9. Medical Emergencies in the Radiology Department Flashcards
1
Q
ASSESSMENT OF LEVELS OF NEUROLOGIC AND COGNITIVE FUNCTIONING
A
- RT must be able to quickly assess the patient’s neurologic functioning
- Recognize changes based in the initial assessment data
- Use Glasgow Coma Scale
2
Q
common classification for traumatic acute brain injury
A
Glasgow coma scale
3
Q
quickly gives an overview of the patient’s level of responsiveness
A
Glasgow coma scale
4
Q
• addresses 3 areas of neurologic functioning
A
Glasgow coma scale
5
Q
Glasgow coma scale 3 areas of neurologic fucntioning
A
eyes opening, motor response and verbal response
6
Q
GCS 3 to 8
A
Severe
7
Q
GCS 9 to 12
A
Moderate
8
Q
GCS 13 to 15
A
Mild
9
Q
indicates deep coma or a brain-dead state
A
GCS 3
10
Q
Eyes opening response
o Spontaneously
A
4
11
Q
Eyes opening response
o To voice
A
3
12
Q
Eyes opening response
o To painful stimuli
A
2
13
Q
Eyes opening response
o No response
A
1
14
Q
Motor Response
o Obeys commands
A
6
15
Q
Motor Response
o Localized pain
A
5
16
Q
Motor Response
o Withdraws from painful stimuli (Normal Flexion)
A
4
17
Q
Motor Response
o Abnormal flexion
A
3
18
Q
Motor Response
o Extension
A
2
19
Q
Motor Response
o No response
A
1
20
Q
Verbal response
o Oriented
A
5
21
Q
Verbal response
o Confused speech
A
4
22
Q
Verbal response
o Inappropriate words
A
3
23
Q
Verbal response
o Incomprehensible sounds
A
2
24
Q
Verbal response
o None
A
1
25
Total points possible for Glasgow coma scale
15
26
Body’s pathological reaction to illness, trauma, or severe physiologic or emotional stress
Shock
27
May be due to fluid loss, cardiac failure, decreased tone of the blood vessels, or obstruction of blood flow to the vital body organs
Shock
28
May be reversible
Shock
29
4 TYPES OF SHOCK
Hypovolemic, Cardiogenic,
Distributive,
Obstructive
30
Shock syndrome may progress as a continuum in the patient’s struggle to survive and return to a normal physiologic state
shock continuum
31
As the condition progresses, blood is shunted away from the lungs, skin, kidneys and gastrointestinal tract to accommodate the brain’s and the heart’s critical need for oxygen
shock continuum
32
3 Stages of Shock:
1. Compensatory stage
2. Progressive stage
3. Irreversible stage (Refractory Stage)
33
* Skin is cold and clammy
* Urine output decreases
* Respirations increase
* Bowel sounds are hypoactive
* Blood pressure is normal
* Anxiety level increases; patient may begin to be uncooperative
Compensatory stage
34
* Blood pressure falls
* Respirations are rapid and shallow
* Severe pulmonary edema results from leakage of fluid from the pulmonary capillaries. This is referred to as acute respiration distress syndrome or shock lung (ARDS)
* Tachycardia results and may be as rapid as 150 beats per minute
* The patient complains of chest pain (Angina)
* Mental status changes beginning with subtle behavior alterations such as confusion with progression to lethargy and loss of consciousness
* Renal, hepatic, gastrointestinal, and hematologic problem occur
Progressive stage
35
* Blood pressure remains low
* Renal and liver failure result
* There is a release of necrotic tissue toxins and an overwhelming lactic acidosis
Irreversible stage (Refractory Stage)
36
* Body fluids are contained within the cells of the body and are in the extracellular compartments
* Extracellular fluid is further distributed to the blood vessels (intravascular) and into surrounding body tissues (interstitial)
* When the amount of intravascular fluid decreases by 15% to 25% or by a loss of 750 to 1,300 milliliters
* May be due to internal or external hemorrhage; loss of plasma from burns; or fluid loss from prolonged vomiting, diarrhea or medications
* Excessively thirsty, cold and clammy skin, cyanosis
* Life-threatening if you lose 20% of the body’s blood or fluid supply
Hypovolemic shock
37
Hypovolemic shock
| Causes:
* internal/external hemorrhage
* loss of plasma from burns
* fluid loss from prolonged vomiting, diarrhea, or medications
38
Hypovolemic shock
| Clinical Manifestation:
* Excessively thirsty
* Cold and clammy skin
* Cyanosis
39
Hypovolemic shock
| Radiographer’s response:
1. Stop the ongoing radiographic procedure; place the patient in supine (if there is no head or spinal cord injury). Do not place the patient in Trendelenburg position.
