1. Lecture 2 PIER Review

2. Pressure  Apply a pressure pad and wrap to prevent extra- cellular fluid from moving distally  Take distal pulse to ensure the wrap is not too tight  Maintain compression continuously over the first 24- 48 hours

3. Ice  Apply ice for 15 to 25 minutes directly to the skin  Ice applications should be repeated every 30 minutes to 1 hour when ever possible  Should continue to ice for 24- 72 hours post injury  If skin area is warm to touch continue to ice area

4. Elevation  Elevate the injured body part above the heart  While sleeping raise the end or the bed or use pillows to elevate the injured body part Rest/Restricted Activity  If individual is unable to walk with out a limp, the person should be on crutches  If the injury is an upper extremity injury and unable to move with out pain then a sling should be used

5. Why PIER  The length of the inflammatory phase is a key factor that influence the ultimate stability and scar tissue  The longer the inflammatory process, the more likely the resulting scar tissue will be less dense and weaker

6. Controlling Inflammation  Hemorrhage and edema cause a pooling of tissue fluids and blood products that increase pain and muscle spasm  Cryotherapy leads to vasoconstriction, decreased circulation and capillary permeability and limits secondary tissue hypoxia.  Nerve impulses are slowed, leading to an analgesic effect and there is a reduction in muscle spasm  Elastic compression can assist in decreasing edema formation and reduce the swelling by promoting re-absorption, yet can allow for some expansion in the case of extreme swelling

7.  Elevation reduces capillary hydrostatic pressure and therefore decreases the amount of fluid forced out of the capillaries into the surrounding spaces  End result is less edema formation  Rest or restricted activity decreases stress on the injured area and will reduce swelling and pain

8. Contrast 2:2,3:3,2:4 Heat usually used after the acute phase to increase blood flow and promote healing heat has an analgesic or sedative effect, it is used to decrease muscle spasm and pain vasodilatation and increased circulation result in a influx of oxygen and nutrients to help promote healing