week 7: chapter 20 Medical Emergencies

• An emergency happens when a patient's condition or medical status changes suddenly, requiring immediate attention and action.

Medical Imaging Professional Role

• One must preserve life.
• One must avoid more harm to the patient.
• One must obtain medical help as quickly as possible.
• One must know emergency procedures and be able to start them.

Emergency Priorities

• Make sure the airway is open.
• Stop any bleeding.
• Prevent or treat shock.
• Take care of any wounds or fractures.
• Provide emotional support.
• Check on the patient regularly and do appropriate follow-up.

Crash Cart

• A crash cart contains emergency drugs and supplies.
• It's important to know where the crash cart is located in the department.
• It's important to know what's in the crash cart and where everything is.

Emergency Equipment

• Emergency or crash cart is essential.
• Oxygen is critical.
• Wall-mounted suction is important.
• AEDs (automatic external defibrillators) are necessary.

Crash Cart Standard Equipment

• Backboard provides support.
• Stethoscope for listening to bodily functions.
• Blood pressure cuff to measure blood pressure.
• Ambu bag assists with breathing.
• Laryngoscope helps with intubation.
• Flashlight provides light.
• Batteries power equipment.
• Extension cord extends reach.
• Oxygen flow meter measures oxygen.
• Tourniquet restricts flow.
• Endotracheal tubes assists with intubation.
• Nasopharyngeal tubes stabilize airway.
• Suction catheters removes of fluids.
• Levine tubing assists with feeding.
• Jelco cannulas deliver fluids.
• Tracheostomy tubes for airway management.
• Cut-down tray for surgical procedures.
• Suction bottle collects fluids.
• Hemostat clamps blood vessels.
• Scissors cut materials.
• Surgeon’s gloves in various sizes protect hands.
• Syringes in variety of sizes administer medication.
• Needles in variety of sizes administer medication.
• Stopcocks and connectors, variety controls flow.
• Tongue blades depresses tongue.
• Sterile gauze cleans wound.
• Adhesive and paper tape secures bandages.
• Alcohol swabs disinfect surfaces.
• Surgical lubricant reduces friction.
• Blood collection tubes collects samples.

Crash Cart Emergency Drugs

• Adrenaline/epinephrine is a bronchodilator.
• Atropine is an anticholinergic.
• Benadryl (Diphenhydramine) is an antihistamine.
• Bretylol (Bretylium) is an antiarrhythmic.
• Dilantin (Phenytoin) is an anticonvulsant.
• Dobutrex (Dobutamine) is a stimulant.
• Inderal (Propranolol) is an antiarrhythmic.
• Intropin (Dopamine) is a stimulant.
• Isoptin (verapamil) is a vasodilator.
• Isuprel (Isoproterenol) is a bronchodilator.
• Lanoxin (Digoxin) is an antiarrhythmic.
• Lasix (Furosemide) is a diuretic.
• Levophed (Norepinephrine) is a vasoconstrictor.
• Nitroglycerin is a vasodilator.
• Nitropress (Sodium nitroprusside) is a vasodilator.
• Pronestyl (Procainamide) is an antiarrhythmic.
• Sodium bicarbonate is a fluid replacement.
• Xylocaine (Lidocaine) is an antiarrhythmic.

Contrast Reaction Box

• The contrast reaction box is a mini-emergency kit.
• It contains:
  • Adrenalin - epinephrine (generic)
  • Benadryl - Diphenhydramine (generic)
  • Sulu-cortef - Hydrocortisone (generic)
  • Aromatic Ammonia ampules
  • Syringes (TB syringe - 1cc & 2 3cc syringes)

Radiology Emergencies

• Shock
• Anaphylaxis
• Pulmonary embolus
• Diabetic reactions
• Cerebrovascular accident (CVA)
• Cardiac and respiratory failure
• Syncope
• Seizures

Head Injuries

• Assess the patient's level of consciousness.
• Clinical symptoms may not be immediately obvious.
• Look out for hematoma.
• Look out for brain swelling.
• CT (computed tomography) is the best way to assess.

Levels of Consciousness

• Head injuries are categorized by level of consciousness.
• Alert and conscious is the least severe, and the patient will respond to stimuli.
• Drowsy is a serious condition in which the patient can be roused by loud speaking or gently physical contact.
• Unconscious patients will respond to painful stimuli such as pinches and pinpricks.
• Comatose is the most serious, which patients will be unresponsive to most stimuli.

