Chapter 17: Dealing with Acute Situations Flashcards
Usually caused by blockage of airway by foreign object (choking)
Airway obstruction
What do you do when someone has an airway obstruction (choking)
adult- perform abdominal thrust
infant and small child- alternate back blows with chest thrusts
-Characterized by coughing, wheezing, or shortness of breath
-call for assistance
Reactive airway disease
A substance such as blood clot, fat, or air that travels through the vascular system and lodges in one of the pulmonary vessels
Pulmonary embolism (PE)
Denotes a group of symptoms that indicate myocardial infarction (MI) or heart attack
Acute Coronary Syndrome
-Episodes of chest pain precipitated by exertion or stress
-usually relieved by rest or the sublingual administration of nitroglycerin
Angina Pectoris
-Shake and shout to ensure it is not a syncope
-If no response, check carotid pulse and respirations
-if not present, call code and begin CPR until code team arrives
Cardiac Arrest
Delivers an electric shock to correct an ineffective cardiac rhythm
Defibrillator
how far away should personnel be from the defibrillator when administered
2 feet
Easier to use than standard defibrillator
Automatic external defibrillator (AED)
Steps to use AED:
-turn on power
-attach adhesive pads to victim’s chest
-attach pads to machine cables
-clear the area
-turn on rhythm analysis. AED requires 5 to 15 seconds to analyze rhythm. There must be no movement of the patient during this time. Activating analysis will also charge the AED if the rhythm is ventricular fibrillation
-press the shock control to deliver the shock, if indicated.
four levels of consciousness (LOC) used for assessment
Head injuries
The four levels of consciousness
-alert and conscious
-drowsy, but responsive
-unconscious, but reactive to painful stimuli
-comatose
What is the highest possible sore for the glasgow coma scale
15
What is also used for assessment for a head injury other than the 4 LOC’s
Glasgow coma scale
spontaneously - 4
To speech - 3
To pain - 2
None - 1
Eyes open response
Oriented-5
confused-4
inappropriate words- 3
in-comprehensive sounds-2
none-1
verbal response
obeys commands -6
Localized pain-5
flexion withdrawal- 4
abnormal flexion-3
abnormal extension-2
flaccid-1
Motor Response
True or false
Trauma patients are assumed to have a spinal injury until this is ruled out.
True
Obtained with immobilization in place
Must be evaluated by ED physician before patient is moved
Log-rolling is used to move patients, when necessary.
Cross-table lateral c-spine is first radiographic image obtained.
Blood in the pleural space
Hemothorax
air in the pleural space
Pneumothorax
What is treatment for pneumothorax and hemothorax
thoracotomy
Multiple rib fractures
Flail chest
What do you need to observe closely for flail chest
Observe closely for shock and hemorrhage.
hemorrhage into the pericardial sac
Cardiac tamponade
bone fragments protrude through the skin
Compound
no wound associated with fracture
Closed
How many people are required for long bone fractures
two-One person uses both hands to support the limb above and below the injury while the other places the IR.
-Occurs when the sutures pull apart
-Complete form may lead to tissues protruding.
-In the abdomen, the organs may protrude, termed evisceration.
Postsurgical wound dehiscence
-Severity categorized as first, second, third, or fourth degree
-Respiratory complications occur, such as pleural effusion and pneumonia.
Burns
Early signs of shock:
-Pallor
-Increased heart rate
-Increased respirations
-Restlessness or confusion
-A general term used to describe a failure of circulation in which blood pressure is inadequate to support oxygen perfusion of vital tissues and is unable to remove the by-products of metabolism.
-A dangerous, potentially fatal condition
Shock
Five main types of shock:
-Hypovolemic
-Septic
-Neurogenic
-Cardiogenic
-Allergic (anaphylactic)
Caused by massive blood or plasma loss so that an insufficient amount of fluid is available to fill the circulatory system
Hypovolemic Shock
Results from internal and external hemorrhage, plasma loss from burns, or severe dehydration
Hypovolemic Shock
Caused by severe, often systemic infection
Septic shock
-The failure of arterial resistance
Neurogenic shock
-Causes blood to pool in peripheral vessels
Neurogenic shock
-Occurs with nervous-system injuries
Neurogenic shock
-Closely monitor patients with head or spinal trauma for blood-pressure drop
Neurogenic shock
Results from cardiac failure or interference with heart function
Cardiogenic shock
-Occurs from exposure to foreign substances to which they are sensitized
-Blood pressure falls rapidly; severe dyspnea is caused by respiratory edema, and death can result if not recognized and treated rapidly.
