . Deputy Chief Medical Officer . Chief, Space Medicine](https://reader035.vdocuments.us/reader035/viewer/2022070721/5ee168f0ad6a402d666c4dd1/html5/thumbnails/14.jpg)
10/17/2011 Polk
![Page 15: Space Medicine: Past, Present and Future · Polk Space Medicine: Past, Present and Future J.D. Polk, DO, MS, MMM, CPE, FACOEP . Deputy Chief Medical Officer . Chief, Space Medicine](https://reader035.vdocuments.us/reader035/viewer/2022070721/5ee168f0ad6a402d666c4dd1/html5/thumbnails/15.jpg)
10/17/2011 Polk
Cardiovascular Effects
• Increase in ventricular size initially – Major increase in preload – Inhibition of erythropoietin – Fluid shift into the upper
thorax and head
• Increased GFR prompts a diuresis – Eventual decrease in
preload – Down regulation of
erythropoietin causes a spaceflight anemia.
![Page 16: Space Medicine: Past, Present and Future · Polk Space Medicine: Past, Present and Future J.D. Polk, DO, MS, MMM, CPE, FACOEP . Deputy Chief Medical Officer . Chief, Space Medicine](https://reader035.vdocuments.us/reader035/viewer/2022070721/5ee168f0ad6a402d666c4dd1/html5/thumbnails/16.jpg)
10/17/2011 Polk
Fluid Shift a. On Earth, gravity exerts a downward force to keep fluids
flowing to the lower body (A) b. In space, the fluids tend to redistribute toward the chest and
upper body (B). This is responsible for the face congestion. At this point, the body detects a “flood” in and around the heart
c. The body rids itself of this perceived “excess” fluid. The body functions with less fluid and the heart becomes smaller (C)
d. Upon return to Earth, gravity again pulls the fluid downward, but there is not enough fluid to function normally on Earth (D)
![Page 17: Space Medicine: Past, Present and Future · Polk Space Medicine: Past, Present and Future J.D. Polk, DO, MS, MMM, CPE, FACOEP . Deputy Chief Medical Officer . Chief, Space Medicine](https://reader035.vdocuments.us/reader035/viewer/2022070721/5ee168f0ad6a402d666c4dd1/html5/thumbnails/17.jpg)
10/17/2011 Polk
Neurovestibular
Vestibular Organs Vision
Proprioception
Muscles
Tendons and Joints Skin
![Page 18: Space Medicine: Past, Present and Future · Polk Space Medicine: Past, Present and Future J.D. Polk, DO, MS, MMM, CPE, FACOEP . Deputy Chief Medical Officer . Chief, Space Medicine](https://reader035.vdocuments.us/reader035/viewer/2022070721/5ee168f0ad6a402d666c4dd1/html5/thumbnails/18.jpg)
10/17/2011 Polk
Vertical Pursuit Tracking with Head and Eye
![Page 19: Space Medicine: Past, Present and Future · Polk Space Medicine: Past, Present and Future J.D. Polk, DO, MS, MMM, CPE, FACOEP . Deputy Chief Medical Officer . Chief, Space Medicine](https://reader035.vdocuments.us/reader035/viewer/2022070721/5ee168f0ad6a402d666c4dd1/html5/thumbnails/19.jpg)
10/17/2011 Polk
Musculoskeletal • Acute –
• Postural change with stretching of tendons and ligaments. Increase in on-orbit height by 2-6 cm
![Page 20: Space Medicine: Past, Present and Future · Polk Space Medicine: Past, Present and Future J.D. Polk, DO, MS, MMM, CPE, FACOEP . Deputy Chief Medical Officer . Chief, Space Medicine](https://reader035.vdocuments.us/reader035/viewer/2022070721/5ee168f0ad6a402d666c4dd1/html5/thumbnails/20.jpg)
10/17/2011 Polk
Effects of Spaceflight on Muscle • Decrease in body mass • Decrease in leg volume • Atrophy of the antigravity muscles (thigh, calf)
– decrease in leg strength – extensor muscles more affected than flexor muscles
• Data showed an increase in number of Type II, “fast twitch” muscle fibers (those which are useful for quick body movements but more prone to fatigue)
Ground control Flight
![Page 21: Space Medicine: Past, Present and Future · Polk Space Medicine: Past, Present and Future J.D. Polk, DO, MS, MMM, CPE, FACOEP . Deputy Chief Medical Officer . Chief, Space Medicine](https://reader035.vdocuments.us/reader035/viewer/2022070721/5ee168f0ad6a402d666c4dd1/html5/thumbnails/21.jpg)
