This presentation is going to review Chapter 9 of the Torres Patient Care Book, Medical Emergencies. At the end of this presentation, students will be able to assess the basic levels of neurologic and cognitive functioning, list the three classifications of shock and describe the shock continuum, define distributive shock and three different types, explain the role of the radiographer in recognizing and responding to the patient's immediate medical needs, in various categories of shock, list the clinical manifestations of pulmonary embolus, and describe what the technologist's role should be, define diabetes myelitis, and list the three major types, list the clinical manifestations of cerebral vascular accident, and explain the actions to be taken in the event of these symptoms, list the clinical manifestations of cardiac and respiratory failure, explain the symptoms of mechanical airway obstruction. and emergency intervention if necessary, and describe the actions to be taken if a patient were to faint or have a seizure while under the technologist's care.
Patients often arrive at the diagnostic imaging department in a compromised physical status. In such conditions, unexpected physiologic reactions can arise swiftly, posing life-threatening risks if not promptly recognized and managed. Non-traumatic medical emergencies commonly encountered during imaging include shock, anaphylaxis, pulmonary embolism, diabetes-related issues, stroke, cardiac and respiratory failure, syncope, and seizures.
As a result, the healthcare provider must be able to observe these reactions and radiographers must recognize symptoms and initiate appropriate treatment. Radiographers should assess the patient's neurological and cognitive function upon admission for a diagnostic procedure and establish a baseline. In the event of a life-threatening emergency, the initial step is to call the hospital emergency team.
Radiographers should be familiar with the institution's policy for activating an emergency response team. This is often referred to as a code or code blue. Including knowing the emergency team's contact number and providing precise location and details of the emergency, all imaging departments maintain an emergency cart, commonly known as a crash cart, which should be easily identified and stocked with essential medications and equipment for critical situations. A crash cart is a specialized mobile unit stocked with the emergency supplies and medications essential for resuscitation efforts. It should be strategically positioned for rapid access during medical emergencies.
The CART typically includes items like defibrillators, medications for cardiac support, airway management tools, and other supplies crucial for immediate life-saving interventions by healthcare providers. Cardiac arrest occurs when the heart suddenly stops pumping blood effectively, typically due to an electronic malfunction in the heart. Defibrillators are used as medical devices that deliver electrical shocks to restore normal heart rhythm during cardiac emergencies like a cardiac arrest. The crash cards, organization, and readiness are critical in ensuring prompt and effective emergency response in all healthcare settings.
In a previous chapter, we briefly talked about the Glasgow Coma Scale. So the Glasgow Coma Scale assesses changes in the patient's condition and must be recognized based on the initial assessment data. Neurological assessment can be facilitated using the Glasgow Coma Scale, which is widely adopted in all healthcare settings. This scale evaluates three aspects of neurological function, such as eye opening, motor response, verbal response, and it provides a simple and reliable overview of the patient's responsiveness with a maximum score of 15, and any decline in the scale should be immediately reported to attending physicians. A critical indicator of deteriorating condition is a change in the patient's level of consciousness.
Even subtle changes may not be disregarded. Level of consciousness can be assessed by asking the patient basic questions about their identity, date, location, and reason for being in the imaging department. A prompt and accurate response indicates orientation to person, place, time, and situation.
Note any difficulty in responding, such as slow responses, word choice issues, or unusual irritability. Observing the patient's ability to follow instructions for positioning during an exam is essential. Note any pain during movement, behavioral changes, or lack of response, and report these observations to the attending physician.
Monitoring vital signs is another way to assess the patient's level of consciousness. Baseline vital signs are essential for detecting any deviations. An increase in systolic pressure, widening a pulse, or slowing a pulse rate may indicate rising intracranial pressure due to a bleep. Other signs include increased respiratory rate, decreased blood pressure, or a further decline in pulse rate as potential brain compression worsens. Rapid changes in the body temperature, either an increase in blood pressure or a further decline in pulse rate, may indicate rapid changes in the body temperature.
or a decrease are also concerning. If the patient initially reports no issues, but later complains of issues such as headache or becomes restless or unusually quiet, experiences slowed speech, or shows signs of altered orientation during a procedure, these changes must be reported to the physician. Stop the procedure immediately, stay with the patient, and call for assistance. Shock is the body's normal response to illness, injury, or extreme physiological or emotional stress.