Allergic shock or anaphylaxis
Name some shock symptoms:
Restlessness, apprehensiveness
Increased pulse rate
Pallor with weakness or a change in thinking ability
Cool, clammy skin (except in patients with septic or neurogenic shock)
A decrease in blood pressure of 30 mm Hg below the baseline systolic pressure
Decreased urination
Increased, shallow respirations
Radiographer response to shock
Stop the procedure
Assist the patient to a supine position to avoid a fall.
Elevate the feet to increase blood flow to the brain.
Alternatively, if dyspnea is noted, elevate the head.
Obtain help. Notify the radiologist, physician, or nurse.
If in doubt, call a code.
Check blood pressure.
Assist the dyspneic patient with oxygen.
Be ready to perform CPR.
Assist the code team or physician as necessary.
Chart the occurrence, the treatment administered, and the patient’s response on an incident report form and/or in the chart.
Medical term for fainting
Syncope
mild form of shock
Syncope
Treatment for Syncope
Assist patient into supine position with feet elevated
Now known as posttraumatic stress disorder
Much different from other forms of shock
Different symptoms, signs, and treatment
Psychological Shock
Example of medical emergencies
-Contrast-media reactions
-Drug reactions
-Diabetic emergencies
-Cerebrovascular accidents
-Seizures
-Vertigo
-Orthostatic hypotension
-Epistaxis
-Nausea and vomiting
Mild contrast reactions and treatment
Warmth
Flushing
Metallic taste
Coughing
Nausea
None. Symptoms will resolve
Moderate contrast reactions and treatment
Erythema
Urticaria
Bronchospasm
Antihistamine (orally, IV, or IM)
Bronchodilator drug by inhalation for bronchospasm
Vasovagal Reactions and treatment
Symptoms:
Diaphoresis
Hypotension
Bradycardia
Treatment:
*Place patient supine, feet elevated 20 degrees, and head elevated, if breathing is a problem.
*IV fluids and atropine administered for bradycardia
Severe (Anaphylactic) Reactions and treatment
Warmth
Tingling
Itching palms and soles
Dysphagia
Laryngeal and bronchial edema
Respiratory arrest
Cardiac arrest
Seizures
Maintain airway
Call a code
Epinephrine usually given IV
Other drugs administered as needed by code team
Contrast media reactions
Range from mild to severe
No predictors
what should you do when injecting contrast to see if there will be a reactions
-Begin injection with a small amount and wait to check for signs or symptoms
-Protocol determines how long to wait before proceeding with administration.
what are Patients at risk for reaction premedicated with
Antihistamine and/or corticosteroids
Wide range of symptoms and severity of reaction
Treatment tailored to severity and symptoms
Drug Reactions
Types of diabetic
-Diabetes insipidus
-Diabetes mellitus
-Type I
-Type II
-caused by kidney or pituitary disorder
-Characterized by polyuria and thirst
-If untreated, dehydration results.
-Fluid replacement is essential.
Diabetes Insipidus
Symptoms of Diabetes Insipidus
Fever
Vomiting
Convulsions
Insulin-dependent form
More likely to lapse into diabetic coma
Diabetes Mellitus—Type I
Signs and symptoms
Diabetes Mellitus—Type I
Extreme thirst
Polyuria
Fruity-smelling breath
-Related to obesity
-Treated with hyperglycemic drugs
Diabetes Mellitus—Type II
-Emergent condition
-Occurs in neglected type II DM as a result of dehydration and hyperglycemia
Hyperosmolar hyperglycemic nonketotic (HHNK) syndrome
-Low blood sugar
-Occurs in type I when insulin is taken and a meal is skipped
Hypoglycemia
Symptoms of hypoglycemia
-Sudden weakness
-Sweating
-Tremors
-Hunger
-Loss of consciousness
Treatment for hypoglycemia
-candy
-sweet fruit juice
-Emergency medications include squeeze tubes of glucose gel.
-Administered inside patient’s cheek
Also called a stroke
Cerebrovascular Accident (CVA)
Other symptoms of a stroke may include:
-Extreme dizziness
-Severe headache
-Difficulty in vision or deviation in one eye
-Temporary loss of consciousness
Warning signs of a stroke, easily remembered with acronym FAST:
-Facial droop
-Arm weakness on one or both sides
-Speech difficulty
-Time to call 9-1-1
-Also called a stroke
-Caused by interruption of blood flow to the brain
-Hemorrhage
-Occlusion
Cerebrovascular Accident (CVA)
Brief loss of consciousness
Absent seizures
-petite mal
May have trembling, shaking, or violent spasms
Seizures
what type of seizure would have trembling, shaking, or violent spasms
Major motor—tonic-clonic or grand mal
What should you do when a patient is having a seizure
-Keep patient as safe as possible.