2. Notify the physician in charge and call for emergency assistance from the radiology nurse.
3. Make certain the patient is able to breathe without obstruction caused by position or blood or mucus in the airway.
4. If there is an open wound with blood loss, don gloves and apply pressure directly to the wound with several thickness of dry, sterile dressing.
5. Bring the emergency cart to the patient’s room.
6. Prepare to assist with oxygen, intravenous fluids and medications.
7. Keep the patient warm and dry, but do not overheat the patient as this will increase the need for oxygen.
8. Assess vital signs every 5 minutes until the emergency teams assume this role.
9. Do not leave the patient unattended. Inform him or her as appropriate of what is happening to alleviate anxiety.
10. Do not offer fluids to the patient, even if requested. Explain that he or she may need examination or treatment that requires an empty stomach.
40
* Caused by a failure of the heart to pump an adequate amount of blood to the vital organs.
* Patients with myocardial infarction, cardiac tamponade, dysrhythmias or other cardiac pathology is most vulnerable
* Complaint of chest pain that may radiate to jaws and arms, respiratory distress, dizziness, cyanosis, restlessness, anxiety, difficult to find carotid pulse indicates decreased stroke volume of the heart, decreased blood pressure, decreased urinary output, cold, clammy skin
* Life-threatening in which the heart cannot pump enough blood to meet your body’s need
* Most often caused by heart attack but not all heart attack will have cardiogenic shock
* rare
Cardiogenic shock
41
Cardiogenic shock
| Patients Vulnerable:
* Myocardial Infarction
* Cardiac Tamponade
* Dysrhythmias
* Cardiac Pathology
42
Cardiogenic shock
| Clinical Manifestations:
* Complaint of chest that may radiate to kaws and arms
* Respiratory distress
* Dizziness
* Cyanosis
* Restlessness
* Anxiety
* Difficult to find carotid pulse indicates decreased stroke volume of the heart
* Decreased blood pressure
* Decreased urinary output
* Cold and clammy skin
43
Cardiogenic shock
| Radiographer’s response:
1. Summon the emergency team and have the emergency cart placed at the patient’s side.
2. Notify the physician in charge of the patient.
3. Place the patient in semi-Fowler’s position (45 degrees) or in another position that will facilitate respiration.
4. Prepare to assist with oxygen, intravenous fluid, and medication administration. Chest pain must be controlled.
5. Do not leave the patient alone; offer an explanation of treatment as appropriate; alleviate the patient’s anxiety.
6. Assess pulse, respiration, and blood pressure every 5 minutes until the emergency team arrives.
7. Do not offer fluids.
8. Be prepared to administer cardiopulmonary resuscitation (CPR), if indicated.
44
* Occurs when a pooling of blood in the peripheral blood vessels results in decreased venous return of blood to the heart, decreased blood pressure, and decreased tissue perfusion.
* Loss of sympathetic tone
* abnormal distribution of blood flow in the smallest blood vessels results in inadequate supply of blood to the body’s tissues and organs
* Characterized by the blood vessel’s inability to constrict and their resultant inability to assist in the return of the blood to the heart.
* May occur when chemicals released by the cells cause vasodilatation and capillary permeability
Distributive shock
45
Distributive shock types:
Neurogenic,
Septic,
Anaphylactic
46
* Results from loss of sympathetic tone causing vasodilatation of peripheral vessels
* causes spinal cord injury, severe pain, neurologic damage, depressant action of medication, lack of glucose, or adverse effect of anesthesia
* Hypotension, bradycardia, warm, dry skin, initial alertness if not unconscious because of head injury, cool extremities and diminishing peripheral pulses
* occurs after damage to the central nervous system, such as spinal cord injury and traumatic brain injury
* C3 and C4 injury restricts the flow of spinal fluid resulting to neurologic shoch
Neurogenic shock
47
Neurogenic shock
| Clinical Manifestations:
* Hypotension
* Bradycardia
* Warm, dry skin
* Initial alertness if not unconscious because of head injury
* Cool extremities and diminishing peripheral pulses
48
Neurogenic shock
| Radiographer’s response:
1. Summon emergency assistance.
2. Notify the physician in charge of the patient.
3. Keep the patient in supine position; legs may be elevated with physician’s orders.
4. Have the emergency cart brought to the patient’s side.
5. If spinal cord injury is possible, do not move the patient.
6. Stay with the patient and offer support.
7. Monitor pulse, respirations, and blood pressure every 5 minutes.
8. Prepare to assist with oxygen, intravenous fluids, and medications.
49
* occurs when the blood pressure drops to a dangerously low level after an infection
* Least likely to be observed by RT
* Gram-negative bacteria are the most common causative organisms
* Body releases chemicals that increase capillary permeability and vasodilatation
* Life-threatening condition when the blood pressure drops to a dangerously low level
Septic shock
50
* Hot, dry, and flushed skin
* Increase in heart rate and respiratory rate
* Fever, but possibly not in the elderly patient
* Nausea, vomiting and diarrhea
* Normal to excessive urine output
* possible confusion, most commonly in the elderly patient
Septic shock
Clinical Manifestations:
-1st phase:
51
* Cool, pale skin
* Normal or subnormal temperature
* Drop in blood pressure
* Rapid heart rate and respiratory rate
* Oliguria (decrease urine output) or anuria (no urine output)
* Seizures and organ failure
Septic shock
Clinical Manifestations:
-2nd phase:
52
Septic shock
| Radiographer’s response:
Patient must not become chilled as shivering increases the body’s oxygen consumption
53
* most common in the Radiology department
* Use of contrast agents that contain iodine
* Result of exaggerated hypersensitivity reaction to re- exposure to an antigen that was previously encountered by the body’s immune system
* Histamine and bradykinin are released which cause widespread vasodilatation which results in peripheral pooling of blood
* Produces shock, respiratory failure and death
* The more abrupt the onset, the more severe the reaction will be.
Anaphylactic shock
54
Anaphylactic shock
Clinical manifestations:
-Mild systemic reaction
* Nasal congestion, periorbital swelling, itching, sneezing and tearing of eyes
* Peripheral tingling or itching at the site of injection
* Feeling of fullness or tightness of the chest, mouth, or throat
* Feeling of anxiety or nervousness
55
Anaphylactic shock
Clinical manifestations:
-Moderate systemic reaction
* All of the above symptoms, plus:
* Flushing, feeling of warmth, itching and urticaria
* Bronchospasm and edema of the airways or larynx
* Dyspnea, cough and wheezing
56
Anaphylactic shock
Clinical manifestations:
-Severe systemic reaction
* All symptoms listed above with an abrupt onset
* Decreasing blood pressure; weak, thready pulse either rapid or shallow
* Rapid progression to bronchospasm, laryngeal edema, severe dyspnea, cyanosis
* Dysphasia, abdominal cramping, vomiting and diarrhea
* Seizures, respiratory and cardiac arrest
57
Anaphylactic shock
| Radiographer’s response:
1. Do not leave the patient. Stop any infusion or injection of contrast immediately and notify the radiologist if any of the symptoms occur.
2. If the patient complains of respiratory distress or has any symptoms listed in the severe reaction section, call the emergency team.
3. Place the patient in semi-Fowler’s position or in a sitting position to facilitate respiration.
4. Monitor pulse, respiration, and blood pressure every 5 minutes or until the emergency team arrives to assume responsibility.
5. Prepare to assist with oxygen, intravenous fluid and medication administration. Have large-gauge venous catheters available.
6. Prepare to administer CPR as required.
58
* Results from pathological conditions that interfere with the normal pumping action of the heart ( the heart may be free of pathologic conditions)
* Causes may be pulmonary embolism, pulmonary hypertension, arterial stenosis, constrictive pericarditis, cardia tamnponade or tumors
Obstructive shock
59
* An occlusion of one or more pulmonary arteries by a thrombus or thrombi
* Associated with trauma, orthopedic and abdominal surgical procedures, pregnancy, congestive heart failure, prolonged immobility, and hypercoagulable state.