Assessing Patients

• Assess patients at the beginning of a procedure.
• Look for signs of deterioration in their level of consciousness.
• Be aware of deteriorating head injury.
• A deteriorating situation is indicated by alert and a patient becoming irritable and lethargic.
• Make sure patients are assessed correctly, distinguishing between intoxication and head injury.
• Ask the patient to state their name, date, address, and reason for coming to radiology.
• As the patient is instructed during positioning, note their ability to follow the instructions.
• Compare vital signs against a baseline to note changes.
• Changes in a patient's neurological status or consciousness must never be ignored.

Deteriorating Situations

• Signs of deteriorating situations include sudden irritability, lethargy, slowing pulse rate, slowing respiratory rate, and changes in consciousness.
• Responses should include maintaining airways, moving the patient minimally, stopping procedures, acquiring medical assistance, and monitoring vital signs.

Shock

• Shock is a circulatory system failure to support vital of body functions.
• The shock continuum includes compensatory stage, progressive stage, and irreversible stage.

Compensatory Stage of Shock

• Blood moves from the lungs, skin, kidneys and GI to the brain and heart.
• Skin is cold and clammy.
• Urine output decreases.
• Respiration increases.
• Bowel sounds are hypoactive.
• Blood pressure is normal.
• Anxiety level increases.

Progressive Stage of Shock

• Blood pressure falls and the heart pumps inadequately.
• Capillaries leak fluid, decreasing fluid in circulation.
• Renal, liver, GI, and hematologic systems experience failure.
• Respiration rate is rapid and shallow.
• Pulmonary edema occurs from fluid leaking from pulmonary capillaries.
• Tachycardia is present.
• There is chest pain.
• Mental status changes, causing confusion, lethargy, and loss of consciousness.
• Renal, hepatic GI and hematologic problems present.

Irreversible Stage of Shock

• There is irreparable damage and recovery is unlikely.
• Blood pressure remains low.
• Renal and liver failure ensues.
• Release of necrotic tissue toxins and lactic acidosis happens.

Basic Types of Shock

• Hypovolemic shock is caused by loss of blood or tissue fluids from trauma.
• Cardiogenic shock occurs if the heart can't pump enough blood , due to any cardiac disorder like a heart attack.
• Neurogenic shock is due to spinal anesthesia or damage to the supper spinal cord.
• Vasogenic shock causes the massive dilation of blood vessels and increases arterial blood pressure.

Vasogenic Shock

• This shock type is due to the following reasons:
  • Anaphylactic caused by severe allergic reaction.
  • Septic associated with bacteria in the blood stream that causes inadequate blood supply to body tissues.
  • Deep anesthesia associated with surgery.
• Distributive Shock:
  • Pooling in the peripheral blood leads to decreased venous return, and decreased pressure.
  • Anaphylactic is caused by a severe allergic reaction.
  • Septic shock is associated with bacteria that restricts venous return.
  • Neurogenic - spinal cord injury or medication.
• Obstructive Shock results from pathological condition that interferes normal function of heart.

Hypovolemic Shock Classes

• Class I involves blood loss of 15%.
• Class II involves blood loss of 15%30%.
• Class III involves blood loss of 30%-40%.
• Class IV involves blood loss of more than 40%.

Symptoms and Signs of Shocks

• Restlessness.
• Apprehension or general anxiety.
• Tachycardia.
• Decreasing blood pressure.
• Cold and clammy skin.
• Pallor.

How to Prevent Shock

• Maintain normal temperature.
• Overheating avoidance.
• Reduce on anxiety and stress.
• Prevent sudden change on pain and temperature.
• Talk in a calm tone with emergency patients.

Tech Responsibilities

• Stop procedure.
• Place patient with feet elevated.
• Maintain patient’s body temperature.
• Notify the Physician.
• Check breathing.
• Apply pressure on the wound.
• Keep patients warm.
• Assess and track the Vital Signs.
• Do not leave the patients.
• Do not give water or food.

Anaphylactic Shock

• Anaphylactic shock is a type of vasogenic shock.
• It's most common encountered in medical imaging due to contrast adminstration.
• Symptoms must be monitored as routine with contrast studies.
• The physician should be altered about the symptoms of Anaphylactic Shocks.

Diabetes

• Healthy patients adjust own insulin to meet the normal range.
• Diabetes patients are prescribed to check insulin due to the insulin shots or pills and adjust to insulin balance to maintain blood level, also will need to adjust diet depending on whether they are type 1 or type 2.
• Insulin is produced in islets of Langerhans.
  • Type one occurs in patient with age under 30s with very little production and should not take insulin.
  • Type two occurs patient with age over 40s with associated overweight and impaired sensation level.
  • Gestational: Occurs during the pregnancy that prevents the action of insulin.

