Effects of Salted ice bags on surface and intramuscular coo - PowerPoint Presentation

Slide1

Effects of Salted ice bags on surface and intramuscular cooling and rewarming rates

Presented by:

Eric Hunter and Caitlyn CrowleySlide2

Literature review

Cryotherapy is used among healthcare providers to treat acute injuries by reducing pain and limiting the formation of swelling.

1,2

Lowers the metabolic rate decreasing the amount of oxygen needed.

No optimal temperature has been set to effectively limit the negative effects of inflammation.

3,4

Colder the tissues the better….. No benefit found below 5°C.

4Slide3

Literature review

Ice bags have been shown to be the most effective at cooling tissue when compared to other packs (gel, chemical).

5,6, 7

They cool intra-muscular temperature the fastest and get the coldest.

Skin/intramuscular tissue continue cooling longer after the modality has been removed

Skin/intramuscular tissue

take longer to re-warm to normal temperature

Wetted Ice bags are the most effective at decreasing skin and intramuscular temperature when compared with normal cubed or crushed ice bags.

3

Continued research has looked at most effective ways to cool tissues.

No one has looked at adding salt to an ice bagSlide4

Theory

Using knowledge of basic science

A

dding salt to H

2

O decreases freezing points

Pilot study has demonstrated ability to decrease water temperature by adding saltSlide5

Pilot data

Control Condition: 2000 mL wetted ice



0.5

 C

Experimental Conditions: 2000 mL ice +

uniodized

salt

Amount of Salt Added

Resultant Temperature

1/2

cup

~ -15

o

C

1/4

cup

~ -11

o

C

1/8 cup

~ -8

o

C

1/16

cup (1

Tbsp

)

~

-5

o

CSlide6

Why important to AT Field

Decreased tissue temperature

Decrease effects of secondary hypoxic injury

Potentially decreased

treatment

times

Faster numbing (less cold pain)

Better patient compliance if treatment doesn’t take as long?

Potentially longer re-warming time

Secondary hypoxic injury is reduced for a longer time

May result in less time loss from injury Slide7

Study design

Repeated-measures

Counterbalanced

ABC, ACB, BCA, BAC, CAB,

CBA

Three treatment groups

Wetted cubed ice (A)

Current best practiceSalted cubed ice (B)

Salted crushed ice (C)

Independent

variable

Time

Group

Dependent

variable

Temperature

Skin

IntramuscularSlide8

Participants

24 subjects

Exclusion Criteria

18-26

Healthy

Male and Female

No known vascular disease in lower leg

No injury to lower leg in the last month or during the study

No sensitivity to cold

Not allergic to cold/ice

No compromised circulation of the lower legSlide9

recruitment

Fliers

Tear offs

QR Scan

Announcements in classSlide10

Measurement tools

Skinfold calipers

Skyndex

,

Cadwell

,

Justiss

and Co, Inc., Fayetteville, ARSurface thermocouple SST-1,

Physitemp

Instruments, Inc, Clifton, NJ OR Omega thermocouples

26

-gauge hypodermic needle microprobe

Physitemp

MT-26/4,

Physitemp

Instruments, Inc, Clifton, NJ

Microprocessor thermometer

M

odel

HH23, Omega Engineering,

Inc

,

Stamfort

, CT) Slide11

conditions

Wetted ice bag

Cramer

ice bag

2000 mL cubed ice

300 mL room temperature water

Salted crushed ice bag

Cramer ice bag

1

Tbsp

Morton Unionized

Salt

2000 mL crushed ice

Salted cubed

ice bag

Cramer ice

bag

1

Tbs

Morton

Uniodized

Salt

2000 mL

cubed iceSlide12

Anticipated Procedures

Training on insertion at BYU by Dr. David Draper & colleagues

Calf measurements taken to determine location of largest girth where microprobe will be inserted on the posterior lateral portion of the calf.

