Chapter 17: Dealing with Acute Situations Flashcards
Usually caused by blockage of airway by foreign object (chocking),
Airway obstruction
What do you do when an adult has an airway obstruction (choking)
Abdominal thrust also called heimlich maaneuver
What do you do when an infant has an airway obstruction (choking)
alternate back blows with chest thrusts
the cessation of breathing, caused by obstruction of the airway by a foreign object.
Respiratory Arrest
Characterized by coughing, wheezing, or shortness of breath with an undetermined cause
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
- life threatening
Pulmonary embolism (PE)
allergic shock, occurs when individuals are exposed to foreign substances to which they have become sensitized. An allergic reaction develops, directly affecting the blood vessels and other tissues.
Anaphylaxis
occurs when the coronary arteries are unable to supply the heart with enough oxygen.
-These episodes of substernal chest pain are precipitated by exertion or stress
- usually relieved by rest or the sublingual administration of nitroglycerin
Angina
an abnormal condition characterized by a lack of oxygen
Anoxia
difficulty in breathing caused by bronchospasm. Attacks are sometimes related to allergies and are frequently precipitated by stress. Episodes of paroxysmal dyspnea and wheezing caused by constriction of the bronchi.
Asthma
Denotes a group of systems that indicate myocardial infarction (MI) or heart attack.
Acute coronary syndrome
a condition in which an insufficient blood supply to the heart muscle results from coronary artery disease
myocardial ischemia
What helps asses the nature and severity of ACS
Electrocardiograhy
When a patient complains of sudden, intense chest pain, often described as a crushing pain
They are having a heart attack
a condition in which the heart has stopped breathing and the patient has no pulse.
Cardiac arrest
-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
a basic emergency procedure for life support, consisting of artificial respiration and manual chest compression. It helps circulate the blood in the event of a respiratory or cardiac arrest.
cardiopulmonary resuscitation (CPR)
is the basic life support system used to ventilate the lungs and circulate the blood in the event of a respiratory or cardiac arrest.
CPR
a device that delivers an electrical shock at a preset voltage to the myocardium through the chest wall for the purpose of restoring normal heart rhythm
Defibrillator
How far away should personnel be from the defibrillator?
2 feet
Easier to use than standard defibrillator and helps treat cardiac arrest
Automatic external defibrillator (AED)
Steps to use AED:
- Turn on the power.
- Attach the adhesive pads to the victim’s chest.
- Connect pad cables to the AED machine..
- Clear the area.
- Turn on the rhythm analysis. AEDs require 5 to 15 seconds to analyze the rhythm. The patient must not move during this time. Activating the analysis will also charge the AED if the rhythm is ventricular fibrillation.
- Press the shock control to deliver the shock, if indicated.
an abnormal, high-pitched sound caused by an obstruction in the trachea heard during inspiration. (harsh sound on inspiration)
Stridor
What is the highest possible score for the Glasgow Coma Scale
15
is a numerical scale that can be used to objectively asses changes in a patient’s level of consciousness over time
The Glasgow Coma Scale
Four levels of consciousness (LOCs) used for assessment:
- alert and conscious
- drowsy, but responsive
- unconscious, but reactive to painful stimuli
- comatose
a basic emergency procedure for life support, consisting of artificial respiration and manual chest compression. Or a very brief loss of consciousness. A mild to moderate amount of damage, characterized by “seeing stars” or a very brief loss of consciousness
Concussion
Eyes open response:
spontaneously - 4
To speech - 3
To pain - 2
None - 1
Verbal response
Oriented-5
confused-4
inappropriate words- 3
in-comprehensive sounds-2
none-1
Motor Response
obeys commands -6
Localized pain-5
flexion withdrawal- 4
abnormal flexion-3
abnormal extension-2
flaccid-1
what does HEENT stand for
head, eyes, ears, nose and throat
True or false
Trauma patients are assumed to have a spinal injury until this is ruled out.
True
What x-ray position is used for when a patient has a spinal injury
cross-table lateral c-spine
What method is used when a patient is in a cervical collar
three person log roll
an accumulation of blood and fluid in the pleural cavity, between the parietal and visceral pleura, that is usually the result of trauma ( blood in the pleural space)
Hemothorax
Results in a lung collapse greatly reducing the avaliable surface for oxygen exchange
hemothorax and pneumothorax
a collection of air or gas in the pleural space causing the lung to collapse. (air in the pleural space)
Pneumothorax
What is the treatment used for both hemothorax and pneumothorax
Thoracotomy
a procedure in which a surgical opening is made through the chest wall and a tube is inserted between the visceral pleura and the parietal pleura.
Thoracotomy
surgical removal of fluid or air from the pleural space.
Thoracentesis
a loss of a large amount of blood in a short period, either externally or internally. (Excessive bleeding).
