Use Of Ice Packs Research Articles

ThP7.14 - CSF Leak or Ear Wax? Logical Thinking in Emergency Management of a Collapsed Patient With Heat stroke

Abstract A man in his 60s presented to RESUS by ambulance on the hottest day of the year with suspected STEMI and collapse at home. The patient was intubated and unresponsive (GCS 5), with global rigors. Hospital ECG showed sinus tachycardia. Body temperature was in excess of 41°C, confirmed on central temperature monitoring. Bilateral clear fluid was noted to be discharging from both ear canals. Query CSF leak was indication for CT head, which was unremarkable. Considering this, efforts were focused on optimising body temperature. This was done with the use of ice packs and fans as well as continuous misting of cool water over the exposed patient. Improvement was shown with temperatures decreasing to 38°C. In questioning the cause of the “clear fluid,” a swab of it placed on an icepack swiftly returned the fluid to its natural consistency of ear wax. As a result of the extraordinarily high body temperatures, ear wax had melted in both ear canals and started to leak out, giving the impression of a CSF leak. This was simply identified at the bedside to refute the idea of a CSF leak. As CSF leak was the indication for a CT head, this could have been avoided with rapid cooling initiated earlier. Unfortunately, this patient later died due to heat stroke. Whilst avoiding the delay of a CT head most likely would not have changed the prognosis for this patient, it is useful to note the importance of logical thinking in an emergency setting.

Social interactions and heat stress mitigation among elderly people in a healthy city

BackgroundIncreased frequencies and duration of extreme heat events have caused severe heat stress, especially among elderly people. Despite its obvious cause and universally known preventive measures, heat stress preventive measures have not been implemented effectively at community levels. This study examined heat coping practices among elderly people and their associations with living conditions, social interactions, and community involvement. MethodsA self-administered questionnaire was done to assess heat-coping practices to mitigate heat stress, living conditions, and interactions with family, friends, and neighbours. Participants were 3000 randomly selected elderly people aged 65 years and older living in Owariasahi, Japan, a city that applies the 2004 Healthy City Approach. A generalised linear regression model was applied with binominal distribution to examine the association between social interactions and application of heat-coping practices. Sex and ages were adjusted in the model. FindingsAmong the 2127 elderly people who completed the survey, 745 (35·0%) had heat stress during the summer of the survey year. The presence of heat stress was higher in male participants living alone and having less interaction with friends and neighbours; only interaction with friends and relatives showed difference in the occurrence of the heat-related illness in female participants. The use of ice packs, air conditioners, and the opening of windows or doors were associated with the presence of heat stress. The odds of not applying relevant preventive practices were higher in participants disconnected from relatives and friends (odds ratio 1·52 [95% CI 1·12–2·04]). Participants living alone and disconnected from their neighbours showed similar trends to the connection with relatives and friends but not significantly. InterpretationThe findings of the study indicated that heat stress mitigative measures were underused in elderly people who are socially disconnected. Heat illness prevention programmes need to focus on outreach to the disadvantaged population. FundingJapan Society for the Promotion of Science.

550 CSF Leak or Ear Wax? Logical Thinking in Emergency Management of a Collapsed Patient with Heat Stroke

Abstract A man in his 60s presented to RESUS by ambulance on the hottest day of the year with suspected STEMI and collapse at home. The patient was intubated and unresponsive (GCS 5), with global rigors. Hospital ECG showed sinus tachycardia. Body temperature was in excess of 41°C, confirmed on central temperature monitoring. Bilateral clear fluid was noted to be discharging from both ear canals. Query CSF leak was indication for CT head, which was unremarkable. Considering this, efforts were focused on optimising body temperature. This was done with the use of ice packs and fans as well as continuous misting of cool water over the exposed patient. Improvement was shown with temperatures decreasing to 38°C. In questioning the cause of the “clear fluid,” a swab of it placed on an icepack swiftly returned the fluid to its natural consistency of ear wax. As a result of the extraordinarily high body temperatures, ear wax had melted in both ear canals and started to leak out, giving the impression of a CSF leak. This was simply identified at the bedside to refute the idea of a CSF leak. As CSF leak was the indication for a CT head, this could have been avoided with rapid cooling initiated earlier. Unfortunately, this patient later died due to heat stroke. Whilst avoiding the delay of a CT head most likely would not have changed the prognosis for this patient, it is useful to note the importance of logical thinking in an emergency setting.

