Transcript MEDICAL EMERGENCIES

MEDICAL EMERGENCIES
The dictionary defines an emergency as a serious,
unexpected event that demands immediate attention. Sudden
deterioration in the status of any patient under your care is an
acute situation requiring an appropriate response. Whether
such a situation leads to a more serious problem may depend
on your ability to act quickly and efficiently. Seen from this
perspective, no patient problem can be considered trivial. You
will experience many acute situations over the years, and you
must be prepared to minimize the possibility of further injury or
complication.
EMERGENCY DEPARTMENT
The emergency departments (EDs) of most hospitals serve a
variety of clients. Individuals with health insurance may use
urgent care or surgical centers for minor emergencies. For the
poor and uninsured, however, the ED often serves the
additional function of family physician. Many such admissions
to the ED present valid problems, even if they are not
emergencies. This can rapidly overload both staff and
facilities, especially in an urban setting. Establishing priorities
and functioning effectively under such circumstances can
demand intense application of your patient care and
assessment skills.
Many hospitals have specialized facilities designated as trauma units, which are
usually part of the ED. There are three designated levels of trauma facilities:
•Level I trauma centers are able to care for all levels of injuries and are usually found
in large institutions. They are staffed around the clock with physicians, surgeons,
and support personnel who are highly trained in the care and treatment of traumatic
injuries. Level I hospitals have access to transfer facilities, such as helicopter rescue
units, that permit the most seriously injured patients to reach the center in a
relatively short time. A Level I hospital must be able to provide emergency
radiography, fluoroscopy, computed tomography (CT), and magnetic resonance
imaging (MRI) procedures around the clock. There must also be access to nuclear
medicine studies, angiography, and sonography. Facilities for neurologic care must
also be available.
•Level II trauma centers are the next level of trauma care. An ED physician is on 24hour duty, as are emergency trained nurses and radiology staff. Surgical
radiographic and fluoroscopic procedures must be available, as well as the ability to
perform angiography, CT, and MRI procedures. Patients will be transferred to Level I
facilities only if necessary.
•Level III trauma centers are smaller community hospitals that usually have an ED
physician and radiographer on call at night. Trauma patients with life-threatening
conditions will be transported to a Level I or Level II hospital as needed.
Research has proven that victims of massive trauma who
survive the initial injury have a greater chance of recovery if
their condition can be stabilized within the first “golden” hour
after the accident. For this reason, every minute is precious,
and trauma teams work under great pressure. The care of
highly trained personnel and the immediate availability of
equipment for diagnosis and treatment have greatly
improved the potential for saving lives.
The transport team, usually made up of qualified emergency
medical technicians (EMTs), delivers the patient to the trauma
unit as soon as an airway has been established, bleeding has
been controlled, and the patient has been immobilized. The first
assessments made by the physician at the trauma center
involve evaluation of cardiac status, respiratory status, and the
possibility of vertebral fracture. Trauma patients are transported
on a rigid backboard and are not removed from it until spinal
fracture has been ruled out. The danger of paralysis is so great
that this ranks directly after respiratory arrest (cessation of
breathing) and cardiac arrest (cessation of heartbeat) in terms
of priority.
When accident victims must be taken to the imaging
department, their conditions have usually been stabilized.
They have been thoroughly examined by a physician, blood
loss has been controlled, an airway has been established,
intravenous (IV) fluids have been started, and medication for
pain or blood pressure control has been given. When
radiographs are taken on the way to the operating room,
cast room, or intensive care unit (ICU), a nurse usually
accompanies the patient.
Emergency patients are subject to sudden changes in condition and may go into
shock. Once the acute phase of an accident is over, many patients who were full of
fortitude experience a delayed emotional reaction. This may consist of
uncontrollable crying or a compulsive urge to tell everyone about the accident. They
may even have a physical reaction, such as fainting, trembling, or violent nausea.
Your most positive action is to be available, offer nonverbal support, and watch
carefully for any signs of a deteriorating physical condition. Your ability to speak
calmly and work competently under pressure is reassuring.
When accident victims are brought to x-ray dressed in street clothes, it is
sometimes necessary to remove garments before the radiographic examination.
Avoid cutting or tearing clothing whenever possible. Keep all the patient's personal
possessions in one place. One easy system is to place everything in a plastic bag
clearly identified with the patient's name. The bag is then placed on the stretcher or
wheelchair with the patient. Check the procedure in your clinical area and be
consistent in using it.
