Unit 3-Medical Emergencies Flashcards
Define medical emergency:
A situation in which a sudden change in a patient’s medical/physiological status requires immediate intervention.
What is the MRT’s role in a Medical Emergency?
- Preserving life.
- Avoid further harm to the patient.
- Obtain appropriate medical assistance as soon as possible.
What is the first step in recognizing medical emergencies?
Establishing baseline. (with the patient)
What behaviours must a technologist establish a baseline prior to the start of an exam?
Neurologic and cognitive functioning
What are the steps in taking action during emergencies?
- Alert the Hospital emergency response team
- Locate and make crash cart available for use.
- Locate oxygen administration equipment.
- Locate fluid management equipment.
What things must you note when you call after you call an emergency?
- Note time
- Be prepared to explain exact location
- Once team has arrived explain event (when did the baseline change and why)
What is a Neurologic Assessment?
Assessment of sensory, motor and cognitive responses to assess functioning of the nervous system.
What is assessed in a Neurological Assessment?
- Level of consciousness (LOC)
- Pupillary response
- Limb movement/strength
- Vital signs
When may a neurologic assessment not be effective?
Under the influence of substances, medications that alter neurological function
What is the most sensitive indicator of neurological condition?
Level of consciousness (LOC)
What is Level of consciousness (LOC) defined as?
- Arousal and wakefulness (brainstem and hypothalamus response)
- Awareness and cognition
What can physically be done to assess patient’s response to pain?
- Central stimulus
- Peripheral stimulus
What are the 4 central stimulus?
- Trapezius Squeeze (central stimulus)
- Supraorbital pressure (central stimulus)
- Mandibular pressure (central stimulus)
- Sternal rub (central stimulus)
How do you preform a trapezius sqeeze
- Use the thumb and two fingers as pinchers
- Take a hold of about 2 inches of the muscle located at the the angle where the neck and the shoulder meet
- Twist and gradually apply increase pressure for 10-20 seconds to elcit a response
How do you preform a Supraorbital pressure stimulus?
How do you preform a Mandibular pressure stimulus?
- Apply upward pressure at the angle of the mandible.
- Apply gradually increasing pressure for 10 to 20 seconds to elicit a response.
How do you preform a Sternal rub stimulus?
- Fist is clenched and knuckles rubbed up and down sternum.
- Can result in bruising, residual pain and discomfort.
When should Central stimuli be used?
Central stimuli should always be used when attempting to assess if the patient is localizing to pain.
True or false?
If the patient reacts to the central pain stimulus normally, then a peripheral stimulus is required.
False; If the patient reacts to the central pain stimulus normally, then a peripheral stimulus is unlikely to be required.
Is Peripheral Pain Stimulus a good indicator of brain function?
No, not an indication of intact brain function. (can still have a limb response without brain function)
Give an example of a peripheral stimulus:
Squeezing nailbeds (lunula area of the finger or toenail)
What is the Glasgow Coma Scale?
- Standardized tool used for the assessment of neurologic & cognitive functioning.
- Points based, rapid neurologic assessment tool.
What does the Glasgow Coma Scale assess?
- Eye opening response
- Verbal response
- Motor response
What is the maximum score possible on the glasgow coma scale?
15 points
What is the minumum score possible on the glasgow coma scale?
3 points
What are the 2 Motor responses in response to an abnormal extension to pain?
- Decerebrate Posturing
- Decorticate Posturing
What is Decerebrate Posturing caused by?
Caused due to damage to upper brain stem
What is Decorticate Posturing caused by?
Damage to one or more corticospinal tracts.
What are some examples of Decerebrate Posturing
- 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
What are some examples of Decorticate Posturing?
- Arms are adducted and elbows flexed
- Wrist and fingers flexed over the chest
- Legs are stiffly extended and internally rotated
- Feet are plantar flexed
How do patients with neurological Spine Injuries present?
- Numbness (pin and needles)
- Pain
- Paralysis
How do we modify exams for patients with Neurological Spinal Injuries?
Angle x-ray tube instead of moving patient., avoid moving spine
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 with other people.
What do we do if patient starts to vomit with Neurological Spinal Injuries?
Log Roll. Prevent aspiration of vomit. (minimum of three staff to do log roll)
What modality do we use for traumatic head injuries?
CT
What is an Traumatic Head Open injury?
Involves an interruption in the bone or meninges – open to infection.
What is an Traumatic Head closed injury?
It is a result of blunt trauma – cause hemorrhage, which results in swelling, and increased pressure within the cranium.
What pathology is shown here? What does it cause?
-Hematoma (large area of swelling) from depressed Skull Fracture
-Causes pressure and damage to brain tissue just beneath it
What pathology is shown here?
No pathology-normal head CT
What type of head injury is being shown here?
Closed Injury
What is Midline Shift (Mass effect)?
From a brain bleed, it pushes the ventricles and other structures in the brain inside
What is a craniotomy?
Surgical removal of part of the bone from the skull to expose the brain.
What fractures are being shown here?
Basal Skull Fractures
What are the physical signs basal skull fractures?
- Battle’s Sign
- Raccoon Eyes
True or false?
Basal skull fractures often also involve fractures of the face.
True
What can shearing of the meninges from basal skull fractures cause?
Can result in leakage of cerebrospinal fluid (CSF) or blood through the ear or nose.
True or false?
Consider all head injuries to have accompanying cervical spine injuries until cleared.
True
What is the physiology behind a seizure?
An unsystematic discharge of neurons of the cerebrum that result in abrupt alteration in brain function that can begin with little to no warning and can last for a few seconds to several minutes.
True or false?
A seziure can be syndrome or a symptom.
True
List 3 Clinical manifestation of a Seizure:
- Muscles become rigid and eye open wide
- Jerky body movements
- Rapid irregular respiration
What is an MRT’s Response to a Seizure?
- Stay with patient and gently secure them to prevent injury.
- Use pillows or sponges and raise side rails of bed. Do not restrain!
- Call for assistance.
- Observe patient – how did it start, how long did it last.
What are the 2 types of strokes?
- Occlusion (Ischemic)
- Rupture (Hemorrhagic) of artery supplying the brain.