-Remove obstacles.
-Protect patient’s head.
-Do not restrain patients
or force objects into
mouth.
-Call for assistance.
-Turn patient to lateral recumbent to prevent aspiration of secretions.
-Provide reassurance and assistance.
-Patient may be irritable and confused.
-Often wishes to sleep
Postseizure
-Dizziness brought on by sitting upright from a prolonged recumbent position
-Can be avoided by assisting the patient to sit upright slowly
Orthostatic Hypotension
-Severe dizziness, sometimes accompanied by nausea
-Caused either by an inner-ear disturbance or a brain or spinal-cord lesion
Vertigo
Medical term for a nosebleed
Epistaxis
-Provide tissues and apply pressure to the nasal septum for 10 min with gloved hands.
-Contact physician if pressure does not cause bleeding to stop.
Epistaxis
What do you do to instruct the patient if they feel nauseous
-Instruct patient to breathe slowly through the nose or to breathe shallowly through the mouth.
-Focus on breathing
takes
the focus away from
the nausea.
must be done at once and indicates that the patient’s well-being may be compromised by any delay
STAT
lack of oxygen. It can result from an inadequate supply of oxygen to the respiratory system, an inability of the blood to carry oxygen to the tissues, or an inability of the tissues to absorb the oxygen.This condition can usually be avoided by having the patient sit up gradually.
anoxia
is difficulty in breathing caused by bronchospasm. a respiratory disorder characterized by recurring episodes of paroxysmal dyspnea, wheezing caused by constriction of the bronchi, coughing, and viscous mucoid bronchial secretions.
asthma
basic life support system used to ventilate the lungs and circulate the blood in the event of a respiratory or cardiac arrest.
cpr
A mild to moderate amount of damage, characterized by “seeing stars” or a very brief loss of consciousness.
damage to the brain caused by a violent jarring or shaking, such as a blow to the head or an explosion.
concussion
loss of organs from a body cavity
damage to the brain caused by a violent jarring or shaking, such as a blow to the head or an explosion.
Evisceration
abdominal thrust to dislodge the foreign body.
Heimlich maneuver
a condition in which an insufficient blood supply to the heart muscle results from coronary artery disease.
Myocardia ischemia
is the medical term for what is commonly called a “heart attach”. When a coronary artery becomes occluded, a portion of the heart wall becomes ischemic, and the heart muscle supplied by the artery will die if the blood flow is not quickly restored.
Myocardia infarction (MI)
excessive bleeding
hemmorrhage
occurs when individuals are exposed to foreign substances to which they have become sensitized.
Anaphylaxis- or anaphylactic shock
- Removing fluid or air from the pleural space by a drainage system.
Thoracentesis
response to a contrast medium may be triggered when the injected agent stimulates the vagus nerve, causing cardiovascular changes resulting in increases vasodilation of arterioles.
vasovagal
quivering
Tremor
(hives), and or bronchospasm.
a pruritic skin eruption, usually the result of an allergic reaction, characterized by transient wheals of varying shapes and sizes with well-defined erythematous margins and pale centers; also called hives.
Urticaria
A harsh sound on inspiration
an abnormal, high-pitched sound caused by an obstruction in the trachea or larynx, usually heard during inspiration.
Stridor
insufficient insulin prevents the use of glucose by the muscles, causing the glucose level in the blood to rise.
Hyperglycemia
inflammation of the lungs
Pneumonia
fluid in the pleural space
an abnormal accumulation of fluid within the thoracic cavity between the visceral and parietal pleura.
Pleural effusion
swelling of the respiratory tract caused by trapped excess fluid
the accumulation of extravascular fluid in lung tissues and alveoli; may be caused by hypervolemia, but is most commonly caused by congestive heart failure.
Pulmonary edema
(cessation of breathing) caused by choking can occur.
Respiratory arrest
is a condition in which the heart has stopped beating and the patient has no pulse.
cardiac arrest
a heart attack; necrosis of heart muscle tissue caused by coronary artery thrombosis or occlusion.
Myocardial infarction (MI)
