Use of Cryotherapy for Managing Epistaxis in the First Aid Setting: A Scoping Review

Epistaxis, or nosebleed, is bleeding from the nostril(s), nasal cavity, or nasopharynx. Anterior nasal bleeding is the most common location for spontaneous nontraumatic epistaxis and is commonly treated with manual compression to the nasal alae. Cryotherapy is also routinely recommended in conjunction with manual compression in the first aid and ED setting. We performed a scoping review on behalf of the International Liaison Committee on Resuscitation First Aid Task Force guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews (PRISMA-ScR). We searched Embase, Cochrane, and PubMed databases for published studies, without date restrictions, and we searched the gray literature using Google.com and Google Scholar. The websites of selected resuscitation councils were searched for guidelines relating to the management of epistaxis. References from included studies were hand-searched. Our published and gray literature search identified 1255 and 61,315 records, respectively. After removing duplicates and following selection criteria, we included 21 records from the published literature and 11 records from the gray literature. Our scoping review found that most of the published studies and website documents focused on managing nontraumatic epistaxis in the first aid setting. They provide recommendations for the use of cryotherapy based on expert opinion or indirect evidence extrapolated from cryotherapy-associated changes in nasal submucosal temperature, nasal blood flow, and nasal blood volume in healthy subjects (three studies). We did not identify any prospective, randomized trials comparing the efficacy of cryotherapy as an intervention for nontraumatic epistaxis in the first aid setting. The limited literature identified in this scoping review does not support the development of a systematic review but highlights the need for future research to better understand the role of cryotherapy in the first aid setting.

Therapeutic hypothermia for moderate and severe hypoxic ischaemic encephalopathy in newborns using low-cost devices - ice packs and phase changing material

Background: Different methods have been used for therapeutic hypothermia for neonates with moderate-to-severe hypoxic ischaemic encephalopathy (HIE). As standard cooling devices are expensive, there is a need to establish the safety and efficacy of low-cost devices such as ice packs (IP) and phase changing material (PCM). Aim: To assess the efficacy and safety of therapeutic hypothermia (TH) and the clinico-laboratory profile of neonates who underwent cooling with IP or PCM. Methods: The study was retrospective. TH for moderate-to-severe HIE was initiated with IP between 2012 and 2014 and with PCM (MiraCradle^TM) from September 2014. A standard protocol for inclusion and management during TH was used for all newborns. All data were collected by means of a local cooling registry. Results: Sixty-two cooled newborns (IP 29, PCM 33) were included in the study. Mean gestational age was 38.6 (1.7) weeks and mean birthweight 2920.6 g (450.7); 66.1% were inborn and 91.9% had moderate encephalopathy. Mean (SD) core temperature during cooling was 33.47°C (0.33) for PCM and 33.44°C (0.34) for IP. Adverse events observed during TH were thrombocytopenia (54.8%), coagulopathy (30.6%), shock (30.6%), skin changes (12.9%) and persistent pulmonary hypertension (8.1%). Forty-nine infants were discharged, two died and 11 were discharged against medical advice. TH was prematurely stopped in seven newborns with serious adverse events such as disseminated intravascular coagulation (DIC), gangrene and arrhythmia (IP 5, PCM 2). Conclusion: Low-cost devices are safe and effective alternatives for maintaining TH in low-resource settings with adequate monitoring. Abbreviations: DAMA, discharged against medical advice; DIC, disseminated intravascular coagulation; HELIX, Hypothermia for Encephalopathy in Low- and Middle-Income Countries Trial; HIE, hypoxic ischaemic encephalopathy; IP, ice packs; LMIC, low- and middle-income countries; NICHD, National Institute of Child Health and Human Development; PCM, phase changing; TH, therapeutic hypothermia (TH); TOBY, total body hypothermia for neonatal encephalopathy.

Heated Debates: Hot-Water Immersion or Ice Packs as First Aid for Cnidarian Envenomations?

Cnidarian envenomations are an important public health problem, responsible for more deaths than shark attacks annually. For this reason, optimization of first-aid care is essential. According to the published literature, cnidarian venoms and toxins are heat labile at temperatures safe for human application, which supports the use of hot-water immersion of the sting area(s). However, ice packs are often recommended and used by emergency personnel. After conducting a systematic review of the evidence for the use of heat or ice in the treatment of cnidarian envenomations, we conclude that the majority of studies to date support the use of hot-water immersion for pain relief and improved health outcomes.

Temperature changes in the human leg during and after two methods of cryotherapy

OBJECTIVE

To compare the cooling and rewarming effects of two clinical 20-minute cryotherapy treatments on the temperature of the human leg.

DESIGN AND SETTING

Sixteen subjects were randomly treated with either 20 minutes of a 1.8-kg crushed-ice pack, placed directly over the left calf, or a 20-minute immersion in a cold (10 degrees C) whirlpool. Data were collected at a university human performance research laboratory.

SUBJECTS

Seventeen male and 15 female healthy college students.

MEASUREMENTS

Subcutaneous and muscle tissue temperatures were measured by 26-gauge hypodermic needle microprobe inserted in the calf, just below the skin, or 1 cm below the subcutaneous fat, respectively.

RESULTS

There was no significant difference in the decrease in intramuscular temperatures between treatments (t (30) = -1.76, P = .09). The ice pack treatment significantly decreased the subcutaneous temperature more than the whirlpool (t (30) = -2.64, P = .01). The subcutaneous temperature rewarmed significantly more in the ice pack group (12.3 +/- 3.3 degrees C) than the cold whirlpool (7.4 +/- 2.1 degrees C) (t (30) = 4.98, P = .0000). The ice pack group's intramuscular temperature increased over each 5-minute interval of the 30-minute post-treatment period for an overall increase of 2.0 +/- 3.1 degrees C. During the 30-minute post- treatment the cold whirlpool group continued to cool, for an overall decrease of 1.8 +/- 1.4 degrees C. This difference between groups at the end of the 30-minute post-treatment was significant (t(30) = 4.44, P = .0001).

CONCLUSIONS

As administered in our protocol, cold whirlpool is superior to crushed-ice packs in maintaining prolonged significant temperature reduction after treatment.