It can arise from factors such as fluid loss, heart failure, decreased blood vessels tone, or blockage of blood flow to vital organs. In shock, inadequate blood circulation deprives the body of its essential nutrients and oxygen. This condition is life-threatening and can develop suddenly and unexpectedly.
Prompt recognition of shock and shock symptoms by the technologist is important, as early intervention can prevent its progression. leading to organ failure or potential death. Shock is a continuum of events that progress through several stages.
The body's vital organs rely on continuous supply of oxygen and nutrients. When this supply is reduced, it leads to detrimental effects on normal physiological processes. In the initial stages of shock, Physiological changes occur at a cellular level and may only manifest clinically as an increased heart rate.
As shock advances into the compensatory stage, blood is redirected from less critical areas like the lungs, skin, kidneys, and GI tract to prioritize the brain and heart's oxygen needs. Symptoms during this stage include cold and clammy skin, nausea and dizziness, increased breathing rate, shortness of breath, heightened anxiety, and decreased blood pressure and increased pulse rate. If shock progresses beyond the compensatory stage, the mean arterial pressure decreases significantly.
This results in inadequate perfusion of all body systems, leading to insufficient pumping of the heart and constriction of the arteries. During the progressive stage of shock, symptoms intensify. Noted by decreased blood pressure with rapid pulse rate, rapid and shallow breathing, fluid leaks from pulmonary capillaries causing severe lung edema, which is acute respiratory distress, rapid heart rate, sometimes reaching up to 150 beats per minute, chest pain, mental status changes, and confusion. Renal, hepatic, gastrointestinal, and hematologic systems start to fail. If shock continues to advance, Unchecked, it reaches the irreversible stage where organ systems become irreversibly damaged and recovery becomes impossible.
This is identified as persistently low blood pressure, kidney and liver failure, and release of toxins from the necrotic tissues and severe lactic acidosis. Shock is broken down into four different categories. hypovolemic shock which is due to loss of blood or tissue fluid cardiogenic shock which is caused from cardiac disorders distributive shock which is due to blood vessels inability to constrict and assist in the return of blood to the heart and obstructive shock which is due to pathological conditions that interfere with the normal pumping action of the heart Hypothalamic shock is a life-threatening medical condition that occurs when there is significant loss of blood or fluids in the body, leading to a decrease in circulating blood volume. This reduction in blood volume causes inadequate perfusion of tissue to the organs, depriving them of oxygen. Body fluids are distributed within the cells and various compartments outside the cells in the body.
This extracellular fluid includes fluid in the vessels, intravascular, and in surrounding tissues, which is interstitial. There is typically three to four times more fluid in interstitial spaces compared to blood vessels. Hypovolemic shock occurs when intervascular fluid decreases by 15 to 25 percent, equivalent to a loss of 750 to 1300 milliliters. This fluid loss can result from internal or external bleeding.
plasma loss due to burns or excessive fluid loss from conditions like prolonged vomiting diarrhea and medication use there are four different classes of hypovolemic shock based on the percentage of blood lost or fluid loss patients with hypovolemic shock may experience excessive thirst due to the fluid loss and they may have cold extremities cold and clammy skin and cyanosis, which is when the fingernails and the lips start to turn blue. Immediate actions include stopping procedures, positioning the patient supine with the legs elevated, excluding the head or spinal injury, and notifying the position. This positioning with the supine with the legs elevated causes more blood to return back to the heart. and helps minimize the symptoms and call a physician immediately.
Cardiogenic shock results from the heart's inability to pump sufficient blood to meet the body's needs, often developing gradually or suddenly and particularly in patients hospitalized for conditions such as myocardial infarction or cardiac arrhythmias. A subset known as obstructive shock can arise from conditions like cardio tamponade, pulmonary embolism, or arterial stenosis, which obstruct blood flow through the heart, exacerbating the heart's pumping efficiency. In response to these emergencies, immediate actions include activating the emergency team, positioning the patient appropriately for respiratory support, administering oxygen, intravenous fluids, and medications to manage symptoms like chest pain.
closely monitoring vital signs and preparing for potential cardiopulmonary resuscitation cpr if indicated it's important that if you notice signs of cardiogenic shock that you grab a crash cart and you're ready to come and help and you want to sit the patient up help with their breathing but not leave them alone in this position Distributive shock occurs when blood pools in the peripheral blood vessels, leading to reduced venous return to the heart, lowering the blood pressure, and inadequate tissue perfusion. This can result from a loss of sympathetic tone where blood vessels fail to constrict effectively, impairing blood return to the heart. Additionally, chemicals released by the cells can induce vasodilation and increase capillary permeability.
causing significant blood volume to accumulate in the peripheral arteries. Neurogenic shock is caused by spinal cord injuries or severe emotional distress. Septic shock results from the systemic infection where inflammatory mediators cause widespread vasodilation and capillary leakage.