Skinfold measurements will be taken 3 times and then the average will be used

Divide mean measurement by 2 for amount of subcutaneous fat

For intramuscular depth measure a vertical distance of 2 cm plus the ½ mean

skinfold

Mark the lateral aspect of the lateral head of the

gastrocnemius

using a fabricated template labeled to

the nearest millimeter to ensure proper insertion point

Insertion of microprobe and placement of surface

thermocouple on participants by the same two

researchers Slide13

Anticipated Procedures

Insertion area will be shave and cleaned prior to insertion

Baseline period of 20 minutes for intramuscular temperatures to reach plateau (participants lying prone on table for entire process)

Ice condition applied

Treatment time of 20 minutes

Ice removed

Recovery time of 45 minutes

Surface thermocouple, treatment template and microprobe will be removed

Area will be cleaned and covered with a self-adhesive bandage

** Temperatures will recorded every 30 seconds throughout the studySlide14

Timeline

Spring semester 2013

Training in microprobe insertion techniques

Secure funding

Subject recruitment period

Beginning September 2013

Data collection period

Sept

ember - November 2013

Data analysis period

November 2013

Prepared to defend/prepare manuscript for publication!!

Spring 2014Slide15

Statistical analysis

Repeated measure ANOVA

Skin temperature

Baseline, 30-second intervals for 20-minute treatment time, 30-second intervals for 45 minute rewarming period

Intramuscular temperature

Baseline, 30-second intervals for 20-minute treatment time, 30-second intervals for 45 minute rewarming period

Microprocessor thermometer will be video recorded to ensure accurate temperature capture at desired intervalsSlide16

Null Hypotheses

There will be no difference in surface and intramuscular cooling and rewarming rates between the three treatment conditions.Slide17

Research Hypotheses

Both salted crushed/cubed will decrease skin temperature more than wetted ice

Both salted crushed/cubed will decrease intramuscular temperature more than wetted ice

Both salted crushed/cubed will have longer skin temperature rewarming times than wetted ice

Both salted crushed/cubed will have longer intramuscular temperature rewarming times than wetted ice

Salted cubed ice will decrease skin temperature more than salted crushed ice

Salted cubed ice will decrease intramuscular temperature more than salted crushed iceSlide18

Challenges/limitations

Ice bag falling off

Template on skin

Limited rewarming time

Initial/exploratory studySlide19

Funding

NATA grant

$1,000

University grant

Moyes

Academic Support & Technology Endowment Committee

Funds used for

Microprobes

Thermocouples

Ice bags

Salt

Sanitizing and sterilizing materials

Adhesive bandages

Subject incentiveSlide20

References

1. Dolan MG, Thornton RM, Fish DR, Mendel FC. Effects of Cold Water Immersion on Edema Formation After Blunt Injury to the Hind Limbs of Rats.

J

Athl

Train

. 1997;32(3):233–237.

2.

Meeusen R,

Lievens

P. The use of cryotherapy in sports injuries.

Sports Med

. 1986;3(6):398–414.

3. Merrick MA,

Jutte

LS, Smith ME. Cold Modalities With Different Thermodynamic Properties Produce Different Surface and Intramuscular Temperatures.

J

Athl

Train

. 2003;38(1):28–33.

4.

Sapega

AA,

Heppenstall

RB,

Sokolow

DP, et al. The bioenergetics of preservation of limbs before

replantation

. The rationale for intermediate hypothermia.

J Bone Joint

Surg

Am

. 1988;70(10):1500–1513.

5. Dykstra JH, Hill HM, Miller MG, Cheatham CC, Michael TJ, Baker RJ. Comparisons of Cubed Ice, Crushed Ice, and Wetted Ice on Intramuscular and Surface Temperature Changes.

J

Athl

Train

. 2009;44(2):136–141.

6.

Kennet

J,

Hardaker

N, Hobbs S,

Selfe

J. Cooling Efficiency of 4 Common

Cryotherapeutic

Agents.

J

Athl

Train

. 2007;42(3):343–348.

7.

Myrer

JW, Draper DO,

Durrant

E. Contrast Therapy and Intramuscular Temperature in the Human Leg.

J

Athl

Train

. 1994;29(4):318–322.Slide21

Any questions?