RT 101 Module B Exam 3 Prep: Emergency Response/Bedside PDF

**[RT 101 Module B -- Exam 3 Prep: Emergency Response/Bedside Radiography/Venipuncture/Pharmacology]** **Emergency Response/Dealing w Acute Situations (Chp 16 &17)** **"Emergency" Defined:** - A situation in which the condition of a pt or sudden change in medical status requires immediate a...

**[RT 101 Module B -- Exam 3 Prep: Emergency Response/Bedside Radiography/Venipuncture/Pharmacology]** **Emergency Response/Dealing w Acute Situations (Chp 16 &17)** **"Emergency" Defined:** - A situation in which the condition of a pt or sudden change in medical status requires immediate action - Objectives: - Preserve life - Avoid further harm to pt - Obtain medical assistance as quickly as possible - Recognize emergency situations, stay calm, take appropriate action **Trauma Units** - **Level I centers** -- highly trained staff on duty 24/7 for any type of traumatic injury. Helicopter rescue units & helipad. Radiography & OR personnel on duty (cooper) - **Level II centers** -- ED doc, nurses, rad techs & CT techs on duty 24/7. OR staff available (atlanticare city -- they do not treat burns) - **Level III** -- smaller hospitals with night staff on-call. Serious injuries diverted to Level I or Level II facility. **Disaster** - Emergency of a huge magnitude that creates an immediate threat to the public health - Natural events such as tornadoes, hurricanes, earthquakes, pandemics, plane crashes etc. - Hospitals will mandate disaster plans & drills to role-play with ALL trauma healthcare staff - The process of identifying the victims, performing initial exams, & assigning priorities for further care = **triage** **Emergency Patients** - Subject to sudden change in condition - May have delayed reaction -- can go into **physical or psychological** shock - **Physical**: Fainting, trembling, nausea/vomiting - **Psychological:** crying, hysteria, uncontrollable urge to talk **Patient Care** - Be alert for delayed emotional reaction - Pts clothing -- not always changed into gown. Be careful moving pt if you asst removing clothing. Watch for glass fragments & wear gloves - Multiple victims -- prioritize & call for assistance as needed - Unstable vitals 1^st^ - If equal urgency, complete shorter exam 1^st^ **"Crash Cart"** - Wheeled container of equipment & drugs typically required for emergencies - Know where they are! - Contents: - Defibrillator on top **[Equipment Commonly Found on the Code Cart]** ------------------------------------------------------------- ----------------------------------------- Backboard Needles, syringes Bag valve mask Pen, Paper, checklist for cart contents Blood collection tubes Protective gowns, eyewear, mask (PPE) Carbon dioxide deteror for ET tube placement Scissors Cardiac Monitor Sterile and non Sterile gloves Cutdown tray Stethoscope Defibrillator Suction Bottle Drugs according to institutional protocol Tongue blades ET tubes Tracheostomy tubes Flashlight IV solutions and tubing Hemostat IV cannulas Laryngoscope **Automatic External Defibrillator** - Public access has reduced mortality rates - Fully automatic or semi automatic - Analyzes pts cardiac rhythm - Determines if defibrillation is needed - Delivers shock **Respiratory Emergencies** - Airway obstruction - **Solid** -- "are you choking?" \> **Heimlich Maneuver** - **Infants** -- turn prone, Trendelenburg, 4-5 back blows, then supine do 2 two-finger thrusts - **Stridor** -- harsh sound on inspiration - **Respiratory arrest** -- cessation of breathing **Reactive Airway Disease** - **Bronchospasm** = coughing, wheezing, or SOB - Triggered by asthma or allergic reaction - **Asthma** = difficulty in breathing caused by Bronchospasm - Pt. needs O2/ Albuterol inhaler - Injection of antihistamines or corticosteroids if needed **Head Injuries** - A severe blow to the head causes the brain to bounce from side to side, resulting in injury to the side opposite of the blow (**contrecoup injury**) - Mild to moderate amount of damage, brief loss of consciousness (concussion) **Chest Injuries** - MVA's & falls most common chest injuries - Fx's of ribs = very painful - **Pneumothorax** (air in plural space) or **hemothorax** (blood in plural space) Lung may collapse, reducing available surface for oxygen exchange - **Thoracotomy** -- insertion