MULTIPLE EMERGENCIES
Radiographers ordinarily encounter only one emergency at a time. Occasionally,
however, a single accident will have multiple victims, or several acute situations may
develop simultaneously. In these cases, you must assess priorities. If you see that it
may be difficult for you to cope alone, do not hesitate to call for assistance before the
situation places lives in jeopardy.
Although patients are usually admitted to the radiology department on a scheduled
or first-come, first-served basis, exceptions must be made for emergencies. An order
designated STAT (from the Latin statim) is to be done at once and indicates that the
patient's well-being may be seriously jeopardized by any delay. When more than one
patient from the ED requires examination at the same time, the radiographer may
need to determine which patient's status is the most urgent. Generally speaking, the
highest priority is assigned to patients whose vital signs are unstable and whose
immediate care depends on the results of the examination, such as those in severe
respiratory distress. With two cases of apparently equal urgency, start with the
patient who can be examined in the shortest amount of time, because this decision
will result in the shortest total waiting period.
DISASTER RESPONSE
A disaster is an emergency of huge magnitude that creates an unforeseen,
serious, or immediate threat to public health. It could be a natural event, such as a
tornado, earthquake, flood, hurricane, or pandemic; or it could be accidental, as in
the case of a plane crash or train wreck. Events of terrorism are manmade
disasters.
Every general hospital is required to have a carefully designed and written disaster
plan, and each member of the health care team must be familiar with the plan and
his or her role in it. Disaster drills are regularly scheduled exercises that prepare
the hospital staff to function effectively if the disaster plan must be implemented. A
major disaster may involve all emergency services in the community, so your
hospital may coordinate its drills with those of other agencies. You must be familiar
with the plan for the institution and participate actively in the practice drills.
The process of identifying the victims, performing initial examinations, and
assigning priorities for further care is called triage. A triage station is set up in a
large area, such as a lobby. The triage officer, usually an emergency care
physician, directs triage activity. Simplified methods of patient identification and
record keeping are used to minimize the time required for paperwork. Usually
patients are assigned numbers, which are written on tags and attached to their
wrists or ankles. These numbers are used to identify the radiographs and any
required records.
Emergency Call Systems
When working alone, or when qualified assistance is not immediately
available, you can obtain help by using the emergency call system. Each
hospital has a procedure to call for emergency help, and several different
codes may be used to identify specific situations. The fire code is one
example. Other codes may be used to announce the arrival of trauma
patients in the ED or to cope with a situation that demands security
personnel. If you need to summon help for the patient undergoing
cardiopulmonary arrest, there is also a special code for this emergency.
Emergency Response Team
Hospitals have a designated group of health care
workers who respond to this type of code. The
emergency response team, or code team, usually
consists of one or more physicians, several nurses, a
respiratory therapist, and an electrocardiographer.
Assisting the Emergency Response Team
When a code is called in the diagnostic imaging department, you must know your
role and be completely familiar with whatever system is used. When the code
team arrives, allow the emergency response personnel to take over immediately
upon their arrival. Tell them the history of the situation and then stand by to follow
their directions. There will be important tasks that you can perform. Record
keeping is essential. Write down the time the emergency started and when the
code team responded. You may be asked to record times and amounts of
medications. It may be necessary to obtain equipment, call for other personnel, or
monitor a telephone. It is important to keep unnecessary bystanders out of the
way and to keep family members calm in an appropriate location, such as a
waiting room.
You should practice going through each code procedure until you feel comfortable
and are able to function professionally, even under very stressful circumstances.
Recent research shows that rapid response teams save lives. You should call for
help whenever you question that the patient may be deteriorating.
Emergency Carts
Emergency carts, or “crash carts,” are rolling, multidrawered cabinets that are kept
in strategic locations throughout the hospital. The code team usually brings the cart
from the location nearest the patient. These carts vary somewhat, but each has
certain essential items, such as airways, artificial ventilation equipment, emergency
medications and the equipment for administering them, a board to slip under the
patient when giving external cardiac massage, a blood pressure cuff, a
stethoscope, and a defibrillator that can also serve as a cardiac monitor. The cart
should have a list of contents and should be inspected daily to ensure that
emergency supplies are available for instant use and that their dates are within the
expiration limits. Some hospitals seal the cart after supplies are replenished. Never
borrow equipment or supplies from the emergency set for routine use! This practice
results in the absence of lifesaving items when they are most needed.