Hemorrhage
Mutiple rib fractures
Flail chest
What must you observe for in a flail chest
observe closely for shock and hemorrhage
no wound associated with fracture
Closed fractures
compression of the heart produced by the accumulation of blood in the pericardial sac. As the pericardial sac fills with fluid, it prevents the heart from expanding.
Cardiac tamponade
Bone fragments protrude through the skin
Compound
- occurs when the sutures pull apart
- complete form may lead to tissue protruding (sticking out) or to evisceration (loss of organs from a body cavity)
- in the abdomen, the organs may proturde termed evisceration
Postsurgical wound dehiscence
The depths of burns are classified as
first, second, third or fourth degree
what kind of burn Inolves the epidermis only, the skin is red, warm, tender and painful but no blistering
first-degree burn
what kind of burn involves the dermal layer but no damage to prevent the growth of new epidermis during healing. pain, swelling, blisters may be extensive
second-degree burn
How many people are required to image a long bone fracture
two
one person used both hands to support the limb and below the injury while the other places the IR
what kind of burn extends deep into the subcutaneous tissue and destroy nerves. skin appears charred, or white life-less
third-degree burn
what kind of burn involves the skin, fat, muscle and bone. charred skin completely burn away
fourth-degree burn
respiratory complications occur such as pleural effusion and pneumonia
burns
swelling of the respiratory tract caused by trapped excess fluid.
inhalation of hot gases
Pulmonary edema
inflammation of the lungs
Pneumonia
fluid in the pleural space
Pleural effusion
-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
what kind of shock causes 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
What are the early signs of shock:
- pallor (change of color)
- increase heart rate
- increased respiration
-restlessness or confusion
-low blood pressure
What are the 5 main types of shock
- hypovolemic
- septic
- neurogenic
- cardiogenic
- allergic (anaphylactic)
How is hypovolemic shock or low volume shock treated
fluid replacement oxygen administration and medication to promote vasoconstriction
Caused by severe, often systemic infection (gram-negative bacteria)
Septic shock
how do you treat spetic shock
antibiotic therapy
- the failure of arterial resistance, causes blood to pool in the peripheral vessels
- occurs in reaction to an injury to the nervous system
- Patients with head or spinal trauma must be monitored closely for a decrease in blood pressure, which is often the first indication of this type of shock
Neurogenic shock
what kind of shock results from cardiac failure or interference with heart function.
- A pulmonary embolus or a reaction to anesthesia may initiate such an event.
- blow to the chest causes hemorrhage into the pericardium. The resulting pressure interferes with the heart’s pumping ability.
Cardiogenic shock
What kind of 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
Bee stings and injections of certain medications, including iodinated contrast media, are the most common causes
Anaphylaxis reaction or allergic shock
What are the symptoms of shock:
-restlessness and apprehensiveness
- increased pulse rate
- pallor with weakness or a change in thinking ability
- cool, clammy skin (except in patients with septic or neurogenic shock)
- decreased urination
- increased, shallow respiration (taking less air)
How should radiographers 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 (difficulty breathing or shortness of breath) 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.
a very mild form of shock that sometimes occurs when fright, pain, or unpleasant events are beyond the coping ability of the patient’s nervous system. Also known as fainting.
Syncope
When a patient faints what position should you put them in
assist patient into a supine position with feet elevated
Now known as posttraumatic disorder caused by psychological events as in “shell shock”
- far different from other types of shock with respect to its signs, symptoms, and treatment
- can cause sudden changes in mood and behavior long after the traumatic event, but is very unlikely to create an emergency situation for radiographers.
Psychological Shock
Examples of medical emergencies:
- contrast media reactions
- drug reactions
- diabetic emergencies
- cerebrovascular accidents
- seizures
- vertigo
- orthostatic hypotension
- epistaxis
- nausea and vomiting
what reaction range from mild to severe
No predictors
Contrast- Media Reactions
If patients are sensitive to the contrast media what do they do
They are premedicated with antihistamine such as diphenhydramine (Benadryl) or corticosteroid such as cortisone (Solu-Medrol) an anti-inflammatory
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 is the tretament for mild contrast reactions symptoms
There is no treatment needed because symptoms will resolve quickly without treatment
allergic reaction of hives characterized by blotchy reddening of the skin
Urticaria
What are the mild contrast reactions symptoms:
warmth, flushing, metallic taste, coughing and nausea
What are the moderate contrast reaction symptoms:
- erythema (skin redness)
- urticaria (hives)
- bronchospasm (wheezing)
What is the treatment for moderate contrast reactions symptoms
Antihistamine adminstered orally, intravenously, or intramuscularly. When bronchospasm is present the inhalation of a bronchodilating mediaction may be indicated
What is the treatment for severe (anaphylactic) reaction
- maintain airway
- call a code
- epinephrine usually given IV
- other drugs administered as needed by code team
What are the severe (anaphylactic) reactions of contrast media symptoms
Warmth, tingling, itching of palms and soles, dysphagia, and throat constriction; progresses rapidly to laryngeal and bronchial edema, leading to respiratory arrest, cardiac arrest, or seizures; may be fatal if not treated promptly
What are the treatments for vasovagal reactions symptoms
- Place patient supine, feet elevated 20 degrees, and head elevated if breathing is a problem
- IV fliuds and atropine administered for braadycardia to increase the heart rate and elevate blood pressure
Vasovageal reactions to contrast media symptoms:
- diaphoresis ( excessive sweating)
- hypotension (low blood pressure)
- bradycardia (slow heart rate)
A drug reaction can range in severity from a sudden bout of dizziness to cardiac arrest. The nature of the symptoms will determine the appropriate treatment.
