Quiz 1: inflammation, pain, cryo Flashcards
inflammatory
1-6 days
acute: early phase
chronic: late phase
3 phases of tissue healing
- inflammation: 1-6 days
- proliferation: repair, 4-21 days
- reemodeling: 14 days
proliferation
repair, 4-21 days
granulation tissue formation
re-epithelialization
wound contraction
remodeling
14 days +
inflammatory response
- occurs in vascularized tissue
- essential for tissue healing
- non-specific: same pattern throughout body
- attracts phagocytes: neutrophils, monocytes: destroys bacteria, clean up dead tissue
acute inflammatory response: time, signs
lasts between 24-48 hrs complete within 2 weeks cardinal signs: 1.swelling (tumor) 2.heat (calor) 3.redness (rubor) 4.pain (dolor)
acute inflammation: 4 primary responses
- vascular: vasconstrict, vasodilate, edema
- cellular: plateletes, neutrophils, monocytes/macrophages, lymphocytes, plasma, RBCs
- hemostatic: control blood loss; platelets release fibrin & platelet-derived growth factor
- immune: mediation by cellular, humoral factors
12 steps of vascular response resulting in edema
- trauma disrupts tissue, blood, lymph vessels
- immediate, transient vasoconstrict:
- slow blood loss, occurs in all vessels
- larger vessels: brief constrict due to NE release
- smaller vessels: prolong constrict due to serotonin & endothelin - initial vasoconstriction –>inner surfaces of damaged vessels pressed together
- endothelin –>approximation due to stickiness–>occlusion
- neutrophilic margination: w/in 1 hr after injury; entire endothelial wall of capillaries covered w/ neutrophilic leukocytes
- vasodilation follows –>increased permeability
- dilation –>dilute toxins, remove pathogens
- dilation promoted by bradykinin prostaglandins, histamine, NO
- edema = vasodilation, permeability, vessel damage –>excess fluid in interstitial space
- edema further developed by exit of plasma proteins in interstitial space –>reduces oncotic pressure, increases net filtration outward (30-40mmHg), decrease in reabsorption on venule side of capillary bed (leaves leaky vessel first and in greatest quantity –>drives edema mechanism
- results in: measurable edema & impairments
proliferation phase
Subacute, repair, & healing stage
- removal of noxious stimuli
- increase capillary beds
- collagen formation
- fibrous healing aligns to stress
- granulation tissue formation
- tissue is fragile
remodeling phase
chronic
- maturation of CT
- contracture of scar tissue
- remodeling of scar
- collagen continues to align w/ stress
- tissue is STURDY
injury management for acute stage of inflammation
modality directed towards limiting swelling, reducing pain
swelling: cryo, compression
pain: cryo, estim
treatment of vascular response
goal: offset filtration outward pressures (30-40 mmHg)
1. compression
- elastic wraps: 50% overlap, 50% stretch (40 mmHg)
- garments: vary from 18-60 mmHg
- intermittent pneumatic compression (IPC)
2. elevation
- above heart if possible
compression contraindications (6)
- presence of DVT (deep vein thrombosis)
- presence of PVD
- presence of arterial insufficiency
- pulmonary edema
- CHF
- dermatological infections
intermittent pneumatic compression
- 1st treatment pressure: 40-50 mmHg
- max pressure should never exceed (diastolic - 10)
- duration: 45-60 min
ultrasound during inflammatory stage
non-thermal: alters permeability of cell membranes to sodium, calcium