10/17/2011 Polk
Musculoskeletal
• Chronic – – Decrease in weight bearing causes muscle
atrophy and bone demineralization, 1% - 2.4% per month in lower extremities and spine, with increased urine and fecal calcium
• A direct effect of microgravity is the loss of mechanical stress on the skeletal system
Konieczynski, D. D., Truty, M. J., and Biewener, A. A. Evaluation of a bone's in vivo 24-hour loading history for physical exercise compared with background loading. J Orthop Res 16; 1998, 29-37
![Page 22: Space Medicine: Past, Present and Future · Polk Space Medicine: Past, Present and Future J.D. Polk, DO, MS, MMM, CPE, FACOEP . Deputy Chief Medical Officer . Chief, Space Medicine](https://reader035.vdocuments.us/reader035/viewer/2022070721/5ee168f0ad6a402d666c4dd1/html5/thumbnails/22.jpg)
10/17/2011 Polk
Loss of Bone Mineral Density
Bone Density Loss of 1-2.4% per month in the weight bearing areas, with the hips and lumbar spine being the highest areas. But density is only ½ of the story…matrix architecture changes
are also a concern, ie- Quality as well as quantity of bone.
![Page 23: Space Medicine: Past, Present and Future · Polk Space Medicine: Past, Present and Future J.D. Polk, DO, MS, MMM, CPE, FACOEP . Deputy Chief Medical Officer . Chief, Space Medicine](https://reader035.vdocuments.us/reader035/viewer/2022070721/5ee168f0ad6a402d666c4dd1/html5/thumbnails/23.jpg)
10/17/2011 Polk
Immune System
• Depression of lymphocyte function affects at least 50% of space crew members – Decreased lymphocyte response to mitogens
in cosmonauts after space flight was reported for the first time in the early 1970s by Soviet immunologists
Cogoli A. Space flight and the immune system.Vaccine.1993;11(5):496-503.
![Page 24: Space Medicine: Past, Present and Future · Polk Space Medicine: Past, Present and Future J.D. Polk, DO, MS, MMM, CPE, FACOEP . Deputy Chief Medical Officer . Chief, Space Medicine](https://reader035.vdocuments.us/reader035/viewer/2022070721/5ee168f0ad6a402d666c4dd1/html5/thumbnails/24.jpg)
10/17/2011 Polk
Hematopoietic system
• Reduction in Circulating Red Blood Cell mass – “Space Flight Anemia” Udden MM, Driscoll TB, Leach-Huntoon CS, Alfrey CP.
Decreased production of red blood cells in man exposed to microgravity. New England Journal of Medicine, 1994.
Lawrence Rice, Clarence P. Alfrey. Modulation of red cell mass by neocytolysis in space and on Earth. Pflugers Arch- Eur. J. Physiol., 441 (Suppl):R91-R94, 2000.
![Page 25: Space Medicine: Past, Present and Future · Polk Space Medicine: Past, Present and Future J.D. Polk, DO, MS, MMM, CPE, FACOEP . Deputy Chief Medical Officer . Chief, Space Medicine](https://reader035.vdocuments.us/reader035/viewer/2022070721/5ee168f0ad6a402d666c4dd1/html5/thumbnails/25.jpg)
10/17/2011 Polk
Behavioral/Psycho-Social • Symptoms - Fatigue and
irritability • Causes
– Work load – Sleep habits and facilities – Crew personalities, “crew
space”, and cultural differences
– Temperature – Noise – Odors – Atmosphere – Diet – Lack of family contact
Changes in crew mood, morale, and circadian rhythm
![Page 26: Space Medicine: Past, Present and Future · Polk Space Medicine: Past, Present and Future J.D. Polk, DO, MS, MMM, CPE, FACOEP . Deputy Chief Medical Officer . Chief, Space Medicine](https://reader035.vdocuments.us/reader035/viewer/2022070721/5ee168f0ad6a402d666c4dd1/html5/thumbnails/26.jpg)
10/17/2011 Polk
Radiation
• Exposure based on orbital altitude/inclination, duration, and solar activity
• Crewmembers are radiation workers • Limits for mission and career exposure are set by the
National Council on Radiation Protection
• As Low As Reasonably Achievable (ALARA) principle for mission planning
• Exposure monitored by active and passive dosimeters
