Agents - 7 - Estim for Tissue Repair & Edema

• pressure injuries

• diabetic ulcers

• venous stasis ulcers

• arterial ulcers

• traumatic wounds

• surgical wounds

• burns

• donor sites

examples/indications of estim for wounds:

pressure injuries

research shows that the greatest effect of estim with wound healing is for ________

angiogenesis, good quality granular

estim for wounds can help up regulate _________ to produce __________ tissue

acute 

(acute/chronic) wounds heal better with estim 

galvanotaxis

the MOA with estim for wounds is ____________, where cells sense change in electricity and follow DC in tissue healing

high voltage pulsed / twin peak monophasic

the waveform for estim for wound healing is _______________ aka ______________

100 pps

pulse frequency for wound care estim is ______pps

4-100 msec

pulse duration for wound care estim is ___-___ msec, but often preset 

100 msec

our machines have a preset pulse duration of _____msec

45-60 min, 5-7x/wk

duration of HVPC for wound care is ____-____, __-__x/week

cathode

with wound healing, the (cathode/anode) is used in the wound early in healing

anode 

with wound healing, the (cathode/anode) is used in the wound later in healing

DON’T

when using electrodes in a wound, (do/don’t) reuse them

F; doesn’t mean it’s always positive

T/F: the active electrode is the treatment electrode and is positive

CLOCK, rotate

document estim for wound healing as a _______ and make sure to _________ pads

6-12 in

dispersive electrodes should be places ___-___ away from the active electrode 

MONOPOLAR

dispersive and active electrodes only apply to ________ configurations

LOCALIZED

estim can be used for _______ edema

get yourself a tasty treat

tee hee

ONSET of swelling 

for acute localized edema, the purpose of HVPC is to limit the ___________

24-72

for acute localized edema, HVPC should be used within ___-___ hours

negative, negative serum proteins

for acute localized edema, the cathode (____charge) repels _____________

F; MONOPOLAR

T/F: for acute localized edema, HVPC is bipolar

T

T/F: with HVPC for acute localized edema, you should also elevate the leg 

100-125pps

acute localized edema: parameters for frequency: ___-___pps

2-100 msec, preset at 100 for us

acute localized edema: parameters for pulse duration: ___-___ msec, preset ______

barely comfortable sensory

acute localized edema: parameters for amplitude are _____________

CATHODE 

acute localized edema: the active electrode is the ________ over the edema 

20-45 minutes

acute localized edema: parameters for time duration are ____-____

T

T/F: there is some solid evidence for HVPC in the acute phase of edema

NMES

estim for chronic localized edema is similar to ________

russian or biphasic pulsed 

the waveforms used for chronic localized edema are _______ or _________

20-80 pps (or bursts/sec)

chronic localized edema: parameters for frequency are ___-___pps

100-600 msec

chronic localized edema: parameters for pulse duration are ___-___ msec

tetanic contraction

chronic localized edema: parameters for amplitude are a _____________

1:1 ratio, 1-3 min 

chronic localized edema: parameters for on off time are a __:__ ratio for ___-___ min

10-20 min

chronic localized edema: parameters for duration are ___-___ min

repetitive muscle action

the MOA for estim for chronic localized edema is ________________

iontophoresis

____________ is a technique that utilizes a direct galvanic current to deliver a drug or other substance through the skin

ARE 

with ionto, chemicals (are/are not) going to build up under the skin 

direct

iontophoresis uses ______ current

***polarity dependent ***

with ionto the substance used needs to be ionic in nature because the application is ____________

deliver a drug in high concentration to a specific site

the purpose of ionto is to __________________________

minimizing adverse local or systemic side effects 

an advantage of drug administration via ionto is ____________

positive

an anode repels (positive/negative) ions

negative

an anode attracts (positive/negative) ions

positive 

the anode is (positive/negative) 

negative

a cathode repels (positive/negative) ions

positive 

a cathode attracts (positive/negative) ions 

negative

the cathode is (positive/negative)