of chest tube - **Thoracentesis** -- draining of fluid from pleural space **Spinal Injuries** - Suspicion of cervical spine injury, collars stays in place until the pt is cleared - X-rays should be taken w/o moving the pt. - Use the 3-person log roll method to move pt to table - One person should remain at the head & stabilize the next during the transfer **Extremity Fractures** - Compound fractures or closed fractures - Support both proximal & distal joints of fx site -- helps to limit pain & prevents damage to the soft tissue & vascular system **Wounds / Burns** - Open wounds treated before x-ray -- notify nurse if fresh bleeding occurs - Wound dehiscence -- suture line separates. Partial or complete **Burns** - Categorized by the cause of the injury, the percentage of body surface involved, & the dept of the tissue destruction - Depth of burn classification least to greatest: - First \> Second \> Third \> Fourth Degree - Burns may be accompanied by other traumatic injuries and/or respiratory complications **Minor Medical Emergencies** - Nausea/Vomiting -- slow deep breaths, turn pt. on left side, remove loose dentures, give basin, moist cloth for head - **Epistaxis** (nosebleed) -- lean forward, pinch nose, hold till stops, or seek assistance if over 15 min - **Vertigo** (dizziness) & **Syncope** (fainting) -- recumbent position/Trendelenburg position **Key Terms** - **Thrombus/embolus** -- clot /a free-floating clot, air bubble, or other substance in the bloodstream - **Hemoptysis** -- coughing up blood or blood-stained mucus from the respiratory tract - **Edema** -- the abnormal accumulation of fluid in interstitial spaces of tissues aka. swelling - **Lethargy** -- feeling of drowsiness, unusual tiredness, or lack of alertness - **Pallor --** an unnatural paleness, or absence of color in the skin - **Anuria** -- absence (lacking) of urine production - **Dyspnea** -- difficult or painful breathing that can be caused by certain heart conditions, lung conditions, asthma, strenuous exercise or anxiety - **Hemorrhage** -- a loss of a large amount of blood in a short period, either externally or internally - **Stridor** -- an abnormal, high-pitched sound caused by an obstruction in the trachea or larynx, usually heard during inspiration - **Concussion** -- damage to the brain caused by a violent jarring or shaking - **Syncope** -- a brief lapse in consciousness caused by transient cerebral hypoxia; aka fainting - **Urticaria** -- a pruritic skin eruption, usually the result of an allergic reaction (hives) - **Vasovagal** -- a stimulation of the vagus nerve in which irritation of the larynx, trachea, or rectum results in slowing of the pulse rate and a reduction in blood pressure - **Anoxia** -- an abnormal condition characterized by a lack of oxygen. - **Vertigo** -- a sensation of instability, loss of equilibrium or rotation caused by disturbance in the semicircular canal of the inner ear or the vestibular nuclei of the brainstem - **Shock** -- an abnormal condition of inadequate blood flow to the body's peripheral tissue with life-threatening cellular dysfunction, caused by abnormally low blood pressure (hypotension) - **Hypovolemic** -- Loss of blood from injury or internal hemorrhage, loss of plasma from burns, or other cause of severe dehydration - **Septic** -- Massive infection, usually by gram-negative bacteria - **Neurogenic** -- Injury to the nervous system caused by head of spinal trauma - **Cardiogeni**c -- Cardiac failure caused by interference w/ the heart function; may be caused by embolism, cardiac tamponade, or complications from anesthesia - **Anaphylaxis** -- Contact w/ foreign substances, usually proteins, to which the individual has become sensitized (including bee stings & some medications); iodine contrast agents for radiographic imaging may precipitate a similar response **[Bedside Radiography (Chp 20)]** **Key Terms** - CCU -- Coronary Care Unit - PACU -- Post-anesthesia Care Unit - MICU -- Medical Intensive Care Unit - TICU -- Trauma Intensive Care Unit - NICU - Neonate -- newborn - STAT -- urgent, to be performed immediately - Atelectasis -- failure of the lungs to expand completely. **Mobile (portable) Radiography** - Performed on pts who cannot be transported to the imaging dept. due to serious injury, illness or condition (*orthopedic traction, isolation, unstable vitals)* - Pt rooms, IR, OR/Recovery Room, NICU - Requires critical thinking skills to adapt to each unique situation to get the job done efficiently **Prior to Bringing Portable into any Room:** - Greet pt -- introduce yourself, check wristband to verify identity - Observe room -- move anything in way - Once the equipment is placed: - Get help from nurse if any questions or for lifting help - Be way of rooms that share pt beds **ER Mobile Radiography** - Assume the worse & be prepared - Remember to use infection control measures - Radiation Safety -- Bring enough lead aprons for self, pt, & team. Stand as far away from the tube as possible **Do:** **Don't:** ------------------------------------------------------------- ---------------------------------------------------------------------------------------- Assess & develop action plan quickly Remove any dressings, splints, neck braces, antishock garments, etc. unless OK'd by MD Introduce yourself & explain procedure Move patient off of stretcher or backboard unless OK'd by MD Prepare all needed equipment before moving patient Disturb impaled objects Take at least 2 radiographs 90º apart Move a patient's head or neck prior to having the x-table lateral c-spine cleared Try to align as close to routine as possible Panic...remain calm & stay focused on task Include all anatomy of interest -- use markers Work quickly, paying attention to patient comfort & modesty Get direction/assistance as needed **Spinal Injuries** - Pt remains immobilized- use log roll technique - Do not remove the collar until lat. C-spine is cleared - Observe pt. carefully for signs of shock - Keep the pt warm **Portable Chest Radiograph** - Perform the exam erect whenever possible - To get proper reading of air and fluid levels in pt - Leave the pt in the same condition as when you arrived - Place furniture & belongings in pts reach before leaving - Ask "Is there anything else I can do for you?" **PACU** (*Post Anesthesia Care Unit/recovery room)* - Pts are still groggy from anesthesia - Many have O2, catheters & drainage tubes - *Chest x-rays & orthopedic exams most common* **NICU** (*Neonatal Intensive Care Unit)* - Premature, low birth weight, other health issues such as respiratiory distress - Clavicle fractures in nursery (common) - Open/closed incubators - Open -- radiant warmer for infants at risk - (en)closed -- provides warmth, moisture, & oxygen while premature infants & those at risk gain maturity and strength - **Use gloves when handling baby and enlist help of the nurse (provide lead)** - Shield baby - Be extra careful w/ lead markers **ICU/CCU** (*Intensive Care/Coronary Care)* - Pts need constant monitoring - Need frequent chest x-rays - Need to deal w/ an assortment of life-sustaining equipment - Consult w/ pts nurse - Limited space to maneuver - Use a draw sheet or chuck to lift pt or slide IR - If alarms go off, call nurse **ER Trauma** - *Chest & Pelvis most common x-rays* - Pts may be on backboard or wearing pneumatic anti-shock garments, splints etc - Blood or body secretions (wear protective apparel) - **Be alert to the needs of other team members for access to the pt. [MD Prioritizes ]** **Orthopedic Exams** - \#1 Goal -- not to cause further injury - Open vs. closed fx's **Radiographer's Role** - Keep the affected part immobilized - Limbs must be supported above and below the fx when lifting - Always attempt to get 2 projections 90 degrees from each other -- manipulate equipment, not the pt - Standard Precautions/Aseptic Techniques - Shoot thru x-rays if applicable **Tubes, Lines, & Catheters** **Endotracheal Tubes (ETT)** - Artificial airway inserted into trachea via mouth **(intubation)** - Has a radiopaque line extending along its length - Indications: - Ensure patent airways - Improve ventilation & oxygenation - Control mechanical ventilation - Administer anesthetic gases & meds - Remove tracheobronchial secretions **ETT : What to look for?