Medical Emergencies Flashcards
What is a medical emergency?
A situation in which a sudden change in a patient’s
medical/physiological status requires immediate
intervention.
What is an MRT’s role in a medical emergency?
- Preserving life.
- Avoid further harm to the patient.
- Obtain appropriate medical assistance as soon as possible.
- Although infrequent, it is imperative that an MRT is able to recognize medical emergencies AND take appropriate action.
Non-trauma related emergencies
- Shock - infection
- Anaphylaxis – reaction to contrast or meds
- Pulmonary embolism – air introduced via IV
- Reactions related to diabetes mellitus – hypoglycemic event
- Cerebral vascular accident (stroke) – ischemic/hemorrhagic
- Cardiac & respiratory failure – numerous causes
- Syncope – vasovagal reaction/hypoglycemic event
- Seizures – reaction to meds
What is assessed in a neurological assessment?
- Level of Consciousness (LOC); most sensitive indicator of neurological condition
- Pupillary response
- Limb movement/strength
- Vital signs
Trapezius Squeeze (central stimulus)
- Using the thumb and 2 fingers as pincers
- Take hold of about two inches of the muscle located at the angle where the neck and shoulder meet
- Twist and gradually apply increasing pressure for 10-20 seconds to elicit a response
Supraorbital Pressure (central stimulus)
- Place the flat of the thumb on the supra-orbital ridge (
small notch below the inner part of the eyebrow), while the hand rests on the head of the patient - Apply gradually increasing pressure for 10-20 seconds to elicit a response
Mandibular Pressure (central stimulus)
- Apply upward pressure at the angle of the mandible
- Apply gradually increasing pressure for 10-20 seconds
Sternal Rub (central stimulus)
- Fist is clenched and knuckles rubbed up and down sternum
- Extremely painful
- Can result in bruising, residual pain and discomfort
Peripheral Pain Stimulus
- Central stimuli should always be used when attempting to assess if the patient is localizing to the pain
- If the patient reacts to the central pain stimulus normally, then a peripheral stimulus is unlikely to be required
- Not an indication of intact brain function
Squeeze Nailbeds (peripheral stimulus)
Peripheral stimuli are generally applied to the limbs, and a common technique is squeezing the lunula area of the finger or toenail
What is the Glasgow coma scale?
standardized tool used for the assessment of neurological and cognitive functioning
- points based, rapid neurological assessment tool
- assesses: eye opening response, verbal response and motor response
simple, reliable and convenient to use
ongoing assessment possible
What is the maximum score possible with the Glasgow coma scale?
15 points
What is the minimum score possible with the Glasgow coma scale?
3
Decerebrate Posturing
- Caused due to damage to upper brain stem
- Extends limbs at the elbow in response to central painful stimuli
- Adduction of shoulders
- Flexion of wrist with while fingers make a fist or extend
- Legs are stiffly extended
- Feet are plantar flexed
Decorticate Posturing
- Damage to one or more corticospinal tracts.
- Arms are adducted and elbows flexed
- Wrist and fingers flexed over the chest
- Legs are stiffly extended and internally rotated
- Feet are plantar flexed
Presentation of Neurological Spine Injuries
- Numbness (pins and needles)
- Pain
- Paralysis
How do you modify exams for patients with neurological spinal injuries?
Angle X-ray tube instead of moving patient
How do we transfer patients with neurological spinal injuries?
- Use spinal cord precautions (do not adjust head, do not remove collar, log roll).
- Transfer the patient on the transfer board to the x-ray/CT table.
What do we do if a patient starts to vomit with neurological spinal injury?
Log roll, prevent aspiration of vomit
Traumatic head injury?
- exceedingly common
- “head injury” refers to injury of the brain, skull or both
- CT imaging is king
- Head injuries may be open or closed
What is an open head injury?
Involves an interruption in the bone or meninges
– open to infection
What is a closed head injury?
Result of blunt trauma
– cause hemorrhage, which results in swelling, and increased pressure within the cranium
CT appearance of closed injury?
Bleed (hyper density)
Midline shift (mass effect)
What can happen if a closed head injury is untreated?
Change in LOC
Seizures
Permanent deficits
Strokes
Respiratory arrest
Death
What is a craniotomy?
surgical removal of part of the bone from the soul to expose the brain
What are a battle’s sign and raccoon eyes indicative of?
Basal Skull fractures
what is a basal skull fracture?