Backboard
Stethoscope
Blood pressure cuff
Bag valve mask
Laryngoscope
Endotracheal tubes
Carbon dioxide detector for ET tube placement
Tongue blades
Suction catheters
Tracheostomy tubes
Flashlight
Sterile and nonsterile gloves
Cardiac monitor
Defibrillator
Cutdown tray
Suction bottle
Hemostat
Scissors
Needles, syringes
IV solutions and tubing
IV cannulas
Blood collection tubes
Drugs according to institutional protocol
Protective gowns, eyewear, masks
Pen, paper, checklist for cart contents
PATIENT ASSESSMENT
Patients come to the imaging department in widely varying states of health.
Individuals suffering from prolonged illness or trauma, or those who are
weakened by extensive preparation for examination, may suffer a sudden, lifethreatening change in status. Patients with a history of chronic cardiac or
pulmonary disease are at greater risk when an invasive procedure is performed.
Before any patient is injected with a contrast medium or subjected to an invasive
procedure, a thorough history of previous cardiac events, allergies, chronic
diseases, and medications should be taken. Baseline vital signs must also be
taken and recorded.
Patients in the ED are classified as nonurgent, urgent, or acute (lifethreatening). Obviously, the most acute cases are seen first. Even with the
specialized care available in the United States today, trauma is the most
common cause of death for individuals under the age of 40. Deciding the
order in which patients receive treatment is ultimately the ED physician's
responsibility.
Families of trauma victims can be distraught and demanding when they
perceive that others are being cared for first. On these occasions, your role is
to reassure and explain to concerned individuals how priorities are set in
such emergency situations.
Assessment of Levels of Neurologic and Cognitive
Functioning
•
•
•
Ask the patient to state his or her name, date, address, and the reason for
coming to the radiographic imaging department.
Note the patient's ability to follow directions during instruction regarding
positioning for the examination. Also note any movement that causes pain
or other difficulty in movement, as well as any alterations in behavior or lack
of response.
Assess the patient's vital signs at this time if current readings are not on the
chart. Baseline readings are a must to have in order to note any changes
that may occur. An increasing systolic blood pressure or widening of the
pulse pressure may indicate increasing intracranial pressure. Slowing of the
pulse may also indicate increasing intracranial pressure. As compression of
the brain increases, the vital signs change. Respirations increase, blood
pressure decreases, and the pulse rate decreases further. A rapid rise in
body temperature or a decrease in body temperature is also an ominous
sign.
TRAUMA:
Head Injuries
Patients who have received a blow to the head may have sustained
serious injury, even when there are no external signs of trauma. Damage
may occur with or without a skull fracture. The brain is soft, has a rich
blood supply, and is suspended in cerebrospinal fluid within the skull. A
severe blow to the head causes the brain to bounce from side to side,
resulting in injury on the side opposite the blow. This is called a
contrecoup injury. A minimal amount of damage, characterized by “seeing
stars” or a very brief loss of consciousness, is called a concussion. If
bleeding or swelling occurs inside the skull, a rise in intracranial pressure
(ICP) may cause seizures, loss of consciousness, or respiratory arrest.
Incidentally, similar symptoms may also occur in patients with increased
ICP related to brain tumors.
Four levels of consciousness (LOCs) are generally
recognized and are described as follows:
• Alert and conscious
• Drowsy, but responsive
• Unconscious, but reactive to painful stimuli
• Comatose
The Glasgow Coma Scale is a numerical scale that can be used to
objectively assess changes in a patient's level of consciousness over
time. The patient who is alert and oriented when admitted, but then
becomes increasingly incoherent, drowsy, and stuporous, may be
showing signs of increased ICP. The earliest signs of increasing
pressure may be irritability and lethargy, frequently associated with a
slowing pulse and slow respirations. Notify the attending physician
immediately if you suspect a change in LOC. Remember that the
unconscious patient must have side rails in place, should not be left
alone, and must be constantly monitored to maintain an airway.
Some trauma patients are under the influence of alcohol. Their
condition may vary from inappropriate jocularity to an alcoholic stupor,
or they may be argumentative or verbally abusive. It is easy to assume
that the unconscious intoxicated patient has only “passed out” because
of a high level of blood alcohol, but these patients are just as subject to
sudden changes in condition as nonintoxicated persons. Be especially
alert to LOC changes in these patients, because the effects of alcohol
may obscure important symptoms. Patients taking pain medications, or
those who are insulin-dependent and have gone too long without
insulin, may exhibit similar signs and symptoms.
GLASGOW COMA SCALE
Action
Response
Score
Eyes open
Spontaneously
To speech
To pain
None
Oriented
Confused
4
3
2
1
5
4
Inappropriate words
3
Incomprehensible sounds
2
None
1
Obeys commands
6
Localized pain
5
Flexion withdrawal
4
Abnormal flexion
3
Abnormal extension
2
Flaccid
1
Verbal response
Motor response
Highest Possible Score
15
SHOCK
Shock is 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.