![Page 27: Space Medicine: Past, Present and Future · Polk Space Medicine: Past, Present and Future J.D. Polk, DO, MS, MMM, CPE, FACOEP . Deputy Chief Medical Officer . Chief, Space Medicine](https://reader035.vdocuments.us/reader035/viewer/2022070721/5ee168f0ad6a402d666c4dd1/html5/thumbnails/27.jpg)
10/17/2011 Polk
Countermeasures
![Page 28: Space Medicine: Past, Present and Future · Polk Space Medicine: Past, Present and Future J.D. Polk, DO, MS, MMM, CPE, FACOEP . Deputy Chief Medical Officer . Chief, Space Medicine](https://reader035.vdocuments.us/reader035/viewer/2022070721/5ee168f0ad6a402d666c4dd1/html5/thumbnails/28.jpg)
10/17/2011 Polk
Countermeasures • Cardiovascular
– Fluid loading – Lower Body Negative
Pressure – G-suits and Liquid
Cooling Garment – Exercise – Medication
![Page 29: Space Medicine: Past, Present and Future · Polk Space Medicine: Past, Present and Future J.D. Polk, DO, MS, MMM, CPE, FACOEP . Deputy Chief Medical Officer . Chief, Space Medicine](https://reader035.vdocuments.us/reader035/viewer/2022070721/5ee168f0ad6a402d666c4dd1/html5/thumbnails/29.jpg)
10/17/2011 Polk Team Building Training “Care Packages”
Communications
Behavioral Health and Performance
![Page 30: Space Medicine: Past, Present and Future · Polk Space Medicine: Past, Present and Future J.D. Polk, DO, MS, MMM, CPE, FACOEP . Deputy Chief Medical Officer . Chief, Space Medicine](https://reader035.vdocuments.us/reader035/viewer/2022070721/5ee168f0ad6a402d666c4dd1/html5/thumbnails/30.jpg)
10/17/2011 Polk
![Page 31: Space Medicine: Past, Present and Future · Polk Space Medicine: Past, Present and Future J.D. Polk, DO, MS, MMM, CPE, FACOEP . Deputy Chief Medical Officer . Chief, Space Medicine](https://reader035.vdocuments.us/reader035/viewer/2022070721/5ee168f0ad6a402d666c4dd1/html5/thumbnails/31.jpg)
10/17/2011 Polk
![Page 32: Space Medicine: Past, Present and Future · Polk Space Medicine: Past, Present and Future J.D. Polk, DO, MS, MMM, CPE, FACOEP . Deputy Chief Medical Officer . Chief, Space Medicine](https://reader035.vdocuments.us/reader035/viewer/2022070721/5ee168f0ad6a402d666c4dd1/html5/thumbnails/32.jpg)
10/17/2011 Polk
Levels of Care • Sure you can do major
surgery. It is feasible. But should you?
• Will there be prophylactic surgery on long duration Moon and Mars explorers (ie: appendectomy)?
• Will your consumables limit your ability to provide critical care?
![Page 33: Space Medicine: Past, Present and Future · Polk Space Medicine: Past, Present and Future J.D. Polk, DO, MS, MMM, CPE, FACOEP . Deputy Chief Medical Officer . Chief, Space Medicine](https://reader035.vdocuments.us/reader035/viewer/2022070721/5ee168f0ad6a402d666c4dd1/html5/thumbnails/33.jpg)
10/17/2011 Polk
Pragmatic Tenets
• Mass • Power • Volume • Time • Money • Risk
![Page 34: Space Medicine: Past, Present and Future · Polk Space Medicine: Past, Present and Future J.D. Polk, DO, MS, MMM, CPE, FACOEP . Deputy Chief Medical Officer . Chief, Space Medicine](https://reader035.vdocuments.us/reader035/viewer/2022070721/5ee168f0ad6a402d666c4dd1/html5/thumbnails/34.jpg)
10/17/2011 Polk
Application of the Pragmatic Tenets
![Page 35: Space Medicine: Past, Present and Future · Polk Space Medicine: Past, Present and Future J.D. Polk, DO, MS, MMM, CPE, FACOEP . Deputy Chief Medical Officer . Chief, Space Medicine](https://reader035.vdocuments.us/reader035/viewer/2022070721/5ee168f0ad6a402d666c4dd1/html5/thumbnails/35.jpg)
10/17/2011 Polk Paramount pictures
![Page 36: Space Medicine: Past, Present and Future · Polk Space Medicine: Past, Present and Future J.D. Polk, DO, MS, MMM, CPE, FACOEP . Deputy Chief Medical Officer . Chief, Space Medicine](https://reader035.vdocuments.us/reader035/viewer/2022070721/5ee168f0ad6a402d666c4dd1/html5/thumbnails/36.jpg)
10/17/2011 Polk
Futuristic?
