Electrothermal Agents Flashcards
How to explain to a patient what Ultrasound does?
Ultrasound helps to improve healing, by sending sound waves through the tissues and this causes a small vibration
How should ultrasound feel?
Jelly will probably feel. cold - shouldn’t be uncomfortable - may feel a slight pressure as I move the treatment head over the area.
Some people feel a mild heating effect - this is normal
Risk of ultrasound?
React to the Gel
What are the contraindications to non-thermal (pulsed) ultrasound? (7)
- Pregnancy
- Malignancy
- Active implants (e.g. pacemaker, deep brain stimulator)
- Active epiphysis
- Local circulatory insufficiency - diabetes
- Actively bleeding tissues
- Devitalised tissues
What are the contraindications to thermal (continuous) ultrasound? (8)
- Pregnancy
- Maliganancy
- Active implants (e.g. pacemaker, deep brain stimulator)
- Active epiphysis
- Metal implants
- Local circulatory insufficiency – emboli, DVT
- Actively bleeding tissues
- Devitalised tissues
What are the ultrasound treatment parameters - depth of lesion?
o Superficial (>2cm) = 3MHz o Deep (2-5cm) = 1 MHz
What are the ultrasound treatment parameters - pulse ratio?
o Acute (up to 2 weeks post injury) = 1:9 or 10% duty cycle o Sub-acute (2 to 6 weeks post injury) = 1:4 or 20% duty cycle o Chronic (over 6 weeks post injury) = 1:1 or 50% duty cycle
What are the ultrasound treatment parameters - intensity?
o Acute (up to 2 weeks post injury) = 0.1 to 0.3 W/cm3 o Sub-acute (2 to 6 weeks post injury) = 0.2 to 0.5 W/cm3 o Chronic (over 6 weeks post injury) = 0.5 to 1 W/cm3
How to calculate the dose for ultrasound?
Time = pulse ratio x number of treatment heads (e.g. for 1:9 ratio and 1 treatment head = (1+9)x1 = 10 minutes)
How to explain TENS to a patient?
This will involve using this small machine – we will apply these sticky pads around the affected area, and when I turn it on it will send very small electrical signals to the tissues. This should provide you with some pain relief to allow us to progress your treatment program.
How does TENS feel?
- for acute pain - Patient should definitely feel tingling but not painful
- for chronic pain – patient should feel a strong tingling sensation
- ask if it is a strong or mild sensation **
Risk of TENS?
Allergic reaction to the pads
What are the contraindications for TENS? (8)
- Pregnancy
- Malignancy
- Implanted medical devices (e.g. pacemakers, deep brain stimulators)
- Active epiphysis
- Local circulatory insufficiency
- Epilepsy (CI for neck)
- Actively bleeding tissues
- Devitalised tissues
What NOT to do with the TENS at home?
- Get it wet
- Don’t sleep in it – because if you do roll over and knock the dial you will get a sudden surge of TENS – not dangerous but very uncomfortable
- Don’t drive with it (for the same reason as above)
- Only use it over the area we are treating today – not anywhere else”
What are the TENS treatment parameters for acute pain?
30 mins
90-130Hz & 100ms in constant mode
What are the TENS treatment parameters for chronic pain?
2-5Hz & 200-250ms in burst mode
Risk of ice?
Normal for underlying skin to go red - usually resolves soon after
Risk of burns - reduced by using towels to provide a barrier, and reduced by checks during treatment
What are the contraindications for ice? (5)
- Malignancy
- Local circulatory insufficiency
- Devitalised tissues
- Bleeding tissues – infection risk
- Pregnancy
How to layer ice?
- Wrap the ice pack in a wet towel
- Place ice pack in the wet towel over the affected area
- Apply the plastic layer over the top of the wet towel (acts as an insultating medium)
- Use the dry towel as a wrapper to keep the cold pack in place
What are you looking for on 5 minute check for ice?
white skin (add another towel layer),
blue skin (remove ice!!),
abnormal sensation,
excessive pain
Effect of ICE to tell the patient?
This should provide you with some pain relief and reduce swelling to allow us to progress your treatment program.
Effect of heat to tell the patient?
This should provide you with some pain relief and stiffness, it can also speed up the healing process to allow us to progress your treatment program.
Risks of heat?
Normal for underlying skin to go red - usually resolves soon after
Risk of burns - reduced by using towels to provide a barrier, and reduced by checks during treatment
What are the contraindications for ICE? (6)
- Malignancy
- Active epiphysis
- Metal implants
- Local circulatory insufficiency
- Actively bleeding tissues – infection risk
- Devitalised tissues
How to apply heat?
- Wrap the hot pack in a towel – ensure that there is two layers of towel between the pack and the skin
- Apply hot pack over affected area (if treating hands – ensure hot pack is on both sides)
- Use the second towel as a wrapper to keep the heat pack in place
What are you looking for on 5 minute check for heat?
o Erythema – add an additional layer of towelling
o Skin does not feel hot – remove a layer of towel