Shock is a dangerous, potentially fatal condition. Early signs of shock are
pallor, increased heart rate and respirations, and restlessness or
confusion. There are five main types of shock, categorized according to
the cause, which may be medical or traumatic: hypovolemic, septic,
neurogenic, cardiogenic, and allergic (anaphylactic).
Type of Shock
Hypovolemic
Neurogenic
Cardiogenic
Septic
Anaphylactic
Cause
Loss of blood from injury or internal
hemorrhage; loss of plasma from burns, or
other cause of severe dehydration
Injury to the nervous system caused by head
or spinal trauma
Cardiac failure caused by interference with
heart function. May be caused by embolism,
cardiac tamponade, or complications of
anesthesia.
Massive infection, usually by Gram-negative
bacteria.
Contact with foreign substances, usually
proteins, to which the individual has become
sensitized (including bee stings and some
medications). Iodine contrast agents for
radiographic imaging may precipitate a
similar response
Syncope
Fainting, or syncope, is a very mild form of shock that sometimes occurs when
fright, pain, or unpleasant events are beyond the coping ability of the patient's
nervous system. Blood pressure falls as the diameter of the blood vessels
increases and the heart rate slows. When the blood pressure is too low to supply
the brain with oxygen, the patient faints. Placing the patient in a dorsal recumbent
position with the feet elevated usually relieves this type of shock.
Patients who have been allowed nothing by mouth (NPO) for 12 hours and are
feeling anxious and stressed may undergo syncope.
Patients who feel faint should be assisted into a sitting or recumbent position. If a
chair is not within reach, ease the patient to the floor. If the patient does not
respond immediately, spirits of ammonia held under the nose usually bring a rapid
return to consciousness. Small, crushable vials of ammonia are usually kept in
imaging departments for this purpose. A physician's order is not usually required
for their use. A physician should assess anyone who has more than a momentary
loss of consciousness before the examination is resumed.
Recognizing and Treating Shock
The following symptoms indicate
some degree of shock in any or all
combinations:
•Restlessness and a sense of
apprehension
•Increased pulse rate
•Pallor accompanied by weakness
or a change in thinking ability
•Cool, clammy skin (except in
patients with septic or neurogenic
shock)
•A fall in blood pressure of 30 mm
below the baseline systolic
pressure
•Decreased urination
•Increased and shallow
respirations
Anaphylactic Shock
Because some imaging procedures use contrast agents that contain iodine,
to which some people are allergic, this is the most frequently seen type of
shock in radiographic imaging. The radiographer must be able to recognize
it at its onset to prevent life-threatening consequences.
Anaphylactic shock (anaphylaxis) is the result of an exaggerated
hypersensitivity reaction (allergic reaction) to re-exposure to an antigen that
was previously encountered by the body's immune system. When this
occurs, histamine and bradykinin are released, causing widespread
vasodilatation, which results in peripheral pooling of blood. This response is
accompanied by contraction of nonvascular smooth muscles, particularly the
smooth muscles of the respiratory tract. This combined reaction produces
shock, respiratory failure, and death within minutes after exposure to the
allergen. Usually, the more abrupt the onset of anaphylaxis, the more severe
the reaction will be.
The signs of anaphylactic shock may be
classified as mild, moderate, or severe as follows:
Mild Systemic Reaction:
•Nasal congestion, periorbital swelling, itching,
sneezing, and tearing of eyes
•Peripheral tingling or itching at the site of
injection
•Feeling of fullness or tightness of the chest,
mouth, or throat
•Feeling of anxiety or nervousness
Moderate Systemic Reaction:
•All of the above symptoms, plus:
•Flushing, feeling of warmth, itching, and
urticaria
•Bronchospasm and edema of the airways
or larynx
Dyspnea, cough, and wheezing
Severe Systemic Reaction:
•All symptoms listed above with an
abrupt onset
•Decreasing blood pressure; weak,
thready pulse either rapid or shallow
•Rapid progression to bronchospasm,
laryngeal edema, severe dyspnea,
cyanosis
•Dysphasia, abdominal cramping,
vomiting, and diarrhea
•Seizures, respiratory and cardiac
arrest
Radiographer's Response:
•Do not leave the patient. Stop any infusion or injection of
contrast immediately and notify the radiologist if any of the
symptoms occur.