Diabetes Emergency

• Insufficient production.
• Inadequate utilization.
• Hypoglycemia:
  • Take quick insulin.
  • Do not give to unconscious patient.

Hyperglycemia

• Excessive sugar leads to diabetic.
• It slowly takes hours or days.
• Symptoms include thirstiness and rapid breathing.
• Leads to diabetic if not get treated.

Other results

• Diabetic Ketonacidosis
• Body breakdown Free-T to the body.
• Liver converts it to Ketosis due to insultion.
• It cased by infection and missed insulin shot.
• Hyperosmolar Nonketotic Syndrome
• Occurs in patient with loss of insulin.

Respiratory Distress

• Asthma
• Choking

Asthma

• Dilation when inspiring and collision of exhaling.
• Stress with asthma patient may have Attack.

Symptoms and Cares

• Patient make have sound when they breath.
• Patients mostly carry Inhaler .
• Technologist/ Anyone should be stopped the and help the patient by letting the patient using the Inhaler.

Choking

• Due to blockage.
• Patient will grab throat with two hands.
• First ask can they speak or not.
• Abdominal use in successful coughing.

Process in The Procedure

• Rescuer must stand up back to the victim and grap the both Arm.
• Please the side of thumb on the fist to the patient by side of thumb with midline.
• Held arms away by exerting arms.
• The process must be separate up to 6 to 10 times until object is completed out.
• If patient lose conscious to do the process.
• Must check the mouth after breathing 30 times with 2 compressed.
• Breaths in may help object to dislodged.

Obstruct airways

• Rescuer to sweep the airway from mouth .
• Should not blind sweep.
• To increase interthoracic pressure to let the object to dislodge.

Unconscious patient

• Please the patients behind when they are suppine and kneel with one hand to middle.
• Second and should be used in the side and repeat the process.

In pregnant patients

• Abdominal for pregnant with the use of sternum.
• In infants use two fingers to push.

Types The Heimlich Maneuver

what is Cardiac arrest?

• This is suppoge due to blockage of blood into heart.
• Know how and where contact and facility is.

CardioPulmonary Resuscitation (CPR)

• Do what needs to be done before taking of and using the code.

Symptoms

• Crushing the chest, arm will not move.

Defibrillors, External

• It's a electric therapy shock to stop from fluttery.

• Is needed when heart stops. -AED can be used and stoped when needed 2 mins. -Fully automatic -Determins delivery with shock. -Semi automatic analysis cardiac put let you known with Defibrillation with operator for push to do shock Precautions. There be use of DNR . and make sure to keep the process of it and call For health professional . Improper for CPR and cuased juries when broken sternum of ribs. Defibrillatiors. -must be profession to do CPR check up the lead often and analysation has to be in 2 min -Check for for any gaps breathing for 5_10 sec

• Do not interupt cpr unless told. Using AED

• Determined when using cardiac is needed and AED .and analysation and delivery. -Keep pad away , no to used pad to pad to close -Do put on back unless need back or side.

ABC. check that . Breathing: cpr . Is need and brain must be alive for five to six minutes. Make sure if there cardiac arrest happening with patient Child rate 100 with compression is 12 and 20 breathing. Child - compress less 2 inches. use two fingers and 1 /1 1/2 rate with same for one breath at 3

_5 100rate

• Adult two compress should be done at sternum level each breath

Foreign body for the air

infants back and first repete unless expel and dont sweep child adlment adult same as child . Check sweep out

• The other

One patient resturt

• CAB is to use comprsssion with airway and breathing. Make sure its secure Shake to see they need . Call in the aed and help for . Make sure patirnt has something to check breafibung and see can rise chest or move nose. Compress should be done after and push sternum

• Two peoolr will swap 30to1 for comprssion at the top of chest and 1/2min

Stroke

Is most common or brain attacj often people 75 and above are stroke patients. Symptom - weak / parlisya and speak What cuases it?

• occliation or bressel hurt What types there is?

• ischimic

• hhemorggaic

• tia / mini The most to what is caused? Damage is caused to the neurology system.

• Medicne is use to help stroke out

Minor

-Naisa -is pshilgly Epatais -is sllydom Verto -_patient Sziresa Falls Wnds pain Normal way. Make sur to comftablw and understand the procedure Always underatdn thw procedure. Always stop of patients has bad effect.

_ For type of extinguisher.