* May also be caused by air, fat, amniotic fluid or sepsis
* Rapid, weak pulse; hyperventilation; dyspnea and tachypnea; tachycardia; cough and hemoptysis; diaphoresis; syncope; hypotension; cyanosis; coma
Pulmonary embolus
60
Pulmonary embolus
| Radiographer’s response:
1. Stop the procedure immediately, and call for emergency assistance.
2. Notify the physician, and bring the emergency cart to the patient’s side.
3. Monitor vital signs.
4. Do not leave the patient alone; reassure the patient.
5. Prepare to assist with oxygen and IV administration
61
* Caused by occlusion of the blood supply to the brain, rupture of the blood supply to the brain, or rupture of a cerebral artery, resulting in hemorrhage directly into the brain tissue or into the spaces surrounding the brain
* Brain attack
* Possible severe headache, numbness, muscle weakness or flaccidity of face or extremities, usually one- sided, eye deviation; possible loss of vision, confusion, dizziness or stupor (state of unconsciousness), dysphasia (slurred speech), ataxia (mimic drunk behavior: muscle incoordination, stumble, fall and slurring of speech), stiff neck, nausea or vomiting, loss of consciousness.
Cerebral vascular accident (stroke)
62
Cerebral vascular accident (stroke)
| Radiographer’s response:
1. Call for assistance, do not leave the patient alone
2. Assist the patient to a sitting or semi-fowler’s position
3. Attempt to relieve the patient’s anxiety
4. Prepare to administer oxygen
5. Prepare to use the emergency cart
63
* May precede respiratory arrest
* Can be a result of airway obstruction caused by positioning, the tongue falling backward into the throat of an unresponsive person, a foreign object lodged in the throat, disease, drug overdose, injury or coma
* Labored, noisy breathing; wheezing; use of accessory muscles of the neck, abdomen, or chest on inspiration; neck vein distension, diaphoresis, anxiety, cyanosis, productive cough with pink-tinged frothy sputum
Respiratory dysfunction
64
Respiratory dysfunction
| Radiographer’s response:
1. Call for assistance; do not leave the patient alone.
2. Assist the patient to a sitting or semi- Fowler’s position.
3. Attempt to relieve the patient’s anxiety.
4. Prepare to administer oxygen.
5. Prepare to use the emergency cart.
65
* When heart ceases to beat effectively, the blood can no longer circulate, no effective pulse
* Electrical activity of the heart may be disrupted- heart to beat too rapidly, may beat too slowly
* From hypovolemic shock, cardiac tamponade, hypothermia, or a pulmonary embolism, drug overdoses, severe acidosis, myocardial infarction
* Loss of consciousness, pulse and blood pressure
* Dilation of the pupils
* seizures
Cardiac arrest
66
Cardiac arrest
| Radiographer’s response:
1. If the patient is an adult and is found to be unresponsive, shake the patient and ask, “Are you all right?” if there is no responsive, call emergency medical service. Or shout for help. Do not leave the patient
2. Assess the carotid pulse
3. Place patient in supine position, perform CPR
67
* Patient stops responding
* Pulse continues to beat briefly and then quickly becomes weak and stops
* Chest movement stops, and no air is detectable moving through the patient’s mouth
Respiratory arrest
68
Respiratory arrest
| Radiographer’s response:
1. If the patient is an adult and is found to be unresponsive, shake the patient and ask, “Are you all right?” if there is no response, call emergency medical service. Or shout for help. Do not leave the patient.
2. Assess the carotid pulse.
3. Place patient in supine position, perform CPR.
69
Foreign body- chewing gum or food
Airway obstruction
70
Airway obstruction
| Radiographer’s response:
1. If the patient does not respond and breathlessness is established, seal the patient’s nose and mouth, and ventilate him or her
2. If the patient’s chest rises and falls, proceed for basic CPR.
3. If the patient’s chest does not rise and fall, reposition the head using the head tilt, chin lift, or jaw thrust as indicated. Then attempt to ventilate again.
4. If this is unsuccessful, assume that the airway is obstructed and use the abdominal thrust (Heimlich maneuver) to attempt to remove obstruction
71
* Unsystematic discharge of neurons of the cerebrum that results in an abrupt alteration in brain function
* May be caused by infection, extreme stress, head trauma, brain tumors, structural abnormalities of the cerebral cortex, genetic defects (epilepsy), birth trauma, vascular disease, congenital malformations or postnatal trauma.