•If the patient complains of respiratory distress or has any of the
symptoms listed in the severe reaction section, call the
emergency team.
•Place the patient in semi-Fowler position or in a sitting position
to facilitate respiration.
•Monitor pulse, respiration, and blood pressure every 5 minutes
or until the emergency team arrives to assume responsibility.
•Prepare to assist with oxygen, intravenous fluid, and medication
administration. Have large-gauge venous catheters available.
•Prepare to administer CPR as required.
•Chart the occurrence, the treatment administered, and the
patient's response on an incident report form and/or in the chart.
The medications usually given for anaphylactic shock are
epinephrine, diphenhydramine, hydrocortisone, and
aminophylline.
Information Requested before Administration of Contrast
Agents
Name
Age
Date
Have you had the study you are having today at any other time?
If the answer is yes, did you have any allergic or unusual
reaction?
Are you allergic to any food, medications or any other
substance? If you are, please specify.
Recent laboratory tests performed and results
Blood urea nitrogen (BUN) and createnine
Have you had any protein in your urine? If so, to what degree?
Do you have heart disease?
Hypertension?
Diabetes mellitus?
Sickle cell anemia?
Asthma?
Have you had any procedures such as a cryptogram that
involved use of contrast agents? If so, please explain.
Pulmonary Embolus
A pulmonary embolus is an occlusion of one or more pulmonary arteries
by a thrombus or thrombi. The thrombus originates in the venous
circulation or in the right side of the heart and is carried through the
vessels to the lungs, where it blocks one or more pulmonary arteries
Clinical Manifestations
•Rapid, weak pulse
•Hyperventilation
•Dyspnea and tachypnea
•Tachycardia
•Apprehension
•Cough and hemoptysis
•Diaphoresis
•Syncope
•Hypotension
•Cyanosis
•Rapidly changing levels of consciousness
•Coma; sudden death may result
Radiographer's Response
•Stop the procedure immediately, and call for emergency assistance.
•Notify the physician, and bring the emergency cart to the patient's side.
•Monitor vital signs.
•Do not leave the patient alone; reassure the patient.
•Prepare to assist with oxygen administration and administration of
intravenous medication and fluid
Diabetic Emergencies
Diabetes mellitus is now recognized as a group of metabolic
diseases resulting from a chronic disorder of carbohydrate
metabolism. It is caused by either insufficient production of
insulin or inadequate utilization of insulin by the cells of the body.
There are four major types of diabetes
mellitus
• Type 1 diabetes mellitus.
• Type 2 diabetes mellitus
• Diabetes mellitus associated with or produced by other
medical conditions or syndromes.
• Gestational diabetes
There are three complications of diabetes mellitus that
may occur when caring for a patient:
•Hypoglycemia occurs when persons who have diabetes mellitus have an excess
amount of insulin or oral hypoglycemic drug in their bloodstream, an increased
metabolism of glucose, or an inadequate food intake with which to utilize the
insulin. This may occur when the patient has not had anything to eat or drink prior
to coming to the department for his or her procedure. The onset of symptoms is
rapid, and immediate action is necessary to prevent coma.
•Diabetic ketoacidosis occurs when insufficient insulin causes the liver to produce
more glucose, resulting in hyperglycemia. The kidneys attempt to compensate by
excreting glucose with water
and electrolytes. There is excessive urination (polyuria) with an outcome of
dehydration and electrolyte imbalance in the body.
•Hyperglycemic hyperosmolar nonketotic syndrome (coma) may be a complication
of mild type 2 diabetes mellitus, or it may occur in the elderly person with no
known history of diabetes mellitus.
Clinical Manifestations
The following occur in all cases:
•Tachycardia
•Headache
•Blurred or double vision
•Extreme thirst
•Sweet odor to the breath may occur in diabetic ketoacidosis
Radiographer's Response
•Stop the procedure and notify the radiologist in charge of the
procedure.
•Do not leave the patient unattended.
•Monitor the vital signs and prepare to administer intravenous
fluids, medication, and oxygen as they may be needed and
requested by an emergency team.
Hypoglycemia
The diabetic patient who has taken insulin but no food may develop
hypoglycemia, or low blood sugar. Unlike the slow onset of diabetic
coma, hypoglycemia is characterized by a sudden onset of weakness,
sweating, tremor (quivering), hunger, and finally, loss of
consciousness. While the patient is still alert and cooperative,
hypoglycemia can be quickly treated by giving the patient a small
amount of candy or sweet fruit juice. Squeeze tubes containing a
measured amount of glucose may be stored with the emergency
medications. These prepackaged doses of glucose are useful because
the gel-like material can be placed inside the patient's cheek. This
decreases the chance that a semiconscious or confused patient will
aspirate it, as might be the case with candy or juice.