Anaphylactic shock is triggered by severe allergic reaction causing rapid vasodilation and increased capillary permeability due to histamine releases. Neurogenic shock is a type of distributive shock caused by sudden loss of sympathetic tone due to spinal cord injury and severe emotional stress or neurological damage. Medication or even anesthesia can cause this to occur. This loss of sympathetic nervous system activities results in widespread vasodilation leading to a drop in blood pressure and a decrease in tissue perfusion.
Unlike other forms of shock, neurogenic shock typically presents with bradycardia, also known as a slow heart rate, instead of the usual tachycardia, which is an increased heart rate seen in other types of shock. Septic shock is a severe condition caused by a systemic infection that leads to a significant drop in blood pressure and impaired organ function. It's important that radiographers know that the signs and symptoms of septic shock because you may encounter patients with septic shock in critical care settings, and this requires on-site imaging to avoid moving unstable patients.
Clinical signs include initial fever with flushed skin and elevated heart rate. and respiratory rates, progressing to cool pale skin, low blood pressure, and potential organ failure if untreated. While radiographers seldom initiate the treatment for septic shock, they do play a crucial role in maintaining patient comfort and minimizing factors that could exacerbate the condition, such as avoiding chilling the patient to prevent increased oxygen demand. This type of shock usually does not happen in our department because it is caused by an infection. and the patient will be in the hospital for that condition, and we may see them while doing a mobile study or when they come to the department.
Patients may have pneumonia, and we will be doing a chest x-ray on them, and septic shock is more commonly seen in the hospital than in other areas. Again, it is a type of distributive shock, so the blood isn't getting to where it needs to be, this time because the body's immune system is fighting the infection caused by the capillaries to become dilated. The manifestations are divided into two stages. The first causes the heart rate and respiration to increase and the patient may have nausea and vomiting. And the second stage presents with a drop in blood pressure and a rapid heart rate and increased respiration.
Many patients with septus that can develop septic shock have pneumonia, as demonstrated on this chest x-ray here. If you notice, one lung is black with some white spots and the other lung is more white. That is an indication of pneumonia.
Anaphylactic shock is the most common type of shock seen in radiographic imaging due to the use of contrast media that contains iodine. which can trigger allergies in some individuals and radiographers must promptly recognize its onset to prevent potentially life-threatening outcomes. Anaphylaxis happens when the immune system reacts excessively to encountering an antigen releasing a histamine. This causes widespread dilation of the blood vessels and leads to blood pooling in the extremities and at the same time the muscles in the respiratory tract may contract, worsening the situation and potentially causing shock, breathing problems, and rapid death shortly after exposure to the allergen. A faster onset of anaphylaxis generally indicates a more severe reaction.
Common triggers include medications, iodinated contrast media, and insect venom, and allergic reactions can occur via skin contact, inhalation, ingestion, or injection. Different severities of reactions exist. There are mild reactions, moderate reactions, and severe reactions. A mild reaction is categorized when a patient exhibits nasal congestion, swelling around the eyes, itching, sneezing, and watery eyes, tingling or itching at the site of an injection, chest tightness or fullness or tightness in the mouth or throat, and sensation of anxiety or nervousness. A moderate reaction includes all of the symptoms that occur in a mild reaction, but also the patient will exhibit flushing, warmth, itching, hives, also known as urticaria, bronchospasms, swelling of the airways or larynx, difficulty breathing, coughing, and wheezing.