Actually, It has already been done
NASA Houghton Mars Project
CPOD, NASA AMES
Pat Rawlings
EKG in Heads Up Display
![Page 37: Space Medicine: Past, Present and Future · Polk Space Medicine: Past, Present and Future J.D. Polk, DO, MS, MMM, CPE, FACOEP . Deputy Chief Medical Officer . Chief, Space Medicine](https://reader035.vdocuments.us/reader035/viewer/2022070721/5ee168f0ad6a402d666c4dd1/html5/thumbnails/37.jpg)
10/17/2011 Polk
![Page 38: Space Medicine: Past, Present and Future · Polk Space Medicine: Past, Present and Future J.D. Polk, DO, MS, MMM, CPE, FACOEP . Deputy Chief Medical Officer . Chief, Space Medicine](https://reader035.vdocuments.us/reader035/viewer/2022070721/5ee168f0ad6a402d666c4dd1/html5/thumbnails/38.jpg)
10/17/2011 Polk
![Page 39: Space Medicine: Past, Present and Future · Polk Space Medicine: Past, Present and Future J.D. Polk, DO, MS, MMM, CPE, FACOEP . Deputy Chief Medical Officer . Chief, Space Medicine](https://reader035.vdocuments.us/reader035/viewer/2022070721/5ee168f0ad6a402d666c4dd1/html5/thumbnails/39.jpg)
10/17/2011 Polk
![Page 40: Space Medicine: Past, Present and Future · Polk Space Medicine: Past, Present and Future J.D. Polk, DO, MS, MMM, CPE, FACOEP . Deputy Chief Medical Officer . Chief, Space Medicine](https://reader035.vdocuments.us/reader035/viewer/2022070721/5ee168f0ad6a402d666c4dd1/html5/thumbnails/40.jpg)
Polk-Aug 2009
Questions?
Slide courtesy of USAF 40
![Page 41: Space Medicine: Past, Present and Future · Polk Space Medicine: Past, Present and Future J.D. Polk, DO, MS, MMM, CPE, FACOEP . Deputy Chief Medical Officer . Chief, Space Medicine](https://reader035.vdocuments.us/reader035/viewer/2022070721/5ee168f0ad6a402d666c4dd1/html5/thumbnails/41.jpg)
10/17/2011 Polk
References • Brooks AJ, et al. Fast on operational military deployment. Emerg Med J. 2005 Apr;22(4):263-5. • Bacal K, Beck G, McSwain NE Jr. A concept of operations for contingency medical care on the
International Space Station. Mil Med. 2004 Aug;169(8):631-41. • Wilde RC et al. One hundred US EVA’s: A perspective on spacewalks. Acta Astronaut. 2002 Jul-
Nov;51(1-9):579-90. • Skelton PA, Droege L, Carlisle MT. EMEDs and SPEARR teams: United States Air Force ready
responders. Crit Care Nurs Clin North Am. 2003 Jun;15(2):201-12.
• Peoples GE, Gerlinger T, Budinich C, Burlingame B. The most frequently requested precombat refresher training by the Special Forces medics during Operation Enduring Freedom. Mil Med. 2005 Jan;170(1):31-7.
• Chambers LW et al. Initial experience of US Marine Corps forward resuscitative surgical system during Operation Iraqi Freedom. Arch Surg. 2005 Jan;140(1):26-32.
• Billica RD et al. Perception of the medical risk of spaceflight. Aviat Space Environ Med. 1996 May;67(5):467-73.
• Busby DE. Space clinical medicine. A prospective look at medical problems from hazards of space operations. Space Life Sci. 1968 Aug;1(2):157-427. Review.
• McGregor A. Fitness standards in airline staff. Occup Med (Lond). 2003 Feb;53(1):5-9. Review. • Ridker P et al. C-Reactive Protein Levels and Outcomes after Statin Therapy. NEJM 2005.
Volume 352:20-28. • Peoples GE et al. From the war zone to the United States: Caring for the wounded in Iraq- A
photo essay. NEJM. 2004. Volume 351:2476-2480 .