ToMedicalPersonnel

Awareness Through Education, Inc., founded in December 1997, is a school that provides education to healthcare professionals. We are approved by the Florida Board of Nursing, provider #3085. Our mission is dedicated to providing quality training and education to the healthcare professional with the most current clinical information. All courses and home study programs offered provide in-service hours and or continuing education hours for the healthcare professional to meet their re-licensure requirements.

Awareness is committed to quality and excellence. Our educators consist of nurses and paramedics who are experts in their fields. Our classes offer a multimedia approach with the use of the latest video, textbooks and training supplies and equipment.

Our classes are offered at the Awareness Through Education Headquarters classroom located at 7362 W Atlantic Blvd., Margate, Florida. We can also provide seminars at your facility for a group rate. Please contact us for more information.

CRPS/RSD is a chronic condition characterized by severe burning pain, pathological changes in bone and skin, excessive sweating, tissue swelling, and extreme sensitivity to touch. The syndrome is a nerve disorder that occurs at the site of an injury (most often to the arms or legs). It occurs especially after injuries from invasive procedures, such as surgeries, intra venous treatments, injections or anything that penetrates the skin. However, it may occur without apparent injury. It can also occur from something such as a broken limb, sprained ankle or a simple bee sting. The condition was first documented (and named "Causalgia") in the 19th century by physicians concerned about pain that Civil War veterans continued to experience after their wounds had healed. Doctors often called it "hot pain," after its primary symptom. Over the years, the syndrome was classified as one of the peripheral neuropathies, and later, as a chronic pain syndrome.

Currently, there are two types of CRPS that are differentiated-type I and type II. Both types share the same basic set of symptoms, but have one distinct difference: type I (previously referred to as RSD) describes cases in which there is no nerve injury, while type II (formerly called causalgia) refers to cases in which a distinct nerve injury, for example a surgery or invasive trauma, has occurred.

CRPS/RSD is one of the most painful afflictions known to medical science.

What are the symptoms?

The symptoms of CRPS/RSD usually occur near the site of an injury, either major or minor, and include: burning pain, muscle spasms, local swelling, increased sweating, softening of bones, joint tenderness or stiffness, restricted or painful movement, and changes in the nails and skin. One visible sign of CRPS/RSD near the site of injury is warm, shiny red skin that later becomes cool and bluish.

The pain that patients report is out of proportion to the severity of the injury and gets worse, rather than better, over time. It is frequently characterized as a burning, aching, searing pain, which may initially be localized to the site of injury or the area covered by an injured nerve but spreads over time, often involving an entire limb. It can sometimes even involve the opposite extremity. Pain is continuous and may be heightened by emotional stress. Moving or touching the limb is often intolerable. Eventually the joints become stiff from disuse, and the skin, muscles, and bone atroph

Patient Identification

1. Place red bracelet on unaffected limb

2. Place red dot sticker on patient chart

Transport

1. Ask what kind of help the patient needs when transferring

to a stretcher or wheelchair (simply touching arms or legs may cause hyperalgesia)

2. Use extreme care over bumps, such as elevator doorways

Procedures

1. Perform a phlebotomy on unaffected limb only

2. Use Pediatric needles (any trauma can cause the spread of RSD to a new site)

3. Warm Alcohol or Beta dine wipes with warm running

water on outside of package before opening package

(these wipes can be very cold to the patient)

4. If PICA site is available, see if blood can be obtained

from PIC instead of using vena puncture technique.

Blood Pressure and Pulse Rate

1. Use cuff on unaffected limb only

2. Use thigh cuff if both upper extremities are affected

In General

1. Consult with the patient before making physical contact

2. Extreme care should be used when moving medical equipment or such

things as food trays to ensure no contact is make with an affected limb .

Patient Room

1. Whenever possible patient should be in a quiet part

of the hospital

2. In a semi-private room, patient should be in the second

bed to avoid inadvertent bumping

3. A Zone-Air bed should be used (adjust mattress pressure

to patient preference)

4. Heat and air conditioning should be well regulated

5. Standing orders should be issued for patients to have

warm blankets

6. Foot Cradle to hold bed linens off body area (will

diminish tactile stimuli)

7. Frequent linen changes may be necessary due to

hyperhidrosis (increased sweating).

8. Allow family members to bring in clean sheet and pillowcases

for patient. Hospital sheets are not soft and

can irritate the skin.

9. Place a sign above bed designating affected limb

The symptoms of CRPS/RSD vary in severity and duration. However, there are usually 3 stages associated with CRPS/RSD, and each stage is marked by progressive changes in the skin, nails, muscles, joints, ligaments, and bones. Stage 1 lasts from 1 to 3 months and is characterized by severe, burning pain at the site of the injury. Muscle spasm, joint stiffness, restricted mobility, rapid hair and nail growth, and vasospasm (a constriction of the blood vessels) that affects color and temperature of the skin can also occur.

In stage 2, which lasts from 3 to 6 months, the pain intensifies. Swelling spreads, hair growth diminishes, nails become cracked, brittle, grooved, and spotty, osteoporosis becomes severe and diffuse, joints thicken, and muscles atrophy.

As the patient reaches stage 3, changes in the skin and bones become irreversible, and pain becomes unyielding and may now involve the entire limb. There is marked muscle atrophy, severely limited mobility of the affected area, and flexor tendon contractions (contractions of the muscles and tendons that flex the joints). Occasionally the limb is displaced from its normal position, and marked bone softening is more dispersed.

How is CRPS/RSD diagnosed?

CRPS/RSD is often misdiagnosed because it remains poorly understood. Diagnosis is complicated by the fact that some patients improve without treatment. A delay in diagnosis and/or treatment for this syndrome can result in severe physical and psychological problems. Early recognition and prompt treatment provide the greatest opportunity for recovery.

CRPS/RSD is diagnosed primarily through observation of the symptoms. However, some physicians use thermography (a diagnostic technique for measuring blood flow by determining the variations in heat emitted from the body) to detect changes in body temperature that are common in CRPS/RSD. A color-coded "thermogram" of a person in pain often shows an altered blood supply to the painful area, appearing as a different shade (abnormally pale or violet) than the surrounding areas of the corresponding part on the other side of the body. An abnormal thermogram in a patient who complains of pain may lead to a diagnosis of CRPS/RSD. X-rays may also show changes in the bone.