So a moderate reaction must be treated. rather quickly so it doesn't develop into a severe reaction resulting in potential death. Severe reactions have all of the symptoms from mild or moderate reactions with a sudden onset, so they occur very quickly. And then the patient will also exhibit a drop in a blood pressure, weak, rapid, or shallow pulse, or they call it a thready pulse, rapid progression to severe breathing difficulties, swelling of the throat, bluish skin color, which is classified as cyanosis, difficulty swallowing, abdominal cramps, vomiting, diarrhea, and also seizures and potential respiratory and cardiac arrest. Reactions sometimes happen immediately and other times a reaction won't happen for five minutes or longer.
You never want to leave your patient alone during an injection or after an injection because you want to monitor them. for any possible symptoms, whether it's a mild, moderate, or severe reaction. You want to stay with the patient and immediately stop any contrast infusion or injection and inform the radiologist as soon as possible if any symptoms occur.
A mild reaction can escalate very quickly and the patient should be treated as fast as possible. If a patient experiences difficulty breathing or shows signs of a severe reaction, you need to call the emergency team as well as the radiologist. The patient should be positioned in a semi-upright or sitting position to assist in breathing and if it is appropriate and safe. You want to monitor the patient's pulse, breathing, and blood pressure at least every five minutes until an emergency is seen.
team can take over. Hospitals you would want to call code. You want to also prepare to administer oxygen, IV fluids, and medications that can help alleviate the severity of the reaction.
You want to be prepared to perform CPR if necessary. Often you want to leave the patient on the table in the event that you have to perform CPR because it's a hard surface. Medications commonly used for treating anaphylactic shock include epinephrine, diphenhydramine, hydrocortisone, and aminophylline. These medications are classified as bronchodilators and will open up the airway so a patient can breathe. Before administering contrast, an imaging department requires completion of a standard procedures form, ensuring thorough patient history collection by the radiographer in order to proceed with the injection.
After the procedure occurs, physicians should document the contrast agent used, and any unusual patients'reactions. Anaphylactic reactions are always noted in the patient's medical record and imaging history by the administering staff. Reports are kept in the patient's file and by the department so a record is on file if the patient has had an allergic reaction and informed decisions are made in the future prior to contrast media administration. A patient who receives contrast media should remain under observation in the department for 30 minutes, if not hospitalized. If no issues arise, they may leave with a companion and should be educated on recognizing the signs of anaphylactic symptoms and advised to seek immediate medical attention if they occur.
Patients who experience mild allergic reaction during imaging with contrast media should report this for future reference. Severe reactions may require wearing medical alert bracelet to avoid further exposure to similar allergens. This form is an example of an allergy form.
If you let the patient fill it out, you must go over it with the patient before injecting them with contrast media. Oftentimes, the patient will forget that they had something happen or make a wrong answer by accident because they didn't read their question correctly. It's important to explain. what hypertension is or any other areas on the form. Most patients don't know what a BUN is or creatinine and it's up to the radiologic technologist to fill out these forms.
Hypertension is high blood pressure, blood urea nitrogen is BUN, and creatinine indicates how well the kidneys are functioning. BUN does affects kidney function and it measures the nitrogen levels in the blood as well. If any of this should happen to a patient and they check off yes on anything on the form, the technologist is responsible for educating the patient and consulting the physician before moving forward with the injection of contrast media. Pulmonary embolism, abbreviated PE, occurs when one or more pulmonary arteries in the lungs are blocked by a blood clot, also known as a thrombosis, that travels from elsewhere in the body.
Typically, these originate in the veins on the right side of the heart, and it is a common complication among hospitalized surgical patients and can be fatal in over 50% of its cases. PEs contribute to a significant morbidity and approximately 120,000 deaths annually within the United States. Severe COVID cases increase the risk of pulmonary embolism.
Pulmonary embolism-related deaths are rising again, particularly among those under the age of 65, which is concerning given that a DVT, deep vein thrombosis, typically increases with age. PEs are associated with various factors including trauma, orthopedic and abdominal surgeries, pregnancies, heart failure, prolonged immobility, and conditions that increase blood clotting. Most cases stem from deep vein thrombosis, DVT, and symptoms and severity depend on the size and the number of clots affecting pulmonary circulation.
Risk factors include hip surgery, heart disease, cancer, estrogen use, and prior history of deep vein thrombosis. A PE can lead to arterial hypoxemia and potentially be life threatening. Diabetic emergencies are common among the population. Diabetes myelitis is a group of metabolic disorders resulting from chronic issues with how the body handles carbohydrates.
