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Appendix G : Precautions and contraindications for the application of PRICE
Precautions and contraindications for the application of PRICE
Patients exhibiting any of the injuries listed below should receive immediate first aid and should be referred on immediately for further investigation.
Abdomino-thoracic injury
Any injury which results in chest pain, shortness of breath, severe abdominal pain, haematuria
Blocked airway
Any injury which causes respiratory arrest
Cuts / lacerations
Any injury which results in open, bleeding wounds
Head injury / unconsciousness
Any injury which results in altered cerebral function, leading to disturbed consciousness, vomiting, drowsiness or amnesia
Nerve injury
Any injury causing changes in motor and/ or sensory function
Spinal injury
Any injury to the back or neck which causes changes in motor or sensory function Any injury which is suggestive of bony injury
Vascular injury
Any injury resulting in loss of distal pulses, changes in skin colour and temperature or drop in blood pressure
Furthermore, the patient’s previous and current medical history, drug history and general health should be taken into consideration to indicate if therapeutic intervention is contraindicated by current medication or health status.
The following signs and symptoms indicate severe injury. The injured area should be supported and the patient referred on immediately for further investigation:
- Severe pain which does not subside
- Immediate and profuse swelling
- Deformity
- Extreme loss of function
- Guarding, or unusual or false motion
- Noises (grating/cracking) at injury site
Specific precautions and contraindications for application of PRICE
| A | The mode of protection must be capable of accommodating oedema |
| B | A maximum safe period for icing of 30 minutes is recommended, to avoid skin and tissue damage and nerve palsy. A damp towel should be placed between the cooling agent and the skin to avoid “ice burn” |
| C | The athlete should not return to participation immediately following application of ice (or other types of cold application), since nerve conduction velocity, sensation and connective tissue flexibility are likely to be reduced by cold application |
| D | Care should be taken in the application of ice to patients with little subcutaneous fat and in the region of superficial nerves, e.g. common peroneal nerve at the knee, ulnar nerve at the elbow, since cold-induced nerve injury may result. To compensate for this, the duration of application should be reduced (no more than ten minutes) or an insulating material should be applied between the source of cooling and the patient’s skin |
| E | Application of cold is contraindicated for patients who have previously developed cold-induced hypertension during cold treatment, for patients who have allergy to cold (hives, joint pain) or for patients who have Raynaud’s syndrome, peripheral vascular disease or sickle cell anaemia |
| F | If nerve damage, as a result of the injury, is suspected or if there is a history of reduced skin sensation, application of cold should not exceed 20 minutes and the skin condition should be checked every five minutes |
| G | Pressure must not be greater proximally than distally, therefore application of pressure should be uniform throughout the compression |
| H | Compression must be capable of accommodating oedema immediately following injury, and of continuing to apply pressure with diminishing effusion. Therefore:
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| I | Distal areas should be checked immediately following application of compression for signs of diminished circulation (cold, pallor) and then regularly checked throughout the continued application. |