Cerebral Vascular Accident (Stroke)
Cerebral vascular accidents (CVAs) are caused by
occlusion of the blood supply to the brain, rupture of the
blood supply to the brain, or rupture of a cerebral artery,
resulting in hemorrhage directly into the brain tissue or
into the spaces surrounding the brain
Clinical Manifestations
•Possible severe headache
•Numbness
•Muscle weakness or flaccidity of face or extremities, usually one-sided
•Eye deviation, usually one-sided; possible loss of vision
•Confusion
•Dizziness or stupor
•Difficult speech (dysphasia) or no speech (aphasia)
•Ataxia
•May complain of stiff neck
•Nausea or vomiting may occur
•Loss of consciousness
Myocardial Infarction
Myocardial infarction (MI) is the medical term for what is also called a
heart attack. When a coronary artery becomes occluded, a portion of the
heart wall becomes ischemic, and the heart muscle supplied by the artery
will die if blood flow is not quickly restored.
When a patient complains of sudden, intense chest pain, often described
as a crushing pain, you should assume that the patient is having a heart
attack until proven otherwise. Patients may underestimate the importance
of this type of pain and assume instead that the sudden onset is terrible
heartburn or indigestion. Pain may be referred to the left arm, jaw, or
neck. These patients often become diaphoretic, have an irregular
heartbeat, become pale, and may feel nauseated and short of breath. You
must prevent further damage by minimizing patient exertion. Stay with the
patient, call a physician, and assist the patient to a comfortable position. If
the patient has shortness of breath, raise the head of the bed or stretcher
and administer oxygen at 2 to 4 L/min. The treatment for MI varies and
can include the administration of pain medication, aspirin, oxygen, and
often vasodilating and/or clot-dissolving drugs.
Angina Pectoris
Angina pectoris, often shortened to “angina,” occurs when the coronary
arteries are unable to supply the heart with sufficient oxygen. These
episodes of chest pain are precipitated by exertion or stress and are usually
relieved by rest or the sublingual administration of nitroglycerin The
discomfort caused by angina varies from a vague ache to an intense
crushing sensation. It is frequently mistaken for indigestion, because it often
presents as pain under the sternum. If substernal pain is not immediately
relieved with rest, inform the radiologist and be prepared to give a dose of a
vasodilating medication such as nitroglycerin. A second dose may be
ordered 5 minutes later. An emergency supply of nitroglycerin is usually
stocked in the imaging department. Remember that patients with chronic
angina can also suffer an MI.
Cardiac Arrest
For health care workers, one of the most anxiety-producing situations is to
discover an unconscious patient or to observe a patient suddenly lose
consciousness. When this occurs, it is important to initiate the “shake and
shout” maneuver. Patients who have simply fainted will respond if you call
out their name and give them a gentle shake. If there is no response, feel
for the carotid pulse and observe for respiration. If the patient has stopped
breathing, or if no pulse is detected, an emergency code must be initiated to
summon an emergency response team immediately.
Clinical Manifestations of Cardiac Arrest
•Loss of consciousness, pulse, and blood pressure
•Dilation of the pupils within seconds
•Possibility of seizures
you must allow the emergency response personnel to take over immediately
when they arrive. They will initiate or continue CPR. Stand by to keep records
of medication administration and defibrillation. Your help may be needed to
connect the patient to the cardiac monitor.
Clinical Manifestations of a Partially Obstructed Airway
•Labored, noisy breathing
•Wheezing
•Use of accessory muscles of the neck, abdomen, or chest on inspiration
•Neck vein distention
•Diaphoresis
•Anxiety
•Cyanosis of the lips and nail beds
•Possibly a productive cough with pink-tinged frothy sputum
Radiographer's Response to a Patient with a Partially Obstructed Airway
•Call for assistance; do not leave the patient alone.
•Assist the patient to a sitting or semi-Fowler position.
•Attempt to relieve the patient's anxiety.
•Prepare to administer oxygen.
•Prepare to use the emergency cart.
Respiratory Arrest
Clinical Manifestations
•The patient stops responding
•The pulse continues to beat briefly and then quickly becomes weak and
stops
•Chest movement stops, and no air is detectable moving through the
patient's mouth
Radiographer's Response to Both Cardiac and Respiratory Arrest
•If the patient is an adult and is found to be unresponsive, shake the
patient and ask, “Are you all right?” If there is no response, call
immediately for emergency medical services (call a CODE). If no one is
near, shout for help, stating the location as well. “I need help STAT in
Room 102.” Do not leave the patient.
