Page 212 - PJ MED OPS Handbook 8th Ed

d. Urinary System
i) Spaceflight is associated with many factors which may promote urinary retention. Fe-
males 4x more likely to develop retention than males. An astronaut with urinary reten-
tion is 25x more likely to have a UTI.
ii) Anticholinergic and antihistamines affect bladder muscle function which increases the
risk of developing urinary retention in spaceflight. Phenergan increases risk 3x.
iii) Signs/symptoms:
1) Inability to urinate
2) Painful urination
3) Catheterization inflight
iv) Treatment:
1) If patient can’t urinate and has severe distention of the bladder consider using
straight catheters (red robin)
2) If the issue persist during extended field care consider indwelling Foley catheter
3) Antibiotics prophylactically or for suspected UTI
e. Spaceflight Associated Neuro-Ocular Syndrome (SANS)
i) US astronauts have developed some or all of the following findings either during or fol-
lowing a six month spaceflight the main hypotheses is due to fluid shift
1) Optic disk edema (papilledema)
2) Cotton wool spots
3) Degradation in near vision
4) Choroidal folds
5) Optic nerve sheath distention
6) Optic nerve kinking
7) Globe flattening
8) ↑ CSF pressure post flight 5/6 subjects: 21.0–28.5 cmH2O
ii) Incidence: ~ 60% of crew members have at least one sign SANS
iii) Symptoms: Decreased near vision
iv) Time course: Landing to years post landing
v) Treatment:
1) No treatment in the field
2) Document PERRLA and subjective information given from patient
3) NOTE: SANS does not cause headaches. If astronaut complains of headache and vision
changes, look for cause of headache. Call med control if unsure.
f. Altered Immune Function
i) Possible causes of space flight-induced immunosuppression are:
1) Micro or Zero gravity
2) Stress
3) Exposure to radiation
ii) Use higher index of suspicion when considering infection as possible cause of illness
iii) Use proper sterile, aseptic techniques and infection control during procedures
iv) During an extended field care phase, use proper field hygiene and sanitation techniques
v) Communicate potential altered immune function to receiving MTF
vi) Consider early prophylaxis

210 n Pararescue Medical Operations Handbook / 8th Edition