** - Location of tip? - Tip of tube should be 2-3" (3-7cm) above carina - Portable chest x-ray to confirm position - Stomach distention = [tube in esophagus] **Thoracotomy (Chest) Tubes** - Inserted into pleural space or mediastinum to: - Remove air (pneumothorax) - Drain fluids (pleural effusion, hemothorax, empyema) - Prevent air or fluid from reentering pleural space - After insertion, tube is connected to a negative/positive pressure setup that will allow air & fluid to be expelled aseptically & will maintain negative pressure in the pleural space to keep lung expanded - Make sure chest tube apparatus is below the chest on the floor, and does not get knocked over **PICC Lines** - **Peripherally Inserted Central Catheter** -- usually inserted into the basilic or median cubital vein of arm. Used for longer-term administration of drugs (2-4 weeks)' **Central [Venous] Catheters** - **(aka Midline or Central Line)** - Used for IV administration of chemotherapy drugs, antibiotics, parenteral nutrition, fluids, or for frequent blood sampling - Inserted into internal jugular or subclavian veins - Designed to deliver into central veins (SVC) or Rt. Atrium where vascular space is large & blood volume is high -- minimizes injury due to caustic agents **Pulmonary Artery Flow -- Directed Catheters** - Measures cardiac output, the pressure on the right side of the heart & indirectly the left heart & lung pressures - Used to diagnose right & left ventricle failure - Also has several lumina & a balloon at the tip for admin of fluids and meds. - Inserted through the subclavian, internal or external jugular, or femoral vein & advanced until tip rests in the right atrium - Loops around the heart - **Swan-Ganz** **Pacemaker** - A device that regulates the heart rate by providing low levels of electrical stimulation to the heart muscle to replace the stimulation that is normally provided by nerve impulses - **Tip of catheter inserted into the apex of the right ventricle** - **Chest X-ray to Confirm:** - Location of implanted catheter - Wires not kinked or broken & in proper position - Avoid abducting or elevation the pt's left arm x's 24 hrs. post-op **Port-A-Cath (long-term venous access)** - Chemotherapy - Due to chemo drug running down the veins - Blood transfusions - Blood from superior vena cava **GI Tract** - **NGT** = nasogastric *(NE= nasoenteric)* - *Passed through the nose (NG) or mouth (OG) down into the stomach & peristalsis advances into the small intestines* - Inserted with lube down nose or throat - Used For: - Feeding tube -- Dobbhoff - Decompression (removal of gas & draining of secretions by suction) -- Leven & Salem-Sump - Used for pts w/difficulty swallowing & radiographic exam using oral contrast **PEG Tube** - Percutaneous Endoscopic Gastrostomy -- for long-term feeding ( peg tube or G Tube) - Inserted through the abdominal wall & into the stomach for fluids, nutrition, and medications to bypass the mouth & esophagus - Be sure to document how much contrast is inserted into the tube - More surgically inserted **Foley Catheter** -- Drains bladder of urine. Short-term - Must be kept at level lower than the bladder at all times to prevent CAUTI (Catheter-associated urinary tract infections) - CAUTI -- the most elevated type of infection for a hospital-acquired infection **Super Pubis Catheter** - **Suprapubic catheterization is indicated (when transurethral catheterization is contraindicated or technically no possible) to relieve urinary retention due to the following conditions:** - Urethral injuries - Urethral obstruction - Bladder neck masses - Benign prostatic hypertrophy (BPH) - Prostate cancer - Used for if there is further injury to the ureteral and the pt is unable to get a foley catheter **Tissue Drain** - Surgical drains are tube placed near surgical incisions in the post-operative patient, to remove pus, blood, or other fluid, preventing it from accumulating in the body **Ventriculoperitoneal Shunt** - A surgical procedure that treats hydrocephalus, a condition where there is too much cerebrospinal fluid (CSF) in the brain and spinal cord - Shunt is placed with people who have too much fluid in their brain - Shunt goes all the way down to the mid-abdomen **Ventriculoperitoneal Shunt Series** - Plain X-ray shunt series. AP, anteroposterior. A. AP skull X-ray that shows calcifications around the ventricular catheter (arrow). B. Lateral head and neck X-ray showing calcifications around the ventricular catheter (arrow). C. AP chest and abdomen X-ray showing the rest of the peritoneal catheter with no radiological evidence of calcifications. **[Pharmacology (Chapter 14)]** - Radiographers are often first to observe the onset of medication responses that could have serious consequences **Pharmacology** = the science concerned with the origin, nature, effects, & uses of drugs - In NJ, techs are allowed by law to administer contrast media & pharmaceuticals - If an error occurs, the person who administers is **legally liable** **Why Administer Drugs?