Drug reactions
Types of diabetic emergencies -
- diabetes insipidus
- diabetes mellitus
- type l
- type ll
-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 (spasm)
- Insulin dependent form
- more likely to lapse into diabetic coma
Diabetes Mellitus - Type l
Signs and Symptoms of Diabetes Mellitus- Type l
- extreme thirst
- polyuria (going to the bathroom)
- fruity smelling breath
- emergent condition
- occurs in neglected type ll DM as a result of dehydration and hyperglycemia
Hyperosmolar hyperglycemic nonketotic (HHNK) syndrome
a less than normal amount of glucose in the blood, usually caused by administration of too much insulin. (low blood sugar)
hypoglycemia
Treatment for hypoglycemia
-candy
-sweet fruit juice
-Emergency medications include squeeze tubes of glucose gel.
-Administered inside patient’s cheek
-Low blood sugar
-Occurs in type I when insulin is taken and a meal is skipped
Hypoglycemia
- Realted to obesity
- treated with hyperglycemic drugs
Diabetes Mellitus-Type ll
Symptoms of hypoglycemia
-Sudden weakness
-Sweating
-Tremors
-Hunger
-Loss of consciousness
an emergency procedure for dislodging food or other obstruction from the trachea to prevent asphyxiation; also called abdominal thrust.
Heimlich maneuver
abnormally elevated level of blood glucose. Which prevents the use of glucose by the muscles. (high blood sugar)
Hyperglycemia
(quivering) involuntary shaking or movement
Tremor
Also called a stroke
Cerebrovascular Accident (CVA)
also called a stroke, is the term for interruption of the blood supply to the brain.
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
Caused by interruption of blood flow to the brain
-Hemorrhage
-Occlusion
Cerebrovascular Accident (CVA)
Stroke falls under what
the golden hour
May have trembling, shaking, or violent spasms
Seizures
Brief loss of consciousness
- absent seizures
- petite 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.
The patient may say, “I’m going to have a spell
A major motor (tonic-clonic or grand mal) seizure may be preceded by an aura or premonitory sign.
-Turn patient to lateral recumbent to prevent aspiration of secretions.
-Provide reassurance and assistance.
-Patient may be irritable and confused.
-Often wishes to sleep
- don’t put nothing to their mouth
- put them on the floor
Postseziure
-Dizziness brought on by sitting upright from a prolonged recumbent position
-Can be avoided by assisting the patient to sit upright slowly
Orthostatic Hypotension
an abnormal condition characterized by a lack of oxygen
Anoxia
-Severe dizziness, sometimes accompanied by nausea
-Caused either by an inner-ear disturbance or a brain or spinal-cord lesion
- Does not feel light-headed
- Describe the room as moving or spinning
- laying down too long
Vertigo
a sensation of instability, loss of equilibrium, or rotation, caused by a disturbance in the semicircular canal of the inner ear or the vestibular nuclei of the brainstem
Vertiago
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
bleeding from the nose (a nosebleed).
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.
If a patient expresses the need to vomit,
- don’t roll them on their back
provide an emesis basin or disposable receptacle immediately
- Provide tissues or a washcloth and water to rinse the mouth. It is especially important to support the patient in a sitting or lateral recumbent position to avoid the aspiration of vomitus
the removal of one or more organs from the abdominal cavity.
Evisceration
commonly known as a “heart attack”. 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.
Myocardial infarction (MI)
the cessation of breathing, caused by obstruction of the airway by a foreign object.
Respiratory arrest
response to a contrast medium may be triggered when the injected agent stimulates the vagus nerve, causing cardiovascular changes resulting in increased vasodilation of arterioles. This can cause diaphoresis, hypotension, and sinus bradycardia.
Vasovagal
Look at the different types of fracture worksheet
Look at the different types of fracture worksheet
