Chapter 17 Dealing With Acute Situations PDF

Chapter 17 Dealing with Acute Situations  Objectives  Discuss the procedures for assisting patients during attacks of respiratory distress, myocardial infarction, stroke, asthma, epistaxis, angina, nausea, and syncope.  List the four levels of consciousness...

Chapter 17 Dealing with Acute Situations  Objectives  Discuss the procedures for assisting patients during attacks of respiratory distress, myocardial infarction, stroke, asthma, epistaxis, angina, nausea, and syncope.  List the four levels of consciousness and explain how the Glasgow Coma Scale can contribute to defining these levels.  List precautions to be taken in handling patients with possible fractures of the spine, ribs, or extremities.  Recognize the signs of shock and respond appropriately.  Explain the differences between syncope and vertigo.  Contrast diabetic coma or hyperglycemia and insulin shock or hypoglycemia.  Discuss seizure disorders, including safety precautions and observations to be recorded.  Identify the need for CPR; recognize indications for using an AED and list the steps involved.  Key Terms (1 of 2)  Anaphylaxis  Defibrillator  Anoxia  Edema  Asthma  Epistaxis  Cardiac arrest  Evisceration  Cardiac tamponade  Hemorrhage  Cardiopulmonary  Hemothorax resuscitation (CPR)  Heimlich maneuver  Cerebrovascular  Hyperglycemia accident (CVA)  Hypoglycemia  Concussion  Key Terms (2 of 2)  Myocardial infarction (MI)  Syncope  Myocardial ischemia  Thoracentesis  Pleural effusion  Thoracotomy  Pneumonia  Tremor  Pneumothorax  Urticaria  Pulmonary edema  Vasovagal  Pulmonary embolism  Vertigo (PE)  Respiratory arrest  Stridor  Respiratory Emergencies  Airway obstruction  Usually caused by blockage of airway by foreign object (choking) Adult—perform abdominal thrust Infant and small child—alternate back blows with chest thrusts  Respiratory arrest may result from choking.  Reactive airway disease  Characterized by coughing, wheezing, or shortness of breath  Call for assistance  Pulmonary embolism (PE)  A substance such as a blood clot, fat, or air that travels through the vascular system and lodges in one of the pulmonary vessels  Cardiac Emergencies (1 of 3)  Acute coronary syndrome  Denotes a group of symptoms that indicate myocardial infarction (MI) or heart attack  Angina pectoris  Episodes of chest pain precipitated by exertion or stress  Usually relieved by rest or the sublingual administration of nitroglycerin  Cardiac arrest  Shake and shout to ensure it is not a syncope.  If no response, check carotid pulse and respirations.  If not present, call code and begin CPR until code team arrives.  Cardiac Emergencies (2 of 3)  Defibrillator  Delivers an electric shock to correct an ineffective cardiac rhythm  Personnel must be 2 feet away when administered.  Cardiac Emergencies (3 of 3)  Automatic external defibrillator (AED)  Easier to use than standard defibrillator  Steps to use AED:  Turn on power.  Attach adhesive pads to victim’s chest.  Attach pads to machine cables.  Clear the area.  Turn on rhythm analysis. AEDs require 5–15 seconds to analyze rhythm. There must be no movement of the patient during this time. Activating analysis will also charge the AED if the rhythm is ventricular fibrillation.  Press the shock control to deliver the shock, if indicated.  Trauma  Head injuries  Four levels of consciousness (LOCs) used for assessment: Alert and conscious Drowsy, but responsive Unconscious, but reactive to painful stimuli Comatose  Glasgow Coma Scale also used Highest possible score is 15.  Glasgow Coma Scale Action Response Score Spontaneously 4 Eyes open To speech 3 To pain 2 None 1 Oriented 5 Verbal response Confused 4 Inappropriate words 3 Incomprehensible 2 sounds None 1 Obeys commands 6 Motor response Localized pain 5 Flexion withdrawal 4 Abnormal flexion 3 Abnormal extension 2 Flaccid 1 Highest possible 15 score  Trauma: Head Injuries  Patients with head injuries can change LOC rapidly.  