• repulsion of like charges

• electroporation (estim incr porosity of skin)

• electroosmosis

the three mechanisms for movement of ions into tissues are:

negative

human skin is at a net ______ charge

anode, positive 

the body is going to assist ions delivered from a/n _______ that are _________ in charge 

cathode 

negative ions from the _______ need more current/amplitude for delivery 

dexamethasone

the most common med used with ionto is ________________

red (+)

the anode line is _____ and has a ___ charge

black (-)

the cathode line is _____ and has a ___ charge

POLARITY OF THE DRUG 

for ionto, the therapist MUST know the ________________

negative

if the drug is negative, you need to put the _______ electrode over the treatment area

drive the drug into the skin

the goal with ionto is to ________________

superficially

with a closer electrode placement for ionto, the current goes into tissue more _________

1.7 cm

the medication used in ionto can go into skin up to ____cm

directly over site for tx

for ionto, the active electrode is placed ____________

over muscle belly at site distance to active electrode

for ionto, the inactive electrode is placed _____________

ice = cold = vasoconstriction = keeping drug in target tissue longer

what is the logic for using ice with ionto?

dosage = current * duration 

what is the equation for ionto dosage?

mA-min

ionto dosage is measured in ____

20-80 mA-min

the typical clinical dosage for ionto is ____-____

40 mA-min

the common target for ionto dosage is _________

soft surface 

ionto pads will have a _________ on the pad that absorbs the medication being used 

current density = current amplitude mA / conductive surface of the electrode (cm²)

what is the equation for current density with ionto?

lower

larger pads will have a ______ current density

1.0 mA/cm²

ionto: the maximum safe current density for the anode is ______

0.5 mA/cm²

ionto: the maximum safe current density for the cathode is ______mA/cm²

SODIUM HYDROXIDE - concern for skin damage

the MSCD for the cathode is lower because __________ can form under the cathode

negative

the polarity of dexamethasone is _________

negative 

the polarity of acetic acid is ___________

positive

the polarity of lidocaine is __________

negative

the polarity of salicylates is _________

negative

the polarity of iodine is _________

positive 

the polarity of zinc oxide is ________

dexamethasone, anti-inflammatory

inflammation/-itis is an indication for ____________, which has a/n ___________ effect

acetic acid, increase solubility of calcium deposits

calcific tendonitis is an indication for ____________, which has a/n ___________ effect

lidocaine, local anesthetic

soft tissue pain and inflammation is an indication for ____________, which has a/n ___________ effect

salicylates, analgesic & anti-inflammatory 

muscle and joint pain is an indication for ____________, which has a/n ___________ effect

iodine, sclerolytic

adhesive capsulitis and soft tissue adhesions are an indication for ____________, which has a/n ___________ effect

zinc oxide, general antiseptic

skin ulcers are an indication for ____________, which has a/n ___________ effect

T

T/F: zinc oxide may increase tissue healing

alcohol pad 

for ionto, you should clean the skin with _________

4mA

for ionto, the current amplitude should be no greater than _____ to avoid burns

• educate that redness is normal

• CLOSELY inspect skin

what should you ALWAYS do after ionto:

DIRECT CURRENT, drug being used

with ionto, there is a greater risk of skin irritation and redness because of ________, not because of the _______

active 

irritation with ionto is most common under the ______ electrode 

1-2 hours

redness from ionto DC should go away within ___-___

stinging, ant bites

adverse sensation effects to ionto are often described as _______ or _______

cl

electrochemical effects: anode attracts (na/cl)

na 

electrochemical effects: cathode attracts (na/cl)

hcl

electrochemical effects: anode forms (naoh/hcl)

naoh

electrochemical effects: cathode forms (naoh/hcl)

acidic

electrochemical effects: anode reaction is (acidic/alkaline)