- often also involve fractures of the face
- may involve shearing of the meninges resulting in leakage of cerebrospinal fluid (CSF) or blood through the ear or nose
What are precautions to take with head injuries?
Consider all head injuries to have accompanying cervical spine injuries until cleared
Head injury patient presentation
- headache
- lethargy
- irritability
- confusion
- vomiting
Any of the above could be caused by a bleed
MRT need to continually communicate with the patient to assess their LOC
What is a seizure?
- syndrome or a symptom
- can be caused by infections associated with high fever
- odour and flashing lights can cause a seizure in a person who is seizure prone
Clinical manifestation of a seizure
- Muscles become rigid and eye open wide
- Jerky body movements
- Rapid irregular respiration
- May vomit
- May froth and have blood streak saliva caused by biting lips or tongue
- May exhibit urinary or fecal incontinence
- Usually falls into deep sleep after seizure
How should an MRT respond to a seizure?
- protect the patient: stay with the patient and gently secure them to prevent injury, use pillows or sponges and raise side rails of bed, DO NOT RESTRAIN!
- call for assistance
- do not attempt to insert anything into patients mouth
- observe patient - how did it start, how long did it last
What are Cerebrovascular Accidents (CVA)?
- strokes
- occlusion (ischemic)
- rupture (hemorrhagic) of artery supplying the brain
mild (transient ischemic attack, TIA) to severe, life threatening situations
What are CVA clinical manifestations?
- Severe Headache
- Muscle weakness, Facial droop (one-sided)
- Hemiparesis
- Eye deviation (usually one sided) or loss of vision
- Confusion
- Dizziness
- Dysphasia (slurred speech) or aphasia (no speech)
- Ataxia (lack of coordination of muscles)
- Stiff neck
- Nausea or vomiting
- Change in LOC
Response to a patient having a stroke?
- stop the procedure immediately
- initiate Code
- call for help (NEVER leave the patient)
- monitor vital signs and prepare to administer IV fluids/oxygen as requested
Diagnosis and treatment of a stroke?
- CT imaging
- Fibrinolytic therapy
- Reduces damage from stroke.
- Only for thrombolytic/ischemic stroke
What is fibrinolytic therapy?
tPA (tissue plasminogen activator) can be given up to 4 hours after start of CVA
What is orthostatic hypotension?
- Lightheaded when sitting up or standing
- Temporary cerebral hypoxia
- Blood pooled in extremities after one position for long periods
- Very common in elderly
- Assist the patient to a sitting position
- Let them sit for a minute before getting up
What is vasovagal syncope and what causes it?
- Fainting or transient loss of consciousness.
- Usually resulting from insufficient blood supply to the brain.
- Can result from emotional trauma or stress, hunger, fatigue, pain, fear or events exceeding the coping ability of the person.
What are the symptoms of vasovagal syncope?
- cold, clammy skin
- pallor
- complaints of dizziness/nausea
- hypotension
- bradycardia
How do you respond to a patient experiencing vasovagal syncope?
- lie patient down
- elevate legs
what are respiratory emergencies?
caused by inadequate or non-existent gas exchange
- asthma
- obstruction of airway due to foreign body, swollen tongue, trauma
What are clinical manifestations of respiratory emergencies?
- laboured, noisy breathing
- wheezing
- neck vein distention
- diaphoresis (excessive sweating)
- anxiety
- cyanosis of lips and nail beds
What is asthma?
- caused by allergies, strong emotions, exercise
- bronchospasm
what is a bronchospasm?
contraction of the smooth muscles in the walls of the bronchi and bronchioles, causing narrowing of the lumen
how should you respond to asthma?
- sit patient up
- “puffer” or nebulizer (bronchodilator)
- severe cases: epinephrine, corticosteroids or intubation
Respiratory arrest clinical manifestations?
- no chest movement
- loss of consciousness
- weak or faint pulse
response to respiratory arrest?
- place patient supine
- initiate code
- grab crash cart
- start CPR if no pulse detected
What is angina (pectoris)?
Ischemia of myocardium due to lack of blood flow to the heart
clinical manifestations of angina?
- chest pain/pressure
- diaphoresis
- pallor
- nausea
- may mimic indigestion
what is stable angina?
- physical exertion/stress
- doesn’t change in frequency or worsen with time
- indicator of impending heart attack (myocardial infarction)
what is unstable angina?