It occurs due to either insufficient production of insulin or the body's inability to use insulin effectively. Insulin, a hormone normally produced by the pancreas, regulates blood sugar levels. In diabetes, this regulation is disrupted, leading to high blood sugar levels, also called hyperglycemia, and various metabolic complications. Common symptoms include increased urination, called polyuria.
excessive thirst, and heightened hunger. There are three different types of diabetes. Type 1 diabetes, which develops in individuals under 30 years of age and has sudden onset. Type 1 diabetes is an autoimmune disorder that cannot be cured, and it is also known as insulin dependent diabetes. Type 2 diabetes is the most common type of diabetes, and it occurs most often in people under 30 years of age.
individuals over the age of 40 and has gradual onset. This is the most common form of diabetes. This is one where the body either makes enough insulin but the body isn't using it correctly or the body does not make enough insulin to begin with. It can be controlled by weight loss, diet, and exercise but must be controlled to prevent damage to the body. Sometimes patients with type 2 diabetes may also take medications such as metformin.
formin to control it. And then there's gestational diabetes, which develops during pregnancy due to hormones from the placenta that interfere with insulin action. It occurs in the later months of pregnancy and is controlled by diet, but insulin may also be given.
This type of diabetes is resolved once the baby is born. However, research has shown that these patients have a higher tendency to develop type 2 diabetes later in life. Babies that are born to gestational diabetes mothers are usually over 9 pounds when they're born. Diabetes increases susceptibility to infections, necessitating stringent skincare and infection control measures is important. While all types of diabetes are manageable with insulin and other medications, they are chronic conditions that generally cannot be cured.
Acute complications of diabetes myelitis include hypoglycemia, which occurs when there is too much insulin, or oral hypoglycemic medication in the bloodstream, or inadequate food intake. Symptoms develop rapidly and can lead to a coma if not treated promptly. Treatment involves giving high sugar foods like candy or orange juice. Diabetic ketoacidosis results from insufficient insulin. This is common in patients with type 1 diabetes, causing the liver to produce excess glucose, leading to high blood sugar levels and altered level of consciousness.
Patients with diabetic ketoacidosis should be referred to the emergency department for fluid electrolyte replacement as well as insulin therapy. Hyperosmolar hyperglycemic non-ketotic syndrome abbreviated HHNS is more common in individuals with type 2 diabetes. or elderly individuals without a known history of diabetes.
It involves severe dehydration and requires emergency department management for fluid as well as potassium replacement. Clinical manifestations common for all of these complications include rapid heartbeat, which is called tachycardia, headache, blurred or double vision, extreme thirst, and a sweet odor to the breath in patients who have diabetic ketoacidosis. In response to a patient in a diabetic crisis, you should stop the procedure and notify an attending physician immediately.
Never leave the patient unattended and monitor vital signs closely and prepare to administer intravenous fluids, medication, and oxygens as directed by the emergency response team. Strokes, also known as CVAs or cerebral vascular accidents, or brain attacks, occur when blood flow to the brain is blocked. This is in the form of an ischemic stroke. Or when a blood vessel to the brain ruptures, causing bleeding.
This is in the form of a hemorrhagic stroke. These events lead to a lack of blood supply to the brain tissue, resulting in rapid and often irreversible damage within minutes. Strokes can range in severity from mild transient ischemic attacks, also called TIAs, which are brief interruptions of blood flow, to severe life-threatening situations. TIAs serve as a warning sign for potential major strokes.
Strokes can occur suddenly and unexpectedly, even during stressful medical procedures within the imaging department. It's important to recognize stroke symptoms and call for immediate emergency evaluation and treatment. Fibroanalytic therapy is a type of therapy that dissolves blood clots and can reduce neurological damage from ischemic strokes and must be administered promptly.
This image here is an image of a CT scan of the head in a patient that has a stroke. If you notice and you look at the brain, the brain tissue has pulled away from the right side of the skull. Looking at the left side, there is a smaller space between the inner wall of the skull and the brain tissue which indicates that there has been more bleeding into the space on the right side. Clinical manifestations of a stroke include sudden severe headaches, numbness or weakness on one side of the face or body, sudden vision impairment, confusion, dizziness, or stupor, difficulty speaking or understanding speech, lack of coordination, complaints of a stiff neck, and possible nausea or vomiting leading to loss of consciousness.
