Tx-ing Edema w Compression

kms013's version from 2016-02-01 14:04


Question Answer
Mechanical (therapeutic agent)pushing or pulling
In your practice, will come across _____ all the timeswelling
pitting edemaObservable swelling of body tissues due to fluid accumulation that may be demonstrated by applying pressure to the swollen area (such as by depressing the skin with a finger). If the pressing causes an indentation that persists for some time after the release of the pressure, the edema is referred to as pitting edema.
use of compressioncompression is mechanical pressure applied to a body segment to overcome pressure in the tissues
indications to compressionAcute (2 wks) and sub acute (up to 3 months) traumatic edema {Acute = immediate post-trauma up to 3 months post-trauma, caused by tissue damage and inflammatory processes, examples: jt sprain, post-surgery, post crush or blow inj, repetitive strain, problems: increase tissue pressure, decr ROM, incr p!, decr blood and lymph circulation; 2. venous return insufficiency and venous stasis ulcers; prevention of DVT; compartment syndrome, stump reduction in amputated limbs, lymphedema, wound healing and scar management, congestive heart failure
RED FLAG to compression (to reduce edema)Compartment syndrome (caused by crush or blow to soft tissue, swelling is contained w/i fascia compartment; inter-compartment pressure builds to cut off BF; tissue necrosis occurs w/o BF; loss of limb is a potential consequence
Acute Edema happens after.... (examples)knee replacement, jt soft tissue injury, bone fx, etc
sx of a fxswelling, redness, heat, incr p!
Acute edematraumat
traumatic compartment syndromewhen a PT is concerned about compartmnet syndrome, pt shoudl be seen by a physician immediately; Acute compartment syndrome occurs after a traumatic injury such as a car crash. The trauma causes a severe high pressure in the compartment which results in insufficient blood supply to muscles and nerves. Acute compartment syndrome is a medical emergency that requires surgery to correct.
exercise induced-- you've overused this mm
Compartment syndrome medical dx partially made by ________ determining compartment pressures
Within the first 3-4 hrs of compartmnet sydrome, mm changes are reversible/irreversible?reversible
yellow in the skin in swellingaccumulation of Fe
varicose veinsVaricose vein: A vein that has enlarged and twisted, often appearing as a bulging, blue blood vessel that is clearly visible through the skin. Varicose veins are most common in older adults, particularly women, and occur especially on the legs. Varicose veins can cause cramping pain and movement problems, or they may simply be a cosmetic concern. Treatment includes elevating the affected limb, wearing support hose to increase pressure on the vein, and in some cases surgery.
DVTthis occurs when blood is pooling in LE ; can be serious complication of immobilization, surgery, prolonged illness; Deep vein thrombosis (DVT) occurs when a blood clot (thrombus) forms in one or more of the deep veins in your body, usually in your legs. Deep vein thrombosis can cause leg pain or swelling, but may occur without any symptoms. Deep vein thrombosis can develop if you have certain medical conditions that affect how your blood clots. Deep vein thrombosis can also happen if you don't move for a long time, such as after surgery, following an accident, or when you are confined to a hospital or nursing home bed. Deep vein thrombosis is a serious condition because blood clots in your veins can break loose, travel through your bloodstream and lodge in your lungs, blocking blood flow (pulmonary embolism).
