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PHASES OF HEALING Phase One Inflammatory phase 3-7 days Marked by local vasodialation & increase in cell migration Need a lg. amount of cells to begin chemotaxis
PHASES OF HEALING Phase Two Granulation tissue formation phase Formation of new blood vessels Production extracellular matrix Formuation granulation tissue
PHASES OF HEALING Phase Three Can last up to 2 yrs. following injury Increase in collagen tissue Tissue becomes more organized Too organized = scarring
Current of Injury presence of skin battery potential in a wound or injury where skin no longer provides a barrier to the tissue below
Why is a moist wound better than a dry wound? A moist wound maintains the current of injury triggering healing
A dry wound consists of what kind of tissue? Dry, leathery, necrotic tissue
Why is a dry wound slower to heal? It loses the current of injury which decreases healing.
What is galvanotaxis? A process in which all cells posses either a + or - charge that attract to the opposite pole.
What is the polarity of a neutraphil? Negative
What is the polarity of a macrophil? Negative
What is the polarity of a epidermal cell? Positive
What pole do neutraphils attract to? positive
What pole do macrphils attract to Positive
What pole do epidermal cells attract to? Negative
What does antimicrobial mean in reference to EStim? Estim has been shown to have bactericidal effects in animal studies. NO HUMAN STUDIES-CONTOVERSY OVER
What happens to blood flow as an influence of Estim? EStim is thought to increase blood flow in wounds hence speeding up the healing process.
What is the influence of EStim on necrotic tissue? The positive pole is thought to increase macro & neutraphils to the wound hence, providing an autolitic reaction.
What is HVPC (aka HBGC)? High Volt Pulsed Current (aka High Volt Galvantic Current)
What is the definition of HVPC? Pulsed current delivered via high voltage to accomplish their means.
What is the waveform of HVPC? Paired unidirectional impulses that rise instantaneously & then pulse fall exponentially (quick rise- slow fall)
What is the pulse duration of HVPC? 50-100 microseconds with electromoto force up to 500 volts. In the U.S. most do not exceed 150 volts per the FDA
With higher volts what is the effect on the skin and why is this important? Higher volt = less impedence from the skin which means we don't need high amp.
What is the purpose of HVPC? -Stimulate lg. afferent neurons to promote pain relief -Promote blood flow & relaxation -Reduce edema via polarity -acceleration of tissue healing *high volt not best for pain - other methods work better
What are the indications of HVPC? -Promote wound healing -Reduce edema (esp. acute)
What are the contraindications of HVPC? -Pacemaker or medical devices including hardware -Over or near preg. uterus -Over eyes, carotid sinus, laryngeal or pharyngeal muscles -During operation of heavy machinery -Over areas of malignancy
What are the precautions of HVPC? -Known cardiac condition -Over anesthetic skin (numb) -Elderly patients
What is the response to treatment with HVPC? -Sensation or tingling or motor response is expected -Should have no obvious skin changes following tx (Check skin pre and post)
What is the intensity of HVPC? strong but comfy (sensory level for edema or wounds)
What is the duration of HVPC? 60 minutes w/ wounds 15-30 minutes for edema or pain (not 1st choice as far as estim)
What is the frequency of tx for HVPC? daily up to 5x/day
What must a wound be free of before placing electrodes? all metals or petroleum products - flush with sterile saline first.
What is the direct electrode placement method for wounds? (HVPC) Pack the wound w/ moist gauze (sterile saline) & place electrode directly on the wound & dispersive electrode 15-20 cm away from wound.
What is the Peri method for wounds(HVPC electrode placment)? electrodes are placed around the wound (on each side of)
For pain and edema what methods of electrode placement are used? Surround the area or use high volt under water.
With underwater high volt, where are the electrodes placed? Electrodes are secured to the side of a plastic or fiberglass tub. DO NOT WANT THEM TO TOUCH PATIENT!!!!
With underwater HVPC, what must be used in addition to the electrodes in the tub? A disbursement pad on the trunk or under the thigh of the limb in the water.
While the estim machine is on, the limb is to remain where? in the water - give pt. a bell, RISK OF HIGH VOLT SHOCK IF REMOVED!
What is Interferential Stim? -Consists of 2 unmodulated medium frequency EStim waves that cross pathways & interfere with each other. -2 different frequencies that meet in multiple points in wave that cause constructive and destructive interference.
What is the waveform with interferential? 2 unmodulated frequency sound waves
What is the frequency for interferential? 2000-5000 Hz
What is the pulse duration for interferential? 125 microseconds
What is the result as far as shape of interferential current? clover leaf shaped wave
What is the purpose/effects of interferential with greater than 50 beats per second apart? -greater than 50 beats per second apart relieves pain by stimulating lg afferent neurons (gate control theory)
What is the purpose/effects of interferential with 0-5 beats per second? produces muscle contractions & relieve pain (endogenous opiates)
What is the purpose/effects of interferential with 1-10 beats per second? Produce small pulsating contractions of innervated muscles.
What is the purpose/effects of interferential with 30-50 beats per second? produce tentanic contractions.
What are the advantages of interferential? -medium frequency face less impedance as they cross the skin thus they reach deeper target tissues.
What are the disadvantages of Interferential? -Even w/ crossing of current, density remains high near the electrodes -pt. not as likely to perceive stim at targeted tissue.
What are the indications of Interferential? -Pain relief -Muscle ex to increase blood flow, muscle relaxation, decrease edema -Relief of urinary incontinence -Tissue, bone healing (disputed) *MOSTLY FOR PAIN RELIEF
What are the Contraindications of Interferential? -Pacemaker or medical devices including hardware -Over or near preg. uterus -Over eyes, carotid sinus, laryngeal or pharyngeal muscles -During operation of heavy machinery -Over areas of malignancy -Open areas, active bleeding
What are the precautions of interferential? -Known cardiac condition -Over anesthetic skin (numb) -Elderly patients
As far as dosage of interferential, what is the amplitude? -sensory level -strong but comfy -No mucle activation
As far as dosage, what is the duration of interferential? 15-30 minutes
As far as dosage, what is the frequency of tx for interferential? daily up to 3x/day
What is the response to tx for interferential? -Tingling under the electrodes -No obvious skin changes following tx -Inspect skin pre & post
What is the electrode placement for interferential? -Surround the area of pain -2 circuits that criss cross -leads on same side (polarities together) to form clover leaf wave
Created by: deepolzin



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