If these symptoms occur during a procedure, it is critical to immediately halt the process and notify the department physician or nurse. The patient should not be left unattended and vital signs must be closely monitored. Prepare to administer intravenous fluids and oxygen as necessary following guidance from the emergency team. In the diagnostic imaging department, unexpected events like respiratory failure, cardiac arrest, or airway obstruction can occur suddenly. Technologists often witness these emergencies firsthand and must promptly initiate emergency procedures as the brain can only survive 4-5 minutes without oxygen before sustaining potential damage.
All healthcare personnel should be trained in basic CPR and abdominal thrust maneuvers. Current guidelines prioritize early defibrillation with automated external defibrillators, AEDs, a critical skill for technologists. Regular updates and basic life support protocols are essential and technologists must stay informed about their responsibilities during cardiac or respiratory emergencies.
Proper training, including annual renewal of CPR certification, ensures readiness to respond effectively. When assisting with airway management, technologists should always wear clean gloves and use a disposable mask with a one-way valve for CPR. Manual resuscitation bags.
and accessible AEDs are vital sources in every imaging department. Cardiac arrest occurs when the heart stops beating effectively, leading to a loss of blood circulation and pulse. This can be caused by various disruptions in the heart's electric activity, such as rapid or irregular beating, ventricular fibrillation or tachycardia, or a slow heart rate. Other causes include conditions like hypovolemic shock, cardio tamponade, hypothermia, pulmonary embolism, drug overdose, severe acidosis, or severe heart attack.
Without immediate intervention, irreversible brain damage and death can occur within minutes, depending on the person's age as well as the status of their health. Clinical manifestations of cardiac arrest include loss of consciousness, pulse and blood pressure, dilated pupils rapidly, and possibility of seizures. Respiratory arrest occurs when breathing stops completely, either in the form of apnea, which is no breathing, or ineffective gasping. Clinical manifestations include labored noisy breathing, wheezing, neck vein distension, diaphoresis, cyanosis of the lips and nail beds, and the pulse may initially continue but become weak and thready and eventually stops. Absence of chest movement and airflow through the mouth will be present, and also the patient will exhibit loss of responsiveness.
Immediate response to cardiac and respiratory arrests for an unresponsive adult, shake and call out loudly, and if there is no response, immediately call emergency medical help. Activate a code within the department and do not leave the patient alone. We want to check for a carotid pulse in adults. Skip measuring the blood pressure, listening for a heartbeat, and save time and call the code and CPR will need to be started.
If an adult has no pause and a code has been called, place them supine on a hard surface if not already on a radiographic table leave them there as it is suitable for cpr a brief overview of cpr begins with 30 chest compressions ensuring that they are at least two inches deep into the chest immediately after compressions use the head tilt chin lift method to open the airway but only if you're certain that there is no c-spine injury You want to look, listen, and feel for any signs of air movement and if there is none, place a bag or a mask over the patient's mouth tightly and this should cover their nose and deliver two slow breaths over two seconds each and ensure minimal air to prevent complications like regurgitation or aspiration. If the patient still isn't breathing after initial attempts, check for a possible airway obstruction, use abdominal thrust if needed, and recheck for breathing. If the patient is breathing, place them in the recovery position, which is laying on their side, and the head should be directed down so that if they vomit, they do not choke. You want to assess circulation by checking for a carotid pulse and look for signs of coughing, movement, or breathing.
If there are no signs of circulation or breathing, and an AED isn't available while waiting for emergency response, resume chest compressions, and start the process of CPR over again. Starting compressions and CPR, you want to locate the lower edge of the rib cage where the ribs meet the sternum. Place your index fingers just above this point and the heel of your other hand beside it. Stack your second hand on top and interlace your fingers.
This positions your hands at about one and a half inches below the notch of the bottom of the sternum towards the patient's head. and ensure your fingers do not touch the patient's chest wall. Keep your elbows straight and use your body weight to compress the sternum downwards two inches and then release fully. You want to prioritize blood circulation by performing 30 compressions in a steady even rhythm before providing any breathing or ventilation.
Maintain an up and down motion without rocking. Administer two breaths to inflate the patient's lung and reassess the patient's carotid pulse and breathing status. If no pulse is detected, continue compressions again.
