BACKGROUND: Hypothermia is frequently observed in near-downing victims, and rewarming is difficult to control. We describe the use of an automatic heating system (Arctic Sun Temperature Management System). The device consists of hydrogel coated pads that adhere to the patient's abdomen, back and thighs, and react to patient temperature by automatically adjusting the circulating pad water temperature to achieve a preset patient target temperature. Temperature is measured by a bladder temperature probe. The process of warming can be adjusted to allow the body temperature to increase at a rate from 0.5 to 1.0 degree C h(-1). CASE REPORT: A 62-yr-old woman was rescued from the Vistula river after a suicide attempt. The temperature of the river water was 150C and it was not possible to estimate the time she was submerged. On admission she was conscious and maintaining partially logical communication. She was hypothermic (temperature measured in the bladder was 32.7 degrees C), and dyspnoeic (SaO2
Mild or moderate hypothermia may be underdiagnosed in Canada. This paper presents five cases of treated hypothermia, describes the pathophysiologic aspects of cold injuries and discusses the rationale and techniques of rewarming. An orderly series of specific clinical and laboratory observations is proposed to ensure prompt and accurate diagnosis and treatment, and to improve the management of hypothermia.
A four-week team-rehabilitation programme in a warm climate decreases disability and improves health and body function for up to one year: A prospective study in Swedish patients with inflammatory joint diseases.
In the era of biologics, we evaluated the short- and long-term effects of team-rehabilitation in a warm climate in patients with arthritis and an inadequate response to physio-therapy in Sweden.
A total of 161 patients with peripheral arthritis and spondyloarthritis, 63% treated with biologics, followed team-rehabilitation for a period of 4 weeks. The outcomes assessed pre- and post-rehabilitation and after 3 and 12 months covered the Heath Assessment Questionnaire (HAQ), Bath Ankylosing Spondylitis Functional Index (BASFI), EuroQoL 5-Dimensions (EQ-5D), general health (VAS-GH), pain (VAS-pain) and the International Physical Activity Questionnaire.
HAQ, VAS-GH and VAS-pain improved significantly from pre-rehabilitation to all follow-up time-points, and BASFI and EQ-5D up to 3 months. In patients treated with biologics, the results were similar. At 3 and 12 months the proportions of patients reporting improvement above the minimal clinically important difference were HAQ 62% and 35%, BASFI 73% and 61%, EQ-5D 47% and 39%, VAS-GH 68% and 52%, and VAS-pain 68% and 51%, respectively. Physical activity increased significantly from pre-rehabilitation to 12 months and this increase correlated with an improvement in EQ-5D (r?=?0.20, p?=?0.040).
Team-rehabilitation in a warm climate resulted in clinically meaningful improvements in body function, activities and well-being, and promoted physical activity for up to one year.
To improve heat transfer, the Medivance Arctic Sun Temperature Management System (Medivance, Inc., Louisville, CO, USA) features an adhesive, water-conditioned, highly conductive hydrogel pad for intimate skin contact. This study measured and compared the heat transfer coefficient (h), i.e. heat transfer efficiency, of this pad (hPAD), in a heated model and in nine volunteers' thighs; and of 10 degrees C water (hWATER) in 33 head-out immersions by 11 volunteers.
Volunteer studies had ethical approval and written informed consent. Calibrated heat flux transducers measured heat flux (W m-2). Temperature gradient (DeltaT) was measured between skin and pad or water temperatures. Temperature gradient was changed through the pad's water temperature controller or by skin cooling on immersion.
The heat transfer coefficient is the slope of W m-2/DeltaT: its unit is W m-2 degrees C-1. Average with (95% CI) was: model, hPAD = 110.4 (107.8-113.1), R2 = 0.99, n = 45; volunteers, hPAD = 109.8 (95.5-124.1), R2 = 0.83, n = 51; and water immersion, hWATER = 107.1 (98.1-116), R2 = 0.86, n = 94.
The heat transfer coefficient for the pad was the same in the model and volunteers, and equivalent to hWATER. Therefore, for the same DeltaT and heat transfer area, the Arctic Sun's heat transfer rate would equal water immersion. This has important implications for body cooling/rewarming rates.
Since the release of acute low back pain management guidelines in 1994, little was known about the effect of these guidelines on clinical practice. The purpose of this study was to examine physical therapists' reported management of acute and subacute lumbar impairment.
One in 10 registered physical therapists who were randomly selected from southern Ontario, Canada, (n=454) and all registered physical therapists from northern Ontario (n=331) were surveyed.
In the questionnaire, case scenarios covered 3 areas related to the management of lumbar impairment: (1) physical examination, (2) treatment and recommendations, and (3) therapists' beliefs regarding its management.
Five hundred sixty-nine questionnaires were returned (response rate=72.5%). Only data obtained for therapists (n=274) whose weekly workload included more than 10% of people with lumbar impairment were used in the analysis. Overall, patient education, exercise, and electrotherapeutic and thermal modalities were the preferred interventions for acute lumbar impairment (symptom onset of less than 5 weeks) with or without sciatica, whereas exercise and work modification were preferred for subacute lumbar impairment (symptom onset of 5 weeks or longer). There was a trend of using electrotherapeutic and thermal modalities with uncertain effectiveness. Only 46.3% of the therapists agreed or strongly agreed that practice guidelines were useful for managing lumbar impairment.
Although the physical therapists surveyed, in general, followed the guidelines in managing acute lumbar impairment, they felt uncertain regarding the value of practice guidelines. Future research should focus on identifying effective treatment approaches and exploring the effectiveness of practice guidelines.