•Assess the carotid pulse of an adult patient. Do not waste time taking the
blood pressure or listening for a heartbeat.
•If the patient is an adult with no pulse and the CODE has been called,
place the patient in a supine position on a hard surface. If the patient is
already on the radiographic table, leave the patient there, as this is a
perfect place to perform CPR.
Cardiopulmpnary resucitation (CPR)
• A – airway In order to breath, or in the case of CPR, to breath for another individual, one must
secure a patent, or viable, airway. Usually by checking for any airway obstruction (Choking
hazard) and placing the adult patient's head into a "neutral" position so that the chin is essentially
centered, not too far towards the chest or in a "sniffing" position where the head is basically
"looking upwards" one can generally maintain an adequate Airway
• B - Look, listen and feel for ventilation, or breathing. Look for rise and fall in the chest, which
would indicate the patient is breathing. Listen for sounds of breathing, or in the case of a partial
choking victim, listen for wheezing or high pitch noises, called "stridors" If breathing is
indadequate, one should initiate rescue breathing or CPR.
• C - Body tissue receives nourishment and oxygenation through circulation. Circulation is
provided by a major pump in the body called the heart. To check for circulation, one should feel
for a pulse by palpating one of several "pulse points" on the body. The most common is the
Carotid, which is palpated by placing two fingers forward, resting on the center of the neck and
sliding gently towards the back of the neck until roughly at center. There are points on either side
of the neck. Another spot to check is the radial artery, which is felt by placing two fingers between
the radial bone and ligament on the arm. This would be the side of the forearm situated on the
same side as the patient's thumb. If indadequate circulation is present, then one should initiate
rescuscitative efforts, such as CPR compressions.
•
Variations in CPR Techniques for Infants
and Children
• Neonate
• Infant under 1 year of age
• Child ages 1 to 8 years
Cardiac compression
•Keep the elbows straight and use the body weight to help
compress the sternum 1.5 to 2 inches directly downward; then
release the compression completely.
•Find the lower margin of the patient's rib cage at the area where
the ribs and sternum meet. Place the index finger above this
junction and the heel of the other hand next to the finger. Place
the second hand on top and interlace the fingers.
•This should place the hands about 1.5 inches from the xiphoid tip
toward the patient's head. The fingers should not touch the chest
wall of the patient
Airway Obstruction
A foreign body such as a piece of chewing gum or food
may lodge in a patient's throat and produce respiratory
arrest. This type of accident occurs most often in the
elderly, the very young, or the intoxicated while eating.
However, the radiographer must consider this possibility in
any case of respiratory arrest.
When airway obstruction caused by a foreign object
occurs, the patient usually appears to be quite normal, and
then suddenly begins to choke. The patient grabs the
throat and is unable to speak. If no one is present to
observe this, the patient eventually loses consciousness.
Unless the early signs are observed, it is impossible to
know the cause of the unconscious state. Airway
obstruction may occur with the patient sitting, standing, or
lying down and must be dealt with initially in that position.
Radiographer's Response
•If the patient does not respond and breathlessness is established as described
in the preceding paragraphs, seal the patient's nose and mouth, and ventilate
him or her as in the initial steps of CPR.
•If the patient's chest rises and falls, proceed as for basic CPR.
•If the patent's chest does not rise and fall, reposition the head using the head
tilt, chin lift, or jaw thrust as indicated. Then attempt to ventilate again..
•If this is unsuccessful, assume that the airway is obstructed and use
the abdominal thrust to attempt to remove the obstruction.
Seizures
A seizure is an unsystematic discharge of neurons of the cerebrum that
results in an abrupt alteration in brain function. It usually begins with
little or no warning and may last only seconds or for several minutes. A
seizure is accompanied by a change in the level of consciousness.
Seizures themselves are not a disease, but are a syndrome or
symptom of a disease. They may be caused by infections or disease,
especially those that are accompanied by high fever. They may also be
caused by extreme stress, head trauma, brain tumors, structural
abnormalities of the cerebral cortex, genetic defects (epilepsy), birth
trauma, vascular disease, congenital malformations, or postnatal
trauma. Odors and flashing lights can cause a seizure in a person who
is seizure prone.
There are basically two types of seizure: generalized and partial.