Alert physician immediately when an LOC change is noticed.  Trauma: Spinal Injuries  Trauma patients are assumed to have a spinal injury until this is ruled out.  Cross-table lateral c-spine is first radiographic image obtained.  Obtained with immobilization in place  Must be evaluated by ED physician before patient is moved  Log-rolling is used to move patients, when necessary.  Trauma: Chest Injuries  Hemothorax—blood in the pleural space  Pneumothorax—air in the pleural space  Treatment for both is thoracotomy  Flail chest—multiple rib fractures  Observe closely for shock and hemorrhage.  Cardiac tamponade—hemorrhage into the pericardial sac  Trauma: Extremity Fractures  Compound—bone fragments protrude through the skin  Closed—no wound associated with fracture  Two people required to image long-bone fractures  One person uses both hands to support the limb above and below the injury while the other places the IR.  Trauma: Wounds (1 of 2)  Postsurgical wound dehiscence  Occurs when the sutures pull apart  Complete form may lead to tissues protruding.  In the abdomen, the organs may protrude, termed evisceration.  Trauma: Wounds (2 of 2)  Burns  Severity categorized as first, second, third, or fourth degree  Respiratory complications occur, such as pleural effusion and pneumonia.  Shock (1 of 2)  A general term used to describe a failure of circulation in which blood pressure is inadequate to support oxygen perfusion of vital tissues and is unable to remove the by- products of metabolism.  A dangerous, potentially fatal condition  Early signs:  Pallor  Increased heart rate  Increased respirations  Restlessness or confusion  Shock (2 of 2)  Five main types:  Hypovolemic  Septic  Neurogenic  Cardiogenic  Allergic (anaphylactic)  Hypovolemic Shock  Caused by massive blood or plasma loss so that an insufficient amount of fluid is available to fill the circulatory system  Results from internal and external hemorrhage, plasma loss from burns, or severe dehydration  Shock (1 of 2)  Septic shock  Caused by severe, often systemic infection  Neurogenic shock  The failure of arterial resistance  Causes blood to pool in peripheral vessels  Occurs with nervous-system injuries  Closely monitor patients with head or spinal trauma for blood- pressure drop  Shock (2 of 2)  Cardiogenic shock  Results from cardiac failure or interference with heart function  Allergic shock or anaphylaxis  Occurs from exposure to foreign substances to which they are sensitized  Blood pressure falls rapidly; severe dyspnea is caused by respiratory edema, and death can result if not recognized and treated rapidly.  Shock Symptoms  Restlessness, apprehensiveness  Increased pulse rate  Pallor with weakness or a change in thinking ability  Cool, clammy skin (except in patients with septic or neurogenic shock)  A decrease in blood pressure of 30 mm Hg below the baseline systolic pressure  Decreased urination  Increased, shallow respirations  Radiographer Response to Shock  Stop the procedure  Assist the patient to a supine position to avoid a fall.  Elevate the feet to increase blood flow to the brain.  Alternatively, if dyspnea is noted, elevate the head.  Obtain help. Notify the radiologist, physician, or nurse.  If in doubt, call a code.  Check blood pressure.  Assist the dyspneic patient with oxygen.  Be ready to perform CPR.  Assist the code team or physician as necessary.  Chart the occurrence, the treatment administered, and the patient’s response on an incident report form and/or in the chart.  Syncope  Medical term for fainting  Mild form of shock  Treatment  Assist patient into supine position with feet elevated.  Psychological Shock  Now known as posttraumatic stress disorder  Much different from other forms of shock  Different symptoms, signs, and treatment Medical Emergencies  Medical Emergencies  Contrast-media reactions  Drug reactions  Diabetic emergencies  Cerebrovascular accidents  Seizures  Vertigo  Orthostatic hypotension  Epistaxis  Nausea and vomiting  Contrast-Media Reactions  Range from mild to severe  No predictors  Begin injection with a small amount and wait to check for signs or symptoms  Protocol determines how long to wait before proceeding with administration.  