** - To relieve (disease) symptoms - To prevent (disease) - To cure (disease) - To diagnose (disease or pathological) conditions -- contrast **Medications vs. Drugs** - **Medications:** Substances prescribed for treatment that produce therapeutically useful effects - **Drugs:** general term, substances used to treat, diagnose, or prevent disease, or component of medicine - Term also applied to substances that are not legal or medicinal and affect CNS, causing behavioral changes & possibly addiction - **All medications are drugs, not all drugs are medication** -- some drugs can have the opposite effect of medications **FDA Standards** - The U.S Food & Drug Administration set standards for control of drugs, including strict rules concerning: - Effectiveness -- produces the expected results - Purity -- no containments - Potency (strength) - Safety -- risks and benefits of the medication - Toxicity -- potential for harm \*Prescription and nonprescription *over-the-counter medications (do for both)* **Prescription Vs. Nonprescription** **Prescription** - Prescribed by a doctor - Intended to be used by one person - Bought at a pharmacy - Regulation by the FDA through the New Drug Application (NDA) process **Nonprescription** - Does not require a doctor's prescription - Off-the-shelf in stores - Regulated through OTC Drug Monographs **[CAUTION Federal Law Prohibits Dispensing w/o Prescription ]** - This warning must be on any drug that: - Requires prescription by licensed practitioner - Refills to be authorized by a licensed practitioner - All prescription medication dispensing to be overseen by prescriber - PYXIS: What is it? Where is it? - Machine that distributes medication, must have an order **Classification by Name (Nomenclature)\*** - **Chemical name** -- chemical (name) structure of drug: - Ex: N-(4hydroxyphenyl)acetamide - **Generic Name** -- (principally one) chemical family: - Ex: Acetaminophen - **Trade/Proprietary (brand) name** -- name created by specific company, usually short and easy to remember - Ex: Tylenol *Medications may be ordered by either generic or trade names* **Medication Properties (Response Factors)** Including how drugs are absorbed, reach their site of action, are metabolized (physically and chemically changed), and exit the body. **[Pharmacokinetics]** = the study of the way the body processes a drug. (ADME) 1. Absorption/entry (blood/mucosal lining) 2. Distribution/circulates (bloodstream) 3. Metabolism/transforms (liver) 4. Excretion/leaves (kidneys, lungs, biliary) **Pharmacokinetics** - Onset of action: - Drug reaches a point when it has its intended effect - Peak concentration level: - Drug reaches max. therapeutic response - Duration of action (half-life): - Length of time drug is working - Lowest (ineffective) concentration: - Drug begins to be excreted from the body *Absorption (onset)* *Distribution (max therapeutic response)* *Metabolism (half-life)* *Excretion (ineffective)* - Half-life is between the highest concentration in the blood to the lowest when it is eliminated **Factors Affecting Pharmacokinetics** - Genetics (genotype, immunity) - Physiology (gender, age, body size, ethnicity) - Environment (radiation exposure, smoking, alcohol, nutrition, toxin exposure) - Pathological (obesity, diabetes, liver & renal function) **Pharmacodynamics: Effects of Drugs** - **Therapeutic Effect** -- Action & anticipated outcome (effectiveness) - **Toxic Effect** -- poisonous - **Idiosyncratic Reactions** -- over, under, or unusual reaction ( unexpected reactions) - **Synergistic Effect** -- Two or more components working together - **Allergic Reaction** -- Unfavorable physiologic response - Involves the immune system & produces a negative effect, warranting discontinuation of meds - **Side Effects** -- Reaction other than therapeutic (risks) - Action that doesn't relate to the drug's main action usually doesn't warrant stopping treatment **Types