Unit7MedicalEmergencies&Trauma

  1. What is a medical emergency?
    Any situation in which the condition of a patient or a sudden change in medical status necessitates immediate attention & action
  2. What are the radiographer's roles during a medical emergency?
    - Recognize the signs & symptoms of a medical emergency

    - Take appropriate action to prevent further harm to the patient

    - Summon assistance as quickly as possible
  3. The 3 areas assessed in Glasgow Coma Scale of neurologic functioning are?
    • - Eyes open
    • - Motor responses
    • - Verbal responses
  4. The 3 steps a radiographer uses to asses the patient's status are?
    1. Ask the patient to state their name, the date, address, & the reason for coming to the department. (take note if they are slow to respond, unusually irritable, or have trouble choosing their words.)

    2. Observe the patient's movements & their ability to follow directions during the exam. Patients should be able to follow simple commands & cooperate to the best of their ability. Take note if the patient has pain or difficulty in movement or has altered behavior or lack of response.

    3. Assess vital signs. Take note of any changes from the baseline vitals listed in the medical record or any abnormal results.
  5. Types of ways to call for help
    - Emergency call "buttons", "bells", or "pull switches" located in patient rooms, bathrooms, & radiographic rooms

    - Telephone system (special number or set of numbers) where hospital operator will immediately pick up and ask: "do you have an emergency?" When responding to the operator, stay calm & state exactly where the emergency is.

    - "Code blue" - respiratory, cardiac, or other emergency event

    - Code team - physicians, nurses, respiratory therapists, ECG technicians, etc. Radiologist, departmental nurse & radiographer may be first responders.
  6. Types of emergency equipment to locate would be?
    • - Emergency cart or crash cart
    • - Oxygen
    • - Wall-mounted or portable suction
    • - AEDs (Automatic External Defibrillators):
    •           - Used to analyze a patient's cardiac rhythm, determine if defibrillation is needed, & deliver a shock if necessary.
  7. Contents you would find in a crash cart?
    • - Backboard (for CPR)
    • - ECG monitor & AED
    • - Airways & laryngoscope
    • - Ambu bag (ventilation) 
    • - Tourniquet & IV supplies (needles, syrignes, etc.)
    • - Suction catheters & ET tubes
    • - Stethoscope & BP cuff
    • - O2 tank
    • - Gloves, tape, etc.
    • - Emergency drugs
  8. Types of Medical Emergencies
    • -Shock
    • -Pulmonary Embolus
    • -Diabetic reactions
    • -Cerebrovascular accident (CVA)
    • -Cardiac arrest & heart attack
    • -Respiratory distress & arrest
    • -Seizures
    • -Syncope
    • -Epistaxis
    • -Trauma
  9. Failure of the circulatory system to support vital body functions.
    Shock

    • Caused by-
    • -Trauma
    • -Loss of blood or body fluids
    • -Obstruction of blood flow
    • -Cardiac failure
    • -Anesthesia
    • -Infection
    • -Allergic reactions
    • -Emotional stress
  10. The 3 stages of shock are?
    • 1. Compensatory Stage - Blood flow in body diminished: blood shunted away from organs such as the lungs, skin, & GI tract & sent to vital organs (brain & heart).
    • Symptoms: cold and clammy skin, nausea, dizziness, SOB, anxiety, lowered BP

    • 2. Progressive Stage - Fluid leaks from capillaries & blood flow to all organs decreases.
    • Symptoms: Decrease BP & increased pulse, rapid/shallow respirations, pulmonary edema, tachycardia, chest pain, changes in mental status

    • 3. Irreversible Stage - Organ systems suffer irreparable damage: recover unlikely
    • Symptoms: very low BP, renal & liver failure, imminent death
  11. The 4 types of shock are?
    • 1. Hypovolemic
    • 2. Cardiogenic
    • 3. Neurogenic
    • 4. Vasogenic
  12. Hypovolemic shock
    • Caused by a large loss of blood or tissue fluid.
    • ex: internal or external hemorrhage, loss of plasma from burns, fluid loss from prolonged vomiting & diarrhea
  13. Cardiogenic shock
    • Caused by different cardiac conditions
    • ex: myocardial infarction (MI), dysrhythmias
  14. Neurogenic shock
    • Caused by loss of signals from the sympathetic nervous system
    • ex: damage to the brain or spinal cord, adverse reaction to anesthesia.
  15. Vasogenic shock
    • Caused by widening of the blood vessels
    • ex: sepsis, anaphylaxis (allergic reactions).
  16. - Stop the procedure
    - Place patient supine if not already
    - Elevate the legs 30° if there are no signs of head or spinal cord injury (Improves venous return of blood to the heart & increases blood circulation)
    - If there is an open wound, apply direct pressure
    - Do not leave the patient unattended - call for help
    - Get the crash cart & prepare to assist
    - Check vital signs
    Response to Hypovolemic Shock
  17. - Stop the procedure
    - Place patient in semi-Fowler position or one that facilitates breathing
    - Do not leave the patient unattended - call for help
    - Get the crash cart & prepare to assist (CPR may be required)
    - Check vital signs
    Response to Cardiogenic Shock
  18. - Stop the procedure
    - Place patient supine if not already
    - If a spinal cord injury is possible, do not move the patient
    - Do not leave the patient unattended - call for help
    - Get the crash cart & prepare to assist
    - Check vital signs
    Response to Neurogenic Shock
  19. - Stop the procedure
    - Place patient in semi-Fowler position or one that facilitates breathing
    - Do not leave the patient unattended - call for help
    - Get the crash cart & prepare to assist (CPR may be required)
    - Check vital signs
    Response to Vasogenic Shock
  20. Most common type of vasogenic shock in radiography is?
    anaphylaxis (an allergic reaction) to iodinated contrast media
  21. Occlusion of one or more pulmonary arteries by a thrombus or thrombi
    Pulmonary Embolus (PE)
  22. Symptoms & Treatment of PE (Pulmonary Embolus)
    • Symptoms:
    • -Rapid and weak pulse
    • -Hyperventilation
    • -Tachycardia
    • -Diaphoresis (sweating)
    • -Hypotension
    • -Dyspnea & cyanosis
    • -Change in LOC

    • Response:
    • -Stop the procedure
    • -Place patient supine if not already
    • -Do not leave the patient unattended - call for help
    • -Get the crash cart & prepare to assist
    • -Check vital signs
  23. A group of metabolic diseases resulting from a disorder of carbohydrate metabolism - the body is not able to regulate levels of glucose in the blood, due to insufficient production of insulin by the pancreas or inadequate utilization of insulin by the cells
    Diabetes Mellitus
  24. the 2 types of complications from diabetes mellitus are?
    1. Hypoglycemia - low blood glucose level that results from an excess amount of insulin in the bloodstream, or when a person has an inadequate amount of food intake in which to metabolize the insulin. Sometimes seen in radiology patients who may have to fast (NPO) for a procedure, but still take their insulin or have a lot of insulin in the body from a prior dosage.

    2. Ketoacidosis - insufficient insulin in the body causes the liver to produce more glucose, resulting in hyperglycemia. Sometimes seen in radiology patients who are NPO for a procedure for long periods of time & do not take their insulin.
  