32315 Postoperative care consideration: Cold panniculitis induced by cooling device after knee surgery

A 52-year-old woman presented with 1-week history of an asymptomatic eruption on the right knee. This started as blanched patches which progressed over a few days to raised urticarial papules. Prior to the onset of the eruption, she had been using a cold therapy device on this knee for three weeks after arthroscopy and medial meniscus repair. On examination, there were smooth indurated round papules localized to the right anterior knee. A punch biopsy was obtained revealing a superficial and deep perivascular lymphocytic infiltrate extending into the subcutis, consistent with cold panniculitis. Cold panniculitis refers to inflammation of the fat following exposure to very cold temperatures. It is most common in the cheeks of young children but has rarely been reported in adults, including in female equestrians and after use of ice packs for chronic lower back pain. There has also been a report of cold panniculitis after use of a cold device after shoulder surgery. Treatment frequently involves removing the source of thermal injury. Our patient was instructed to stop using her cold therapy device and over time her lesions resolved. Given the development and increased availability of such devices, it is possible a similar clinical picture may present more frequently in dermatology clinics in the future.

Local cooling for relieving pain from perineal trauma sustained during childbirth.

Local cooling for relieving pain from perineal trauma sustained during childbirth.

Management of perineal pain among postpartum women in an obstetric and gynecological hospital in China: a best practice implementation project.

Perineal pain is a serious condition that may negatively impact a significant number of postpartum women. Healthcare professionals, including midwives and nurses, are available to support women 24 hours a day during this period in hospital and are in an ideal position to assist in the management of perineal pain for postpartum women. The aim of this evidence implementation project was to improve management of perineal pain among postpartum women in Ward 21 of the Obstetric and Gynecological Hospital, Fudan University. This evidence implementation project utilized the Joanna Briggs Institute Practical Application of Clinical Evidence System, and Getting Research into Practice audit and feedback tools. Six best practice recommendations were used for the audit cycle. A total of 18 nurses, three midwives and 30 female patients participated in the project. A baseline audit was conducted, followed by the implementation of strategies targeted to address the identified barriers. A follow-up audit was then conducted to evaluate change in practice. Improvements in practice were observed for all six criteria. Significant improvements were found for the following: staff education increased compliance by 76% (from 24% to 100%). Education regarding antenatal perineal massage technique increased by 97% (from 3% to 100%). Compliance rates for use of ice packs increased by 63% (from 17 to 80%). Compliance rates for daily perineal pain assessment conducted for three days following childbirth increased by 100%, and analgesia administration rates increased by 27% (from 1% to 40%). Compliance rates for women's acceptance of postnatal perineal care education increased by 70% (from 30 to 100%). The current clinical audit project has made a significant improvement in establishing evidence-based practice of management of perineal pain among postpartum women in the gynecologic and obstetric hospital in Shanghai. It has been effective in increasing staff compliance and reducing the perineal pain among postpartum women.

The use of ice packs for pain associated with arterial punctures

Background: Arterial punctures for monitoring respiratory problems are one of the most painful procedures in hospitalized patients. The knowledge regarding non-pharmacologic methods of pain management, including cold application is limited. Objective: This aim of this study was to determine if the application of ice packs before the procedure would decrease the pain perception of patients during the arterial puncture. Materials and methods: This experimental study was undertaken among patients admitted to emergency ward in a public educational center affiliated to Ilam University of Medical Sciences, Ilam/Iran. Sixty-one eligible subjects were randomly assigned to two groups. The treatment group (n = 31) received ice packs before arterial puncture, whereas the control group (n = 30) received no intervention for pain management. Pain immediately and 5 minute after the arterial puncture were scored on a visual analog scale (VAS) from 0 to 10. Results: The mean of pain score immediately after the arterial puncture were 3.12 (1.68) and 4.6 (1.56) for treatment and control group, respectively (p < 0. 001). The mean pain score 5 minute after the punctures were 1.9 (1.51) for treatment group and 2.53 (1.85) for control group. This difference was not statistically significant. The mean of heart rate during the procedure were 75.45 (9.76) beats/min for the treatment subjects and 75.46 (9.36) beats/min for the control group (p>0.05). Patients with previous arterial puncture reported higher pain intensity. Conclusion: Cold packs is a simple, non-invasive and inexpensive technique for pain management before the arterial puncture. However, there is a need for further research regarding this topic.