How is a DVT diagnosed?using US
Compartment Syndrome: After 6 hrs, there is....clear mm damage that varies depnding on additional insults
Compartment Syndrome: After 8 hrs of establishing compartment syndrome, what happens?irreversible changes have occured int he mm
why would we want swelling out of a stump?so we can fit prosthetic
Chronic exertional compartment syndrome (CECS)a sub actue condition experienced foten by atheletes from repetitive use or trauma to soft tissues
__________ is important in CECSdifferential dx
shin splintsa wastebasket term for leg p! that could have multiple etiology
compression garments are good for healing after what?severe burn (silicone compression bandage to reduce scar)
congestive heart failure--why would you see swelling?when the heart isn't working to push enough pressure, so blood pools in lower extremities (bc pooling = off pressure) so limbs begin to swell; you may see this
Contraindications for compression for using intermittent compression pumpacute pulmonary edema, congestive heart failure, recent or acute DVT, acute fx, uncontrolled hypertension (controlled hypertension is a PRECAUTION)
Causes of edemaincr permeability of capillary walls, incr capillary pressue due to venous obstruction or heart failure, lymphatic obstruction, disturbances in renal fx, reduction of plasma proteins, inflamatory conditions, fluid or electrolyte disturbances, decreased atmospheric pressure, immobility
what is edema?local or generalized condition in which the body tissues contain an excessive amount of fluid
body fluid moves because of _________pressure gradients
What is the law regarding pressure?Starlings Law of the capillaries
Starling equationCompetition of pressure; refers to fluid movement across the capillary membrane that occurs as a result of filtration. equation that illustrates the role of hydrostatic and oncotic forces (the so-called Starling forces) in the movement of fluid across capillary membranes. Capillary fluid movement may occur as a result of three processes: diffusion, filtration, & pinocytosis
osmotic pressure is caused by...caused by protein and fluid
hydrostatic pressure is caused by...caused by water
acute inflammation causes increase in _________vascular permeability
someone just whamed finger in vball. Why is swelling occuring?Vascular permeability
Edema is an accumulation of....EC fluid in the interstitial space of body segments or organs
Compression increases....pressure on the fluid in the interstitial space
When compression is ____ than capillary pressure, fluid returns to venous circulation higher (15-32 mmHg)
When compression is _____ than lymphatsic pressure, interstitial fluid is encouraged to return to circulation via the _____higher, lymph drainage system (<15 mmHg)
Lymph system works at pressures ____ < ______15 mmHG, 5 mmHg
compression > ______ up to _____ encourages superficial venous BF, incresing flow velocity and assisting one-way valve fx32mmHG, 60 mmHg
lymph system: circulation of lymph fluid occurs at __________ pressure gradient very low pressure gradient
Excerpt from Compression paper:resource online
How to measure edema?serveral ways: one is pitting edema, circumference measure, volumetric measure,
pitting edema: how to measure?0+- no PE, 1+= Mild PE, 2+ = mod PE, 3+ mod sev PE, 4+ = sev PE (8mm depression lasting more than 2 min)
use mechanical compression for txthats what we want to do
the lymph system normally drains _ of interstitial fluid/day2-3 liters
lymph systme is a ___ pressure system of approx. ___ decreasing to ____low, 15 mmHg, 5mmHg
if drainage system is blocked or disrupted lymph fluid does not....return to the vena cava where it normally joins the CV system
Lymphedema compressiongarments that maintian pressure to discourage accumulation of interstitiial fluid
Lymphedema Manual techniques encourage what?lymphatic drainage techniques encourage opening of lymph vessesl. This requires special training and is a specialty practice for PT/OT
Prevention of DVT:Compression hose, TED hose (thromboembolism deterrent); intermittent pneumatic compression
tx-ing vascular disease: _____ is ususually unilateralvenous insufficiency (PT shoudl be aware of this condition and work as an interprofessional team player to help pt get proper care; in early stages compression hose may be beneficial)
Use of compression stockings reduce...and prevent....distal edema and promote venous return
Treating runner's legs? In normal healhty legs, _____ promotes venous return. mm pumping action
Do we have good evidence of use of compression sleeves to incre venous return in treating runners legs?No; there are no quality studies looking at use of sport sleeves and CECS
tx-ing edema caused by congestive Heart failure: CHF usually presents with _____ leg edemabilateral
tx-ing edema caused by congestive Heart failure: Addressed by ___ & _____PCP , cardiologist
tx-ing edema caused by congestive Heart failure: often use ______ medicationdiuretic
tx-ing edema caused by congestive Heart failure: use what?copression hose; (PT shoudl be aware of this condition and work as an interprfessional team player to help pt get proper care; in early stages, compression hose may be beneficial)
tx-ing traumatic edema post-surgery: Use of what 2 things?intermittent compression and compression wraps
Using compression post therapy with PRICEProtect, rest, ice, compression,elevation
Kinesiotape to reduce edemathis study showed that KT did not decrease swelling in acute, lateral ankle sprain of athletes (a randomised trial)