Defibrillation is performed to restart the heart. Cardiac arrest can occur before or after respiratory arrest or when the patient's heart electrical activity is ineffective in circulating oxygenated blood. When cardiac arrest happens and the patient is monitored or placed on a monitor, use quick look paddles or defibrillators to check for ventricular tachycardia or ventricular fibrillation.
If not available, apply an AED promptly. Delaying defibrillation reduces survival chances by 10% per minute. Place the AED near the patient's left shoulder and open it to activate and follow the voice instructions. CPR can continue until electrodes are applied.
Attach the electrodes to the patient's chest, one at the right upper sternal border below the clavicle and the other on the left chest, lateral to the left nipple, and ensure good skin contact. Press the Analyze button to determine if defibrillation is needed. If shock is advised, ensure that everyone is clear of the patient's bed and follow the AED's clear command.
Press the shock button as directed by the AED. If no shock is needed but the patient remains pulseless, resume CPR until the patient is shockable. In pediatric cases, cardiac arrest is often due to respiratory causes. Call an emergency medical service after starting CPR.
CPR techniques are different for infants and children when compared to adults. Please review this chart. It is also in your textbook.
Airway obstruction occurs when a foreign object blocks the main bronchi. An airway obstruction can be partial or complete. Airway obstructions occur when air cannot enter or exit the lungs due to a blockage. Symptoms of a partial obstruction include labored noisy breathing, wheezing, use of neck, abdomen, or chest muscles to breathe, neck pain, swelling.
sweating, anxiety, and a bluish color of the lips and nails. Response for partially obstructed airway includes immediately calling for help, never leave a patient alone, position the patient in a sitting or semi-fowler position, provide comfort to the patient, and prep oxygen and emergency equipment as needed. A foreign object like food can lead to sudden respiratory arrest, especially in elderly, young, or intoxicated individuals while eating.
Response for a foreign body complete obstruction. You want to immediately seal the nose and the mouth and ventilate as in CPR. Check for breathing if the chest rises and proceed with CPR steps.
No chest movements are present. You want to reposition the head, tilt the chin. and brush the jaw and attempt ventilation and persist in a persistent obstruction you want to use abdominal thrust to dislodge the object if abdominal thrusts need to be performed stand behind the patient and place both hands above the umbilicus and below the xiphoid process of the sternum position the lower hand with the thumb inward and firmly gasp it with the other hand Perform a quick upward thrust to push the abdomen inward and upward against the diaphragm.
This action helps to push air up through the trachea and dislodge foreign objects within the airway. Never practice this maneuver on someone who is not in distress due to the risk of serious injury. Ensure your hands are positioned away from the xiphoid process to avoid causing any internal injuries.
When performing an abdominal thrust on a patient, In the supine position, so if they're laying down, you place the patient on their back, which is supine, kneel astride the patient's thighs for stability. Position the heel of one hand on the patient's abdomen above the navel and below the xiphoid tip. Place the other hand on top of the first hand and quickly press upwards on the abdomen and ensure the thrust is directed straight upward without deviating left or right. This maneuver achieves the same objective whether the patient is sitting, standing, or lying down. If an infant has an obstructed airway, the procedures for dislodging the object are slightly different than that of an adult.
You want to place the infant face down over your forearm with the legs straddling your elbow and support the infant's head and neck between your thumb and forefinger and ensure the head is lower than the chest. You then want to deliver five sharp blows to the infant's back using the palm of your hand, be just between the shoulder blades. If this attempt is unsuccessful, you then flip the infant over and perform chest thrusts using two to three fingers on the mid-sternal area, about one every second.
A seizure is an abrupt change in brain function due to unsystemic neurological discharge within the cerebellum. It often starts suddenly and can last from seconds to minutes, accompanied by a change in the level of consciousness. Convulsions and seizures are terms used interchangeably, though not all seizures cause uncontrollable shaking. They are a symptom rather than a disease and can be triggered by various factors like infections, high fever, stress, head trauma, brain tumors, genetic defects such as epilepsy, birth trauma.
vascular disease, congenital abnormalities, or sensory stimuli like odors or flashing lights. Different types of seizures exist. Generalized seizures are caused by abnormal electrical activity across both hemispheres of the brain simultaneously. Clinical manifestations include a sharp cry as air is exhaled rapidly, muscle rigidity, wide eyes, jerky body movements, irregular breathing, vomiting, bloodstream, saliva, urinary and fecal incontinence, as well as deep sleep post-seizure. Partial seizures occur when abnormal activity affects only one small area of the brain as compared to general seizures that affect the entire area.