Efficacy of Different Cooling Methods for Capture-Induced Hyperthermia in Antelope

The capture of wild animals is a stressful event which may cause a capture-induced hyperthermia, resulting in morbidity or mortality. We investigated whether various cooling techniques were effective at lowering the body temperature of hyperthermic animals. To achieve this, we implanted miniature temperature-sensitive data loggers into the abdomens of 12 blesbok (Damaliscus pygargus phillipsi ). Five animals were cooled by dousing with water of different temperatures (4°C, 17°C, 28°C) and fanning after dousing with 28°C water. Seven animals were cooled by ice-packs, a fine mist spray of 28°C water, intravenous (IV) infusion of one litre of 4°C saline solution or 28°C water-dousing. The body temperature after capture was significantly elevated to as high as 41°C to 42°C. Water-dousing interventions significantly decreased minimum body temperature but there was no difference in the minimum body temperature reached or the magnitude of cooling between the different water temperatures or by the addition of fanning. The ice-packs also lowered body temperature, whereas mist spraying did not. The use of ice packs and dousing with water between 4°C and 28°C were the most effective techniques to reduce capture-induced hyperthermia in blesbok. Water-dousing, when done appropriately, is the most practical and effective method to cool an animal with capture-induced hyperthermia.

Does the use of thiopental provide added cerebral protection during deep hypothermic circulatory arrest?

A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was: Does the use of thiopental provide added cerebral protection during deep hypothermic circulatory arrest (DHCA)? Altogether, more than 62 papers were found using the reported search, of which 7 represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. Four of the seven papers used thiopental alongside other neuroprotective methods and agents. The methods included the use of ice packs to the head and core systemic hypothermia. Agents used alongside thiopental included nicardipine and mannitol. Thiopental was found to have the ability to lower oxygen consumption, where oxygen consumption was measured using the phosphocreatinine and adenosine triphosphate ratio. The neuroprotective effect of thiopental was evaluated by assessing the electrical activity of the brain during circulatory arrest, by which it was shown to be advantageous. However, other trials suggested that adding thiopental during circulatory arrest did not provide any extra protection to the brain. The timing of thiopental administration is of importance in order to gain positive outcomes, as it's ability to lower the cerebral energy state may result in unfavourable results if added before hypothermic circulatory arrest, where this may lead to an ischaemic event. We conclude that the use of thiopental during deep hypothermic circulatory arrest is beneficial, but if administered too early, it may replete the cerebral energy state before arrest and prove to be detrimental.

Superficial Frostbite Masquerading as Ecchymosis from Improper Cryotherapy Use After Q-Switched Laser Tattoo Treatment

With the development of quality-switched (QS) laser tattoo removal treatment, along with the increasing popularity of tattooing, the number of requests for tattoo removal has increased significantly. Tattoo removal using QS lasers is well established in the medical literature as safe and effective. Cryotherapy using ice packs is widely accepted as a common means by which to diminish postprocedural discomfort and edema from a large variety of medical procedures, including QS laser tattoo removal. In the following case report and discussion, the authors describe what they believe are the first cases of superficial frostbite from improper use of ice packs after laser tattoo removal treatment using QS lasers.

Longitudinal Changes of Nerve Conduction Velocity, Distal Motor Latency, Compound Motor Action Potential Duration, and Skin Temperature During Prolonged Exposure to Cold in a Climate Chamber

ABSTRACTChanges of nerve conduction velocity (NCV), distal motor latency (DML), compound motor action potential (CMAP) duration, and skin temperature with regard to cold have been investigated by use of ice packs or cold water baths, but not after cooling of environmental temperature which has higher ecological validity. The aim of this study was to investigate these parameters during cooled room temperature. NCV, DML, and CMAP duration of the common fibular nerve, and skin temperature were measured in 20 healthy young females during exposure to 15°C room temperature, coming from 25°C room. We found that NCV decreased and DML increased linearly during 45 min observation time, in contrast to CMAP duration and skin temperature which changes followed an exponential curve. To the best of our knowledge, this is the first study investigating changes of these parameters during exposure to environmental cold. The results may pilot some new hypotheses and studies on physiological and pathological changes of the peripheral nervous system and skin to environmental cold, e.g., in elderly with peripheral neuropathies.

