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.
What is an isscemic stroke caused by?
Cardiovascular disease, medication
What is a CVA?
Cerebrovascular Accidents (CVA)
What is an MRT’s Response to 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.
What is Fibrinolytic therapy?
A tPA (tissue plasminogen activator) that can be given up to 4 hours after start of CVA to reduce a damage.
What type of stroke patient can you give Fibrinolytic therapy?
Only for thrombolytic/ischemic stroke
What is orthostatic hypotension caused by?
Temporary cerebral hypoxia (Blood pooled in extremities after one position for long periods)
What is syncope and what causes it?
-Fainting or transient loss of consciousness 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
What is an MRTs Response to Vasovagal Syncope?
- Lie patient down.
- Elevate legs.
What are Respiratory Emergencies caused by?
Caused by inadequate or non-existent gas exchange or obstruction of airway due to foreign body, swollen tongue, trauma
What are some Clinical Manifestations of a respiratory emergency?
- Labored, noisy breathing
- Wheezing
- Neck vein distention
- Diaphoresis (excessive sweating)
- Anxiety
- Cyanosis (blue) of lips and nail beds
What is a Bronchospasm?
Asthma that causes contraction of the smooth muscles in the walls of the bronchi and bronchioles, causing narrowing of the lumen.
What is asthma caused by?
Caused by allergies, strong emotions, exercise
What is an MRTs Response to Asthma?
- Sit patient up
- Give them perscribed “Puffer” or nebulizer (bronchodilator)
- Severe cases: epinephrine, corticosteroids or intubation
What are the clinical manifestations of Respiratory Arrest?
- No chest movement
- Loss of consciousness
- Weak or faint pulse
What is an MRTs response to Respiratory Arrest?
- Place patient supine
- Initiate code
- Grab crash cart
- Start CPR if no pulse detected
What is Angina (Pectoris)?
-Ischemia (no blood flow) of myocardium due to lack of blood flow to the heart.
What are the Clinical Manifestations of Angina (Pectoris)?
- Chest pain/pressure
- Diaphoresis (sweaty, clammy skin)
- Pallor
- Nausea
- May mimic indigestion (epigastric pain)
What is stable angina?
- Occurs during physical exertion/stress
- Doesn’t change in frequency or worsen with time
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 arrythmia
- Hypovolemic shock
- Severe PE (pulmonary embolism)
- Drug overdoses
What is Hypovolemic shock
Loss of blood volume
What are the Clinical Manifestation of Cardiac Arrest?
- Loss of consciousness, pulse and BP
- Dilation of the pupils within seconds
- Possibility of seizures
What is an Automatic External Defibrillator (AED)?
Device uses electrical current to shock heart back into normal rhythm by analyzing the patient’s cardiac rhythm to determine if defibrillation is necessary
What is shock?
Body’s response to illness, trauma, severe emotional or physiological stress.
What can shock lead to?
-Results in inadequate oxygen and nutrients reaching vital organs to to accommodate the oxygen needs of the heart and brain.
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; i.e. lower blood pressure
Is it clinically dectable when changes occur in the physiologic function of cells, at onset of shock?
No; At the onset, changes occur in the physiologic function of cells and are not clinically detectable.
What are the stages of shock?
Stage 1: Compensatory Stage
Stage 2: Progressive Stage
Stage 3: Irreversible Stage
What is physiologically occuring during the Compensatory Stage of shock?
Blood shunted away from other organs to heart and brain
What are the clinical manifiestations of stage 1 shock?
- Cold & clammy skin
- Nausea & dizziness
- Increased respiration (SOB)
- BP drops, pulse rate increases
What is happening in the body once a patient has reached stage 2 shock?
- Drop in blood pressure and blood flow to organs
- ischemia and necrosis.
- Acute renal, liver, GI and hematologic failure.
- Tachycardia (as rapid as 150 beats/minute)
- Change in mental status.
What is occuring in the body during stage 3 shock?
- Low BP
- Renal and liver failure
- Release of necrotic tissue toxins and overwhelming lactic acidosis
Irreversible
What are the Types of Shock?
- Hypovolemic
- Cardiogenic
- Distributive
What are the types of Distributive shock?
- Neurogenic
- Septic
- Anaphylactic-major allergic reactions
What are the causes of Hypovolemic Shock?
Internal and external hemorrhage, burns, prolonged vomiting or diarrhea (severe dehydration), or medications.
How much intravascular fluids have been lost during hypovolemic shock?
15% or greater of intravascular fluids loss (≥750 ml)
What are the 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 (issue with electrical impulses at the wrong pattern or rate)
- Obstructive causes
What are the obstructive causes of cardiogenic shock?
- PE
- Arterial stenosis-narrowing (atherosclerosis)
- Tumors
- Cardiac tamponade
Name 3 Manifestations of Cardiogenic Shock:
- Chest pain
- Respiratory distress
- Cyanosis
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.
Why does blood pool peripherally during distributive shock?
Chemicals released by the cells causes vasodilation and capillary permeability, which in turn prompts a large portion of the blood to pool peripherally.
What does Blood pooling in the peripheral blood vessels result in?
Decreased venous return to heart
Decreased blood pressure
Decreased tissue perfusion
What does Neurogenic shock result from?
Spinal cord injury, severe pain, diabetic shock
What does Septic shock result from?
Systemic infection
What does Anaphylactic shock result from?
Allergic reaction
What is Anaphylactic Shock a result of?
Result of exaggerated hypersensitivity to re-exposure to an antigen that was previously encountered by the body’s immune system.
What is the most common cause of anaphylactic shock in medical imaging?
Iondinated contrast
What are Mild Systemic Reactions of anaphylatic shock?
- Nasal congestion, sneezing, coughing
- Periorbital (around the eyes) swelling
- Itching of eyes, nose, injection site
Tightness in chest, mouth or throat
What physiologically occurs 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 moderate systemic reactions of anaphylactic shock?
- Symptoms of Mild systemic reaction+
- Flushing, feeling of warmth, urticaria
- Bronchospasm and edema of airways or larynx
- Dyspnea (difficulty swallowing), cough, wheezing
What are severe reactions of systemic anaphylactic shock?
- 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 MRTs 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 (site specific)
- Call a code
What is Diabetes Mellitus?
-Group of metabolic diseases resulting from chronic disorder of carbohydrate metabolism.
(Insufficient production or utilization of insulin.)
True or false?
Diabetes Mellitus results in hypogycemia.
False; diabetes Mellitus results in hypergycemia.
What are the classic symptoms of Diabetes Mellitus?
Polydipsia, Polyphagia and Polyuria
True or false?; Type 1 DM occurs in patients over 30 years old.
False; Younger than 30 years of age
What is Diabetic Ketoacidosis?
Occurs when the body uses fat for energy, which produces ketones. Ketones + glucose build up in the blood make it more acidic.
When levels get too high the condition is known as diabetic ketoacidosis.
What are some symptoms of Diabetic Ketoacidosis?
- Vomiting
- Pronounced thirst, excessive urination and abdominal pain
- Fruity odor on breath
What are the symptoms of a hypoglycemic event and what it it predominantly caused by in the imaging department?
Symptoms:
-Sudden onset of weakness, sweating, tremors
-Eventually loss of consciousness/syncope
Caused when: Patient has taken insulin but no food (prep for GI study)
What is the treatment for a hypoglycemic event?
- If alert, patient can be given fruit juice or candy.
- Not alert, parenteral injection of glucagon or dextrose through an IV
What is Type 3 DM?
-Occurs in later months of pregnancy (non-diabetic women)
-Hormones secreted by placenta prevent the action of insulin
How is type 3 DM treated?
-Often treated with diet, insulin if needed
-Typically resolved following birth of child
What can Hyperosmolar Hyperglycemic Nonketotic Syndrome lead to?
- Can lead to life-threatening dehydration as fluid is pulled into bloodstream from other organs.
-May lead to seizures, coma, death.
With hyperosmolar Hyperglycemic Nonketotic Syndrome, how does the body try to get rid of excess sugar?
By passing it into your urine, resulting in hyperosmolality if fluid is not replaced.
What does Hyperosmolar Hyperglycemic Nonketotic Syndrome result from?
-Results from uncontrolled DM.
-Often associated with an illness or infection.
What diabetes is Hyperosmolar Hyperglycemic Nonketotic Syndrome more common with?
More common with Type 2.
At what age does type 2 diabetes usually develop?
Older than 40
What is the most common type of diabetes?
Type 2
True or false; type 2 diabetes has sudden onset.
False; gradual onset
True or false; type 1 diabetes has sudden onset.
True
How is type 2 diabetes treated?
-Controlled by weight loss, dietary control and exercise
-Medications to prevent hyperglycemia
True or false; Type 2 diabetes results from Impaired sensitivity to or decreased production of insulin
True
True or false; diabetic ketoacidosis develops rapidly.
True
How do you treat hypovolemic shock
Lactated ringers solution