Complex partial seizures affect one hemisphere and can impair consciousness. Emotional outbursts facial movements, and confusion after a seizure are normal symptoms. Simple partial seizures are limited to one area and typically patients do not exhibit a loss of consciousness. They may have a finger or hand shaking or unrecognizable speech dizziness or difficulty with sensory perceptions. When a patient has a seizure of any type, you always want to stay with the patient to prevent any further injury and call for assistance.
Do not insert anything into the patient's mouth and remove dentures or foreign objects from the mouth if possible. Place a blanket or a pillow under the head for protection and protect the arms and legs from injury and avoid a restraining. If radiologic table is present and the patient is laying on it, prevent them from falling to the floor.
You want to observe and note the seizure duration and provide privacy. After the seizure ends, position the patient to prevent aspiration, such as in the SIMS position with the face downward to allow any type of drainage or the recovery position. Syncope is a temporary loss of consciousness or fainting caused by inadequate blood supply to the brain.
It can be a result of heart disease, hunger, poor ventilation, extreme fatigue, or even emotional trauma. Elderly patients can experience syncope if they transition from laying to standing or switch positions quickly. Patients are often advised not to eat before diagnostic imaging procedures to prevent fainting.
which can lead to injuries from falling. Fainting can occur unexpectedly, causing head injuries if the patient falls from standing onto a radiographic table or onto a floor within the department. If a patient appears weak due to a recent injury or medication, alternatives to standing for imaging procedures should be considered. Allow elderly patients the time to sit before standing or walking and remain by their side to prevent falls. Symptoms include pale color, dizziness, nausea, rapid breathing, and fast heartbeat.
The skin may also feel cold and clammy. If a patient feels dizzy or confused, instruct them to lay down and provide comfort. If the patient faints, place them in a supine position with their legs elevated to increase the flow of blood back to the heart.
If a patient is about to fall, you want to guide them to the floor to prevent injury. Support them by placing a knee behind their knee. and an arm around their waist.
Patients can experience a variety of other medical conditions while in the imaging department. Nausea is fairly common among patients that receive contrast media. The radiographer must be aware and watch the patient carefully and have an emesis basin or bag ready to go if the patient starts to vomit.
Patients should never vomit in this supine position as this poses a potential choking hazard and patients should be put in the recovery position and laying on their side. Epistaxis is another name for a nosebleed. In the event that a patient sustains a nosebleed while in the department, the patient should be provided gauze to hold under the nose and no trauma should have been sustained. Patients may experience vertigo which is a sensation of spinning or whirling.
often accompanied by feelings of imbalance and dizziness. It can result from various causes, including inner ear problems, vestibular disorders, as well as neurological issues, in particular after remaining supine on the imaging table for a prolonged period of time. Along with postural hypertension and orthostatic hypertension, this refers to a sudden drop in the blood pressure when a patient stands too quickly from a seating or laying position. Vertigo can cause the patient to fall when getting off of the imaging table.
It's extremely important that the patient is never allowed to get off of the radiographic exam table without the radiographer standing alongside them. There are a great many patients that suffer from asthma as well. This is a condition in which the airways narrow and swell and may produce extra mucus.
Patients who are experiencing asthma attack have difficulty breathing, triggered by coughing, wheezing, as well as shortness of breath. Asthma signs and symptoms should be monitored, and if patients exhibit chest tightness and wheezing, they may need a breathing treatment or an inhaler. In conclusion, as radiographers, we should be able to assess patients for medical emergencies as well as changes in mental status and loss of consciousness and be on the lookout for any signs and symptoms that patients may exhibit and alert the necessary medical staff to aid in patient care it's important to know and understand the glasgow comals coma scale the different types of shock signs and symptoms of a pulmonary embolism different types of diabetes and their manifestations, as well as cardiac incidences, respiratory arrest, strokes, and airway obstructions. and in cases patients that are experiencing syncope and may faint and be a danger to themselves as well as others in the exam room. Other medical conditions that a radiographer must be aware of are nosebleeds, vertigo, as well as asthma.
It is our job to be able to recognize these medical emergencies and figure out the best way to handle the patient and assess them and alert the appropriate medical staff.