of Complications/Reactions** - [Local Effects (mild)] - Infiltration -- fluid infuses the tissue surrounding the venipuncture site - Extravasation -- accidental infiltration of a vesicant (contrast media) - [Systemic (severe)] - Shock -- affects the whole body - Severe allergic reaction (anaphylaxis) **The Six Rights** - Right Patient \> Right Medication \> Right Dose \> Right Time \> Right Route \> Right Documentation - \*\*This is for both the patient and the healthcare worker: Document, document, document! Include who, what was given, when, where, and how much. - **WHO\>WHAT\>WHEN\>WHERE\>HOW** - **Documentation -- lot number and amount of medication used** **The Right Drug** - Check label 3x - Ensure correct name - Never use an unlabeled drug - Check expiration date - Show container to person administering drug - Save container till pt is finished w/ exam **Common Medications** - [Adrenergics- vasoconstrictors; epinephrine] - [Analgesics- pain reliever; Tylenol, methadone, fentanyl] - [Anticoagulants- anti-blood clotting; heparin, warfarin] - [Antiemetics- reduces nausea & vomiting; Zofran] - [Antihistamines- relieve allergic reactions; Benadryl ] - [Antimicrobials- suppression microorganisms; Betadine] - [Bronchodilators- dilate smooth muscle; albuterol] - [Opioids- analgesic sedative (narcotic); fentanyl, morphine ] - [Opioid antagonists- prevents respiratory distress; Narcan] - [Vasodilators- relax blood vessel walls (increase flow); nitroglycerin] **Routes of Administration** (Classified by the location of which the drug is administered ) - **Enteral --** *GI Tract* - Oral: by mouth - Rectal - Through a tube: Peg tube (feeding purposed), NG tube - **Parenteral** -- *Outside of GI Tract* - Subcutaneous (underneath skin, into fat layer) - Intramuscular (in a muscle) - Intradermal (under epidermis) - Intrathecal (in the spinal canal) - **Sublingual** -- *Under tongue* - **Inhalation** -- *Respiratory* - **Vaginal** - **Transdermal** -- *through the skin* (i.e. lidocaine patch) *The choice of routes in which the medication is given depends not only on convenience and compliance but also on the drug's pharmacokinetics and pharmacodynamic profile.* **Drug Information Resources** - Physician's Desk Reference (PDR) - Various Names - Effects - Recommended dosages - Common side effects - Drug Package Inserts - GOOGLE -- PDR.net or other reliable sources (use reputable websites) **[Venipuncture: AKA IV Catheters (Chp 15)]** - Administration of contrast media - Administration of medication - Administration of fluids **Types of IV Catheters** - **Peripheral** - Mid-line - **Central** (all lines through the vein) - Peripherally Inserted Central Catheter (PICC) - Long term medication (chest) - Port - Long-term medication, put in the OR (5 years) - Central Line (aka Triple Lumen Catheter) - Bedside, ICU -- used for medications (located: neck, groined, chest arm) looped up to the chest to reach the Vena Cava **Ampules vs. Vials** - **Ampule: \**one time use;*** 3 part: top, neck, bottom: Grasp the body, break the neck, draw through syringe -- where gloves, use a piece of gaze, break the top - **Vial: \**self-sealing* *for multiple-dose drugs;*** clean rubber top with alcohol, insert needle through rubber top **Syringes** - Devices used to inject medication into or withdraw fluid from the body - The part w/o a needles - *3 Parts: Plunger (bottom), Barrel (middle), Luear-lock tip (Top)* **Needles** - Hallow needles used to inject drugs (medication) under the skin - Come in varying sizes & lengths (16g -- 24g) - Inner lumen measured in "gauge" - Bigger the number, the smaller the needle lumen diameter - Bevel up! - **Lumen** -- the hole, bevel **Angles for Inserting Injections** - Intramuscular -- 90 degrees - Subcutaneous -- 45 degrees - Intravenous -- 25 degrees - Intradermal -- 10-15 degrees **Veins Used for Venipuncture** arm\_veins.jpg **Infusions** - Bag should be hung 18 -- 24" above the level of the vein - Height affects the rate of flow - Air must be removed from tubing - 15 mL of air injected = air emboli - Piggyback (IVPB) -- used to add medications to existing IV fluid **Problems with IV?** - Bag too low -- blood backflows into tubing - Position of needle/catheter in vessel - Extravasation - Infiltration - Fluid Overload Phlebitis -- inflammation of veins