Modalities Ch. 6 Flashcards Preview

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Flashcards in Modalities Ch. 6 Deck (46)
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1

orthopedic injury model

normal tissue
-cells
-two blood vessels
-nerve

2

immediate ultrastructural change

primary traumatic damage
damage to the nerve
breakdown of the injured cells

3

hemorrhage

few minutes only
clot forms, stopping hemorrhage

4

what happens of a clot forms

hematoma forms

5

how does a clot form

fibrins form a network
-platelets are caught and it created a plug

6

pain from damaged nerve
-results

muscle spasm and more pain
neural inhibition
-leads to decreases in strength and ROM

7

the damaged cells release...

chemical mediators as a signal to the body that an injury has taken place

8

result of broken blood vessels

extravascular swelling

9

chemical mediators released from dying cells cause...

hemodynamic changes
permeability changes
-histamine
-kinins
-serotonin
leukocyte migration

10

what happens at this point?

secondary enzymatic injury

11

hemodynamic changes

blood flow slows down
OR
blood flow ceases
result
-tissue oxygen decreases
--hypoxia
--metabolic changes
-secondary hypoxic injury soon seen

12

phagocytosis

as cells are broken down free proteins are released
free proteins signal edema

13

pressure on undamaged nearby pain fibers cause additional...

pain
muscle spasm and inhibition

14

immediate care

subset of acute care
first 12 hours

15

RICES

Rest
Ice
Compression
Elevation
Stabilization

16

why RICES?

protection from further damage
decrease or minimize the development of
-swelling
-pain
-muscle spasm
-neural inhibition
-secondary injury
-total injury (because of decreased secondary injury)

17

time course of swelling

immediate swelling
-comes from hemorrhaging
edema
-begins minutes to hours after injury
-continues to develop over many hours

18

secondary injury and edema

secondary injury leads to edema
increased edema increases secondary injury
two mechanisms
-increased distance between blood vessel and tissue cells
-edema can compress the blood vessel
both decrease circulation
-decreased oxygen to tissues

19

rest: why?

limits injury aggravation
-should be total during immediate care
-transition to "relative" rest
-different from, but related to, stabilization

20

ice: why?

most think it's to control swelling
-important but only part of immediate care
limiting secondary injury and neural inhibition are most important than controlling swelling

21

decreased blood flow theory

older, traditional theory
cold decreases blood flow
logic of theory
-cold causes vasoconstriction
-vasoconstriction decreases blood flow
decreasing blood flow decreases hemorrhaging
decreased hemorrhaging = swelling reduced

22

decreased blood flow theory flaw

clotting occurs before tissue is cooled enough to substantially decrease blood flow

23

decreased secondary injury theory

cold decreases cellular metabolism
-reduces oxygen demand (consumption)
-less secondary hypoxic injury
-less total injury
-less free protein generated by phagocytosis
-less edema

24

metabolism and cooling

direct relationship
-greater cooling = greater decrease in metabolism

25

cryotherapy and swelling

decreases edema, not hemorrhage
-most occurs hours after injury, as free protein accumulates from phagocytosis
cold reduces edema formation
-by preventing secondary injury and thus less free protein accumulation

26

compression: why?

controls edema beyond normal volume (i.e. after tissue spaces are filled)
slows swelling
apply constantly until swelling is over

27

compression during immediate care
-RICES added benefit

enhances cooling

28

elevation: why?

decreases capillary hydrostatic pressure

29

stabilization: why?

controls neural inhibition
-process in which neural pathway is blocked so impulses cannot pass
--intended function does not occur
-partial: function is diminished
-total: function is abolished temporarily
allows muscles to relax, thus
-decreases pain-spasm-pain cycle
-numerous braces and splints for stabilization

30

cryotherapy physics and physiology

cold = the absence of heat
conduction
-heat exchange until two substances have exchanged energy and meet in the middle