- occurs at rest or exertion/stress
- pain worsens in frequency and severity
- indicator of impending heart attack (myocardial infarction)
what is cardiac arrest?
heart ceases to beat effectively, causing blood to no longer circulate
what are the causes of cardiac arrest?
- severe myocardial infarction
- impairment of electrical activity resulting in arrhythmia
- hypovolemic shock
- sever PE (pulmonary embolism)
- drug overdoses
Clinical manifestation of cardiac arrest?
- Loss of consciousness, pulse and BP
- dilation of the pupils within seconds
- possibility of seizures
What is an AED?
Automatic External Defibrillator
- it will analyze the patients cardiac rhythm, determine whether defibrillation is necessary
What is shock?
- body’s response to illness, trauma, severe emotional or physiological stress
- shock causes the body to suffer from insufficient blood flow
- life threatening condition that may progress rapidly and without warming
what are the causes of shock?
- cardiac failure
- blood or fluid loss
- obstruction of blood flow to vital organs
- vasodilation - decreased tone of blood vessels
What is shock continuum?
- Occurs in progression
- Inadequate blood flow results in inadequate oxygen and nutrients reaching vital organs.
- At the onset, changes occur in the physiologic function of cells and are not clinically detectable.
- As the condition progresses, blood is shunted away from vital organs to accommodate the oxygen needs of the heart and brain.
Stage 1 in the shock continuum?
the compensatory stage
- blood shunted away from other organs to heart and brain
clinical manifestations of the compensatory phase?
- cold and clammy skin
- nausea and dizziness
- increased respiration (SOB)
- BP drops, pulse rate increases
What is stage 2 of the shock continuum?
the progressive stage
- Arterial pressure drops.
- Vasoconstriction reduces arterial blood flow to organs.
- All body systems are inadequately perfused, causing ischemia and necrosis.
- Acute renal, liver, GI and hematologic failure.
- Tachycardia (as rapid as 150 beats/minute)
- Change in mental status.
What is stage 3 of the shock continuum?
the irreversible stage
- irreparable damage to organs, and recovery is unlikely
- low BP
- renal and liver failure
- release of necrotic tissue toxins and overwhelming acidosis
What are the types of shock?
Hypovolemic
Cardiogenic
Distributive
What are distributive types of shock?
neurogenic
septic
anaphylactic
What is hypovolemic shock?
15% or greater intravascular fluids loss
What are causes of hypovolemic shock?
internal or external hemorrhage, burns, prolonged vomiting or diarrhea (severe dehydration), or medications
symptoms of hypovolemic shock?
- excessive thirst
- cold extremities and clammy skin
- cyanosis of lips and nails, tongue and soft palate
- elevated HR
- decreased BP
What is cardiogenic shock?
failure of heart to pump adequate blood to organs
What are the causes of cardiogenic shock?
- Myocardial infarction
- Arrhythmias
What are obstructive causes of cardiogenic shock?
- Pulmonary embolism
- Arterial stenosis
- Tumors
- Cardiac tamponade
Manifestations of cardiogenic shock
- Chest pain
- Respiratory distress
- Cyanosis
- Rapid change in LOC
- Irregular pulse; may present with tachycardia and tachypnea (rapid, shallow breathing)
- Difficulty finding carotid pulse indicates decreased stroke volume of the heart
- Decreasing BP
- Decreasing urinary output
- Cool, clammy skin
What is distributive shock?
- Characterized by the blood vessel’s inability to constrict (loss of vasal tone) and the resultant inability to return blood to the heart.
- Chemicals released by the cells causes vasodilation and capillary permeability, which in turn prompts a large portion of the blood to pool peripherally.
- Bood pools in the peripheral blood vessels
what is the result of blood pooling in the peripheral blood vessels?
- decreased venous return to heart
- decreased blood pressure
- decreased tissue perfusion
what is neurogenic shock?
spinal cord injury, sever pain, diabetic shock
What is septic shock?
- systemic infection
- high mortality rate
what is anaphylactic shock?
allergic reaction - result of exaggerated hypersensitivity to re-exposure to an antigen that was previously encountered by the body’s immune system.
Why would you never give someone that is having a hemorrhagic stroke tPA?
it is a blood thinner, would make them bleed more
What is the most common cause of anaphylactic shock in medical imaging?
Iodinated contrast media
What are the symptoms of a mild systemic anaphylactic reaction?
- nasal congestion, sneezing, coughing
- Periorbital (around the eyes) swelling
- itching of eyes, nose and injection site
- tightness in chest, mouth or throat
What happens during anaphylactic shock?
Releases histamine, causing vasodilation and peripheral pooling of blood.
Accompanied by contraction of the smooth muscles, particularly of the respiratory tract.
Combined response produces shock, respiratory failure and death within minutes.
What are the symptoms of a moderate systemic anaphylactic reaction?
- Symptoms of Mild systemic reaction+
- Flushing, feeling of warmth, urticaria
- Bronchospasm and edema of airways or larynx
- Dyspnea (difficulty swallowing), cough, wheezing
What are the symptoms of a severe systemic anaphylactic reaction?
- All previous moderate and mild reactions +
- Decreased BP and weak pulse
- Rapid progression of bronchospasm, laryngeal edema, severe dyspnea, cyanosis
- Seizure, respiratory and cardiac arrest
What is the response to intraprocedural anaphylactic shock?
- Stop the infusion of contrast
- Stay with the patient, call for help
- Notify Radiologist
- Sit patient up if they are having breathing issues
- For moderate to severe reactions, may use EpiPen
- Call a code
What is diabetes mellitus?
group of metabolic diseases resulting from chronic disorder of carbohydrate metabolism
What causes diabetic emergencies?
Insufficient production or utilization of insulin
results in hyper glycemia
what are classic symptoms of diabetic emergencies?
polydipsia, polyphagia and polyuria
What is type 1 diabetes?
diagnosed at under 30 years of age
sudden onset
autoimmune process destroys insulin producing pancreatic beta cells
insulin needs to be injected to control blood glucose levels and prevent diabetic ketoacidosis
What is diabetic ketoacidosis?
- Cells do not get the glucose they need for energy
- Burn fat for energy and produces ketones
- Build up of ketones + glucose in the blood make it more acidic
- When levels get too high the condition is known as diabetic ketoacidosis
- Develops rapidly
what are symptoms of ketoacidosis?
- vomiting
- pronounced thirst, excessive urination and abdominal pain
- fruity odour on breath
Type 2 diabetes
- Most common
- Older than 40
- Gradual onset
- Impaired sensitivity to or decreased production of insulin
- Controlled by weight loss, dietary control and exercise
- Medications to prevent hyperglycemia
- May develop hyperosmolar hyperglycemic nonketotic syndrome (HHNS)
What is hyperosmolar hyperglycaemic nonketotic syndrome?
- Results from uncontrolled DM.
- More common with Type 2.
- Often associated with an illness or infection.
- In HHNS, your body tries to rid itself of the excess blood sugar by passing it into your urine, resulting in hyperosmolality if fluid is not replaced.
- Can lead to life-threatening dehydration as fluid is pulled into bloodstream from other organs.
- May lead to seizures, coma, death.
What is Type 3 diabetes?
gestational diabetes
- later months of pregnancy in non-diabetic women
- hormones secreted by placenta prevent the action of insulin
- often treated with diet, insulin if needed
- typically resolved following childbirth
What is a hypoglycaemic event?
patient has taken insulin but no food (prep for GI study)
what are the symptoms of a hypoglycaemic event?
- sudden onset of weakness, sweating and tremors
- eventually loss of consciousness/syncope
What is the treatment of a hypoglycaemic event?
If alert, patient can be given fruit juice or candy
if not alert, parenteral injection of glucagon or dextrose through an IV
Aphasia
inability to speak
Bradycardia
abnormally decreased heart rate
Bronchospasm
Contraction of smooth muscles in the wall of the bronchi and bronchioles, causing narrowing of the lumen and difficulty breathing
Diaphoresis
excessive sweating
Dysphagia
slurred speech
Dyspnea
difficulty breathing
Dysphagia
difficulty swalllowing
Edema
swelling - caused by fluid collection
Hemiparesis
Paralysis affecting one side of the body.
Hyperglycemia
Abnormally high blood glucose level
Hypoglycemia
Abnormally low blood glucose level
Polydipsia
Increased thirst
Polyphagia
Increased hunger
Polyuria
Increased urination
SOB
Shortness of breath
Syncope
Fainting
Tachycardia
(Abnormally) increased heart rate
Tachypnea
Rapid, shallow breathing
Vasodilation
Dilation of blood vessels