Generalized
Clinical Manifestations
•May utter a sharp cry as air is rapidly exhaled
•Muscles become rigid and eyes open wide
•May exhibit jerky body movements and rapid, irregular respirations
•May vomit
•May froth and have blood-streaked saliva caused by biting the lips or
tongue
•May exhibit urinary or fecal incontinence
•Usually falls into a deep sleep after the seizure
Partial
Clinical Manifestations of a Complex Partial Seizure
•Patient may remain motionless or may experience an excessive
emotional outburst of fear, crying, or anger
•Patient may manifest facial grimacing, lip smacking, swallowing
movements, or panting
•Patient will be confused for several minutes after the episode with no
memory of the incident
Clinical Manifestations of a Simple Partial Seizure
•Only a finger or a hand may shake
•Patient may speak unintelligibly
•Patient may be dizzy
•Patient may sense strange odors, tastes, or sounds
•Patient will not lose consciousness
Radiographer's Response to a Patient Having a Seizure
•Stay with the patient and gently secure him or her to prevent injury.
•Call for assistance.
•Do not attempt to insert anything into the patient's mouth.
•Remove dentures and foreign objects from the patient's mouth if possible, but
do not put fingers into the mouth.
•Place a blanket or pillow under the patient's head to protect it from injury.
•Do not restrain the arms or legs but protect them from injury.
•Do not attempt to move the patient to the floor if he or she has not fallen there;
if on a radiographic table, do not allow the patient to fall to the floor.
•Observe the patient carefully and keep track of the time of the seizure to
record later.
•Provide the patient privacy.
•After the seizure has ceased, position the patient to prevent aspiration of
secretions and vomitus. Turn the patient to a Sim's position and put the face
downward so that secretions may drain from his or her mouth.
Epistaxis
A nosebleed, or epistaxis, can be rather frightening to the patient but
is usually not serious. Remove eyeglasses when necessary, and
provide an ample supply of tissues. Instruct the patient to breathe
through the mouth and to squeeze firmly against the nasal septum for
10 minutes. The patient should not lie down, blow the nose, or talk.
Provide an emesis basin, instructing the patient to spit out blood that
runs down the nasopharynx rather than swallow it. If bleeding lasts
more than a few minutes, inform the physician, who may want to
apply more direct treatment.
Nausea and Vomiting
Nausea and vomiting are frequently encountered, and a well-prepared
radiographer learns to cope easily with this situation. Occasionally patients may
feel nauseated for a specific reason, such as after swallowing a barium
preparation. Vomiting can often be prevented by the radiographer's reassuring
presence and by offering breathing suggestions. “Breathe through your mouth,
taking short, rapid, panting breaths,” or “Take some long, slow, deep breaths
through your nose,” are both effective instructions. These suggestions are helpful
because they encourage a focus on breathing that distracts the patient from the
nausea until it passes. On the other hand, if a patient expresses a need for an
emesis basin, offer it immediately. Bring the patient a clean emesis basin before
removing the soiled one. Provide tissues and water to rinse the mouth. It is
especially important to support the patient in a sitting or lateral recumbent position
to avoid aspiration of vomitus. The lateral recumbent position is safest for the
patient with nausea who is unable to sit up. If the patient loses consciousness, be
sure to turn the head to the side and clear the airway. Wear gloves when handling
soiled emesis basins or cleaning up after a patient has vomited.
Extremity Fractures
Trauma involving the long bones of the body may be classified in two categories: (1)
compound fractures, in which the splintered ends of bone are forced through the
skin, and (2) closed fractures. Compound fractures are usually partially reduced and
a dressing applied before radiographic examination. Fractures may also be
classified according to the nature of the injury.
There are many ways of temporarily immobilizing extremity fractures. The two legs
may be fastened together for stability during transportation (self-splinting), or a stiff
object, such as a board or rolled-up magazine, may serve as a splint. Ambulances
often carry pneumatic splints, which are air-filled sleeves that protect and immobilize
the extremity (Splinting devices should not be removed except under the physician's
direct supervision.)
When you must position a fractured extremity that is not supported by a splint,
maintain gentle traction while supporting and moving the arm or leg. Two people
may be required to support and position patients with a potential long bone fracture,
because the extremity must be supported at sites both proximal and distal to the
injury. It is important to minimize motion of the fracture fragments. This helps
minimize pain, prevent damage to the soft tissues around the fracture site, and avoid
the initiation of a muscle spasm that could interfere with the physician's attempt to
reduce and immobilize the fracture more permanently. Movement of fracture
fragments may tear surrounding soft tissues, nerves, and blood vessels, seriously
complicating the patient's condition.