Therapeutic hypothermia and frostbite injury: a preventable source

Frostbite injury from cold exposure is not uncommon. The application of ice pack is well known in clinical practice; however, its improper use can pose danger to the patient. We report a case of frostbite injury due to prolonged use of ice packs in a ventilated patient.

Perineal Analgesia With an Ice Pack After Spontaneous Vaginal Birth: A Randomized Controlled Trial

This study evaluated the effectiveness of an ice pack applied for 20 minutes to alleviate perineal pain after spontaneous vaginal birth. We conducted a randomized controlled trial at the Amparo Maternal Birth Center in São Paulo, Brazil. Study participants included 114 nulliparous women divided into 3 groups (n = 38 per group): experimental (ice packs on the perineum), placebo (water packs at set temperature), and control (no treatment). A numerical scale (0 to 10) was used for pain assessment. A comparison of the average pain at the beginning and after 20 minutes showed a significant reduction of pain (P < .001) in the 3 groups, and the experimental group had a lower average score for pain compared with the control group (1.6 versus 3.3, P = .032). The use of ice packs for 20 minutes was effective for perineal pain relief after vaginal birth.

Complicações na rede venosa de mulheres com câncer de mama durante tratamento quimioterápico

OBJETIVOS: Identificar as reações da rede venosa, investigar a frequência e as características dessas reações em mulheres com câncer de mama durante o tratamento quimioterápico. MÉTODOS: Foram avaliados 339 prontuários de mulheres submetidas à quimioterapia, de 2003 a 2007. RESULTADOS: Durante os tratamentos neoadjuvantes e adjuvantes 17,1% e 22,4% mulheres apresentaram intercorrências registradas no prontuário, sendo as frequentes: extravasamento, dor e alteração na coloração da pele. As condutas mais citadas na neoadjuvância foram: utilização de compressas frias (2,9%) e aplicação de glicocorticoide subcutâneo no local (3,5%) e na adjuvância foram: aplicação de hidrocortisona subcutâneo no local (3,2%), aplicação do protocolo de extravasamento (6,2%) e utilização de compressas de gelo (7,1%). CONCLUSÃO: O registro das intercorrências e o relato da equipe de enfermagem são essenciais para o acompanhamento dos sítios de punções venosas utilizados durante o tratamento quimioterápico, além de mensuração e registro fotográfico do local.

Mild hypothermia induction following cardiac arrest using a water-circulating cooling device

The use of mild hypothermia for comatose survivors of cardiac arrest has been endorsed by the American Heart Association and the International Liaison Committee on Resuscitation [1,2]. Unintentional overcooling is common with some techniques such as cool intravascular fluid or the use of ice packs. Nowadays, the maintenance of hypothermia can be facilitated with new technology to avoid unintentional overcooling.

Hypothalamic, rectal, and muscle temperatures in exercising dogs: effect of cooling.

To investigate mechanisms that may be involved in the prolongation of exercise performance with body cooling hypothalamic (Thy), rectal (Tre), and exercising muscle (Tm) temperatures, as well as the heart rate, respiratory rate, blood lactic acid concentration ( [LA] ), and plasma osmolality (Osm) were measured in five dogs during exhaustive treadmill exercise at an ambient temperature (Ta) of 22 +/- 1 degree C without cooling (control) and with external cooling by use of ice packs. In both series of experiments, dehydration of animals was prevented. Compared with exercise with noncooling, exercise with cooling resulted in 1) increased exercise duration from 90 +/- 14 to 145 +/- 15 min (62%, P less than 0.05); 2) attenuated increases in Thy, Tre, and Tm; 3) decreased respiratory and heart rates; and 4) lowered LA. Significant negative correlations were found between both Tm and delta Tm attained at 60 min of the run and time of exercise until exhaustion (r = -0.72 and -0.74, respectively; P less than 0.02). This work failed to differentiate clearly changes or equilibrium levels of brain, core, or muscle temperature as separate factors affecting work tolerance. However, the inverse relationship between Tm reached at 60 min of the run (in both experiments) and the total duration of exercise indicates that sustained muscle hyperthermia may largely contribute to limitation of working ability.