Seizures
72
* May utter a sharp cry as air is rapidly exhaled
* Muscles become rigid and eyes open wide
* May exhibit jerky body movements and rapid, irregular respirations
* May vomit
* May froth and have blood- streaked saliva caused by biting the lips or tongue
* May exhibit urinary or fecal incontinence
* Usually falls into a deep sleep after the seizure
Generalized seizures
73
o Patient may remain motionless or may experience an excessive emotional outburst of fear, crying, or anger
o Patient may manifest facial grimacing, lip smacking, swallowing movements, or panting
o Patient will be confused for several minutes after the episode with no memory of the incident
Partial seizures:
| • Complex
74
```
o Only a finger or a hand may shake
o Patient may speak unintelligibly
o Patient may be dizzy
o Patient may sense strange odors, tastes, or sounds
o Patient will not lose consciousness
```
Partial seizures:
| • Simple
75
Seizures
| Radiographer’s response:
1. Stay with the patient and gently secure him or her to prevent injury.
2. Call for assistance.
3. Do not attempt to insert anything into the patient’s mouth.
4. Remove dentures and foreign objects from the patient’s mouth if possible, but do not put fingers into the mouth.
5. Place a blanket or pillow under the patient’s head to protect it from injury.
6. Do not restrain the arms or legs but protect them from injury.
7. Do not attempt to move the patient to the floor if he or she has not fallen there; if on a radiographic table, do not allow the patient to fall to the floor.
8. Observe the patient carefully and keep track of the time of the seizure to record later.
9. Provide patient privacy.
10. After the seizure has ceased, position the patient to prevent aspiration of secretions and vomitus. Turn the patient to a sim’s position and put the face downward so that secretions may drain from his or her mouth.
76
* Fainting, transient loss of consciousness, which usually results from an insufficient blood supply to the brain.
* Heart disease, hunger, poor ventilation, extreme fatigue, and emotional trauma, orthostatic hypotension
* Pallor, complaints of dizziness and nausea
* Hyperpnea, tachycardia
* Cold, clammy skin
Syncope
77
Syncope
| Radiographer’s response:
1. If the patient complains of feeling dizzy or appears to be confused, have the patient lie down.
2. If the patient has actually fainted, place him or her in a supine position with legs elevated.
3. If the patient begins to fall, do not try to keep him or her standing. Support and assist the patient to the floor in a manner that prevents injury. Place a knee behind the patient’s knee and an arm around the waist and assist the patient to the floor.
78
The intoxicated patient
* May be quarrelsome and reluctant to cooperate
* May neglect all rules of safety while being treated
* May inadvertently fall from a gurney or radiographic table
* Keep communication simple, direct and non-judgmental
* Do not attempt to argue
* Call for assistance
79
sober
0.0% BAC
80
percentage which it is still legal to drive
0.08% BAC
81
potentially fatal
above 0.4%
82
The Stages of Alcohol Intoxication
| Blood Alcohol Content
- Sobriety
- Euphoria
- Excitement
- Confusion
- Stupor
- Coma
- Death
83
recognition of signs of sudden cardiac arrest (SCA), heart attack, stroke
Basic Life Support
84
Basic Life Support
* foreign-body airway obstruction (FBAO)
* Cardiopulmonary Resuscitation (CPR)
* Defibrillator with and Automated External Defibrillator (AED).28 Nov. 2005
85
EMS
Emergency Medical Services
86
Cardiopulmonary Resuscitation (CPR)
1. Put the heel of your dominant hand at the center of the person’s chest
2. Put your other hand over your dominant hand, then interlock your fingers
3. Start chest compressions
4. Open the person’s mouth
5. Add a rescue breath
6. Watch the chest fall, then do another rescue breath
7. Continues the 30 compressions, 2 breaths cycle
8. Repeat until ambulance arrives
87
- Decline in visual functions
- Inability to perform two tasks at the same time
- Loss of judgment
- Altered mood
0.02% BAC
88
BAC
Blood Alcohol Concentration
89
- Reduced coordination
- Reduced ability to track moving objects
- Difficulty steering
- Slower response to emergency driving situations
0.05% BAC
90
- Reduced ability to concentrate
- Short-term memory loss
- Lack of speed control
- Impaired perception and self-control
0.08% BAC
91
- Clear deterioration of reaction time
- Reduced ability to maintain lane position
- Reduced ability to brake appropriately
- Slurred speech
0.10% BAC
92
- Substantial impairment in vehicle control
- Loss of auditory information processing
- Major loss of balance
- Vomiting may occur
0.15% BAC
