Intermittent compression
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-It is very important treatment specially in edema and swelling.
-Mechanism of swelling:-
-In lymphatic vessels …its outer layer is covered by one layer of endothelial cells.
-And lymphatic vessels are stable in their places as they are incored in side tissues by means of fibrils..so not affected by contraction of surrounding muscles and not change their places.
-In side the vessels plasma proteins are in higher concentration than out side…so cause osmotic pressure and fluids can move from lower concentration to higher conc..
-At trauma, chemical mediators causes vasodilatation..so pores of vessels are widened …and plasma protein leak out side from lymphatic vessels till become higher in concentration out side..so interstitial space increase in fluid causing edema.
-Types of edema:-
A-Pitting edema :
Blanching at compression
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-It is traumatic.
B-Non pitting edema:
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-Lymphedema "Hypo thyroidism" – "Myxoedema
-Causes of edema:-
A-Renal failure: Kidney not able to filtrate fluid from blood…so blood stasis take place leading to swollen feet,, swollen hands and face(moon face
-In this case patient should test for kidney function(( Blood urea _ A-creatin_ K+))…..If all are higher than normal …so renal failure indicated
-Patient can do hemodialysis as it lasts only for 4 hours….while protein dialysis is from 48 to 72 hours so we fear of renal hemorrhage
B-Heart failure: (Note : superior and inferior vena cava return blood back to heart)….At failure:
-Bloo is not pushed in to right ventricle …and venous stasis occurs causing swollen feet , hands and face…..We differentiate it from renal failure that here sacrum area is involved in swelling.
C-Liver cirrhosis (ascitis): Systemic swelling.. Here find yellow color of eyes "Jaundice"…So patient should test for liver function. (S.G.O.T – S.G.P.T – ALT
D-Trauma (sprain –strain-….)…Here only site of trauma is swollen "Extra articular swelling"
-If swelling is in side joint so called effusion.
E-Envenomination: Allergia to insects causing edema of lower limb ….If no treatment so cause leg enlargement (Elephant leg
F-Burns always associated with edema
G-After mastectomy ,causing lymphedema
H-Mal nutrition.
I-Thrombosis…and thrombophlipits as deep venous thrombosis which mostly occur at calf muscle
J-Cortisone causes retention
-The machine used for intermittent compression:-
-It is rubber bag filled with air under intermittent pressure by using compressor…And it is applied to site of edema needed to be treated..
-It aims to return fluids back from EC to IC...and cause it spread in larger area….and to move it from injured to healthy part…also help large plasma protein molecules to return under pressure
-Intermittent compression is better than continuous …As at continuous bllod supply decrease and ischemic pain take place
-To determine pressure of air by compressor:-
a-Measure blood pressure (systolic and diastolic
b-Systole increase by compression(As here heart is in case of contraction
c-But diastole is not…Should observe diastole carefully
_____compressor pressure = 1/2 Diastolic pressure_____
-On time in intermittent compression should = off time…
Or Off time exceeds off time
It depends on patient age , As collateral circulation(which is circulation works at emergency to supply blood to body parts below level of thrombus)…It decrease with age….there for off time should be more
-Indications:-
A-Varicose veins , Fragility
B-Venous stasis ulcer :
If venous return is insufficient so swelling occur….So skin stretch , then breaking down take place
C-Lymphedema…due to mastectomy
-Contraindications:-
A-Osteoprosis
B-Right side heart failure
C-Ischemia
D-Acute inflammation
محاضرة الكترو دكتور سامي
الاربعاء 24/10/2007
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موضوع: محاضرة الكترو دكتور سامي...Intermittent compression 
الثلاثاء أكتوبر 30, 2007 1:39 am
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