Patients at risk for reaction are premedicated.  Antihistamine and/or corticosteroids  Mild Contrast Reactions Symptoms Treatment Warmth None. Symptoms will resolve. Flushing Metallic taste Coughing Nausea  Moderate Contrast Reactions Symptoms Treatment Erythema Antihistamine (orally, IV, or IM) Bronchodilator drug by Urticaria inhalation for bronchospasm Bronchospasm  Vasovagal Reactions Symptoms Treatment Diaphoresis Place patient supine, feet elevated Hypotension 20 degrees, and head elevated, if breathing is a problem. Bradycardia IV fluids and atropine administered for bradycardia Severe (Anaphylactic) Reactions Symptoms Treatment Warmth Maintain airway Call a code Tingling Epinephrine usually given IV Itching palms and Other drugs administered as needed soles by code team Dysphagia Laryngeal and bronchial edema Respiratory arrest Cardiac arrest Seizures  Drug Reactions  Wide range of symptoms and severity of reaction  Treatment tailored to severity and symptoms  Diabetic Emergencies  Types:  Diabetes insipidus  Diabetes mellitus Type I Type II  Diabetes Insipidus  Caused by kidney or pituitary disorder  Characterized by polyuria and thirst  If untreated, dehydration results.  Symptoms  Fever  Vomiting  Convulsions  Fluid replacement is essential.  Diabetes Mellitus—Type I  Insulin-dependent form  More likely to lapse into diabetic coma  Signs and symptoms  Extreme thirst  Polyuria  Fruity-smelling breath  Diabetes Mellitus—Type II  Related to obesity  Treated with hyperglycemic drugs  Hyperosmolar hyperglycemic nonketotic (HHNK) syndrome  Emergent condition  Occurs in neglected type II DM as a result of dehydration and hyperglycemia  Hypoglycemia (1 of 2)  Low blood sugar  Occurs in type I when insulin is taken and a meal is skipped  Symptoms  Sudden weakness  Sweating  Tremors  Hunger  Loss of consciousness  Hypoglycemia (2 of 2)  Treatment:  Candy  Sweet fruit juice  Emergency medications include squeeze tubes of glucose gel.  Administered inside patient’s cheek  Cerebrovascular Accident (CVA)  Also called a stroke  Caused by interruption of blood flow to the brain  Hemorrhage  Occlusion  Warning signs, easily remembered with acronym FAST:  Facial droop  Arm weakness on one or both sides  Speech difficulty  Time to call 9-1-1  Other symptoms may include:  Extreme dizziness  Severe headache  Difficulty in vision or deviation in one eye  Temporary loss of consciousness  Seizures  May have trembling, shaking, or violent spasms  Major motor—tonic-clonic or grand mal  Absent seizures—brief loss of consciousness  Petite mal  Keep patient as safe as possible.  Remove obstacles.  Protect patient’s head.  Do not restrain patients or force objects into mouth.  Call for assistance.  Postseizure  Turn patient to lateral recumbent to prevent aspiration of secretions.  Provide reassurance and assistance.  Patient may be irritable and confused.  Often wishes to sleep  Orthostatic Hypotension  Dizziness brought on by sitting upright from a prolonged recumbent position  Can be avoided by assisting the patient to sit upright slowly  Vertigo  Severe dizziness, sometimes accompanied by nausea  Caused either by an inner-ear disturbance or a brain or spinal-cord lesion  Epistaxis  Medical term for a nosebleed  Provide tissues and apply pressure to the nasal septum for 10 min with gloved hands.  Contact physician if pressure does not cause bleeding to stop.  Nausea  Instruct patient to breathe slowly through the nose or to breathe shallowly through the mouth.  Focus on breathing takes the focus away from the nausea.  Vomiting  Don gloves and provide an emesis basin.  Provide water and tissues to rinse the mouth.  If patient is recumbent, roll to lateral position to avoid aspiration.