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Patient Management 2 > Medical Emergencies > Flashcards

Medical Emergencies Flashcards

1
Q

What is a medical emergency?

A

A situation in which a sudden change in a patient’s
medical/physiological status requires immediate
intervention.

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2
Q

What is an MRT’s role in a medical emergency?

A
  • 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.
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3
Q

Non-trauma related emergencies

A
  • 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
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4
Q

What is assessed in a neurological assessment?

A
  • Level of Consciousness (LOC); most sensitive indicator of neurological condition
  • Pupillary response
  • Limb movement/strength
  • Vital signs
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5
Q

Trapezius Squeeze (central stimulus)

A
  • 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
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6
Q

Supraorbital Pressure (central stimulus)

A
  • 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
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7
Q

Mandibular Pressure (central stimulus)

A
  • Apply upward pressure at the angle of the mandible
  • Apply gradually increasing pressure for 10-20 seconds
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8
Q

Sternal Rub (central stimulus)

A
  • Fist is clenched and knuckles rubbed up and down sternum
  • Extremely painful
  • Can result in bruising, residual pain and discomfort
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9
Q

Peripheral Pain Stimulus

A
  • 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
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10
Q

Squeeze Nailbeds (peripheral stimulus)

A

Peripheral stimuli are generally applied to the limbs, and a common technique is squeezing the lunula area of the finger or toenail

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11
Q

What is the Glasgow coma scale?

A

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

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12
Q

What is the maximum score possible with the Glasgow coma scale?

A

15 points

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13
Q

What is the minimum score possible with the Glasgow coma scale?

A

3

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14
Q

Decerebrate Posturing

A
  • 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
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15
Q

Decorticate Posturing

A
  • 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
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16
Q

Presentation of Neurological Spine Injuries

A
  • Numbness (pins and needles)
  • Pain
  • Paralysis
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17
Q

How do you modify exams for patients with neurological spinal injuries?

A

Angle X-ray tube instead of moving patient

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18
Q

How do we transfer patients with neurological spinal injuries?

A
  • 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.
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19
Q

What do we do if a patient starts to vomit with neurological spinal injury?

A

Log roll, prevent aspiration of vomit

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20
Q

Traumatic head injury?

A
  • exceedingly common
  • “head injury” refers to injury of the brain, skull or both
  • CT imaging is king
  • Head injuries may be open or closed
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21
Q

What is an open head injury?

A

Involves an interruption in the bone or meninges
– open to infection

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22
Q

What is a closed head injury?

A

Result of blunt trauma
– cause hemorrhage, which results in swelling, and increased pressure within the cranium

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23
Q

CT appearance of closed injury?

A

Bleed (hyper density)
Midline shift (mass effect)

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24
Q

What can happen if a closed head injury is untreated?

A

Change in LOC
Seizures
Permanent deficits
Strokes
Respiratory arrest
Death

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25
Q

What is a craniotomy?

A

surgical removal of part of the bone from the soul to expose the brain

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26
Q

What are a battle’s sign and raccoon eyes indicative of?

A

Basal Skull fractures

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27
Q

what is a basal skull fracture?

A
  • 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
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28
Q

What are precautions to take with head injuries?

A

Consider all head injuries to have accompanying cervical spine injuries until cleared

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29
Q

Head injury patient presentation

A
  • 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
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30
Q

What is a seizure?

A
  • 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
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31
Q

Clinical manifestation of a seizure

A
  • 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
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32
Q

How should an MRT respond to a seizure?

A
  • 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
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33
Q

What are Cerebrovascular Accidents (CVA)?

A
  • strokes
  • occlusion (ischemic)
  • rupture (hemorrhagic) of artery supplying the brain
    mild (transient ischemic attack, TIA) to severe, life threatening situations
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34
Q

What are CVA clinical manifestations?

A
  • 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
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35
Q

Response to a patient having a stroke?

A
  • 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
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36
Q

Diagnosis and treatment of a stroke?

A
  • CT imaging
  • Fibrinolytic therapy
  • Reduces damage from stroke.
  • Only for thrombolytic/ischemic stroke
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37
Q

What is fibrinolytic therapy?

A

tPA (tissue plasminogen activator) can be given up to 4 hours after start of CVA

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38
Q

What is orthostatic hypotension?

A
  • 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
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39
Q

What is vasovagal syncope and what causes it?

A
  • 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.
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40
Q

What are the symptoms of vasovagal syncope?

A
  • cold, clammy skin
  • pallor
  • complaints of dizziness/nausea
  • hypotension
  • bradycardia
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41
Q

How do you respond to a patient experiencing vasovagal syncope?

A
  • lie patient down
  • elevate legs
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42
Q

what are respiratory emergencies?

A

caused by inadequate or non-existent gas exchange
- asthma
- obstruction of airway due to foreign body, swollen tongue, trauma

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43
Q

What are clinical manifestations of respiratory emergencies?

A
  • laboured, noisy breathing
  • wheezing
  • neck vein distention
  • diaphoresis (excessive sweating)
  • anxiety
  • cyanosis of lips and nail beds
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44
Q

What is asthma?

A
  • caused by allergies, strong emotions, exercise
  • bronchospasm
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45
Q

what is a bronchospasm?

A

contraction of the smooth muscles in the walls of the bronchi and bronchioles, causing narrowing of the lumen

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46
Q

how should you respond to asthma?

A
  • sit patient up
  • “puffer” or nebulizer (bronchodilator)
  • severe cases: epinephrine, corticosteroids or intubation
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47
Q

Respiratory arrest clinical manifestations?

A
  • no chest movement
  • loss of consciousness
  • weak or faint pulse
48
Q

response to respiratory arrest?

A
  • place patient supine
  • initiate code
  • grab crash cart
  • start CPR if no pulse detected
49
Q

What is angina (pectoris)?

A

Ischemia of myocardium due to lack of blood flow to the heart

50
Q

clinical manifestations of angina?

A
  • chest pain/pressure
  • diaphoresis
  • pallor
  • nausea
  • may mimic indigestion
51
Q

what is stable angina?

A
  • physical exertion/stress
  • doesn’t change in frequency or worsen with time
  • indicator of impending heart attack (myocardial infarction)
52
Q

what is unstable angina?

A
  • occurs at rest or exertion/stress
  • pain worsens in frequency and severity
  • indicator of impending heart attack (myocardial infarction)
53
Q

what is cardiac arrest?

A

heart ceases to beat effectively, causing blood to no longer circulate

54
Q

what are the causes of cardiac arrest?

A
  • severe myocardial infarction
  • impairment of electrical activity resulting in arrhythmia
  • hypovolemic shock
  • sever PE (pulmonary embolism)
  • drug overdoses
55
Q

Clinical manifestation of cardiac arrest?

A
  • Loss of consciousness, pulse and BP
  • dilation of the pupils within seconds
  • possibility of seizures
56
Q

What is an AED?

A

Automatic External Defibrillator
- it will analyze the patients cardiac rhythm, determine whether defibrillation is necessary

57
Q

What is shock?

A
  • 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
58
Q

what are the causes of shock?

A
  • cardiac failure
  • blood or fluid loss
  • obstruction of blood flow to vital organs
  • vasodilation - decreased tone of blood vessels
59
Q

What is shock continuum?

A
  • 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.
60
Q

Stage 1 in the shock continuum?

A

the compensatory stage
- blood shunted away from other organs to heart and brain

61
Q

clinical manifestations of the compensatory phase?

A
  • cold and clammy skin
  • nausea and dizziness
  • increased respiration (SOB)
  • BP drops, pulse rate increases
62
Q

What is stage 2 of the shock continuum?

A

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.

63
Q

What is stage 3 of the shock continuum?

A

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

64
Q

What are the types of shock?

A

Hypovolemic
Cardiogenic
Distributive

65
Q

What are distributive types of shock?

A

neurogenic
septic
anaphylactic

66
Q

What is hypovolemic shock?

A

15% or greater intravascular fluids loss

67
Q

What are causes of hypovolemic shock?

A

internal or external hemorrhage, burns, prolonged vomiting or diarrhea (severe dehydration), or medications

68
Q

symptoms of hypovolemic shock?

A
  • excessive thirst
  • cold extremities and clammy skin
  • cyanosis of lips and nails, tongue and soft palate
  • elevated HR
  • decreased BP
69
Q

What is cardiogenic shock?

A

failure of heart to pump adequate blood to organs

70
Q

What are the causes of cardiogenic shock?

A
  • Myocardial infarction
  • Arrhythmias
71
Q

What are obstructive causes of cardiogenic shock?

A
  • Pulmonary embolism
  • Arterial stenosis
  • Tumors
  • Cardiac tamponade
72
Q

Manifestations of cardiogenic shock

A
  • 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
73
Q

What is distributive shock?

A
  • 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
74
Q

what is the result of blood pooling in the peripheral blood vessels?

A
  • decreased venous return to heart
  • decreased blood pressure
  • decreased tissue perfusion
75
Q

what is neurogenic shock?

A

spinal cord injury, sever pain, diabetic shock

76
Q

What is septic shock?

A
  • systemic infection
  • high mortality rate
77
Q

what is anaphylactic shock?

A

allergic reaction - result of exaggerated hypersensitivity to re-exposure to an antigen that was previously encountered by the body’s immune system.

78
Q

Why would you never give someone that is having a hemorrhagic stroke tPA?

A

it is a blood thinner, would make them bleed more

79
Q

What is the most common cause of anaphylactic shock in medical imaging?

A

Iodinated contrast media

80
Q

What are the symptoms of a mild systemic anaphylactic reaction?

A
  • nasal congestion, sneezing, coughing
  • Periorbital (around the eyes) swelling
  • itching of eyes, nose and injection site
  • tightness in chest, mouth or throat
80
Q

What happens during anaphylactic shock?

A

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.

81
Q

What are the symptoms of a moderate systemic anaphylactic reaction?

A
  • Symptoms of Mild systemic reaction+
  • Flushing, feeling of warmth, urticaria
  • Bronchospasm and edema of airways or larynx
  • Dyspnea (difficulty swallowing), cough, wheezing
82
Q

What are the symptoms of a severe systemic anaphylactic reaction?

A
  • 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
83
Q

What is the response to intraprocedural anaphylactic shock?

A
  • 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
84
Q

What is diabetes mellitus?

A

group of metabolic diseases resulting from chronic disorder of carbohydrate metabolism

85
Q

What causes diabetic emergencies?

A

Insufficient production or utilization of insulin
results in hyper glycemia

86
Q

what are classic symptoms of diabetic emergencies?

A

polydipsia, polyphagia and polyuria

87
Q

What is type 1 diabetes?

A

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

88
Q

What is diabetic ketoacidosis?

A
  • 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
89
Q

what are symptoms of ketoacidosis?

A
  • vomiting
  • pronounced thirst, excessive urination and abdominal pain
  • fruity odour on breath
90
Q

Type 2 diabetes

A
  • 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)
91
Q

What is hyperosmolar hyperglycaemic nonketotic syndrome?

A
  • 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.
92
Q

What is Type 3 diabetes?

A

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

93
Q

What is a hypoglycaemic event?

A

patient has taken insulin but no food (prep for GI study)

94
Q

what are the symptoms of a hypoglycaemic event?

A
  • sudden onset of weakness, sweating and tremors
  • eventually loss of consciousness/syncope
95
Q

What is the treatment of a hypoglycaemic event?

A

If alert, patient can be given fruit juice or candy
if not alert, parenteral injection of glucagon or dextrose through an IV

96
Q

Aphasia

A

inability to speak

97
Q

Bradycardia

A

abnormally decreased heart rate

98
Q

Bronchospasm

A

Contraction of smooth muscles in the wall of the bronchi and bronchioles, causing narrowing of the lumen and difficulty breathing

99
Q

Diaphoresis

A

excessive sweating

100
Q

Dysphagia

A

slurred speech

101
Q

Dyspnea

A

difficulty breathing

102
Q

Dysphagia

A

difficulty swalllowing

103
Q

Edema

A

swelling - caused by fluid collection

104
Q

Hemiparesis

A

Paralysis affecting one side of the body.

105
Q

Hyperglycemia

A

Abnormally high blood glucose level

106
Q

Hypoglycemia

A

Abnormally low blood glucose level

107
Q

Polydipsia

A

Increased thirst

108
Q

Polyphagia

A

Increased hunger

109
Q

Polyuria

A

Increased urination

110
Q

SOB

A

Shortness of breath

111
Q

Syncope

A

Fainting

112
Q

Tachycardia

A

(Abnormally) increased heart rate

113
Q

Tachypnea

A

Rapid, shallow breathing

114
Q

Vasodilation

A

Dilation of blood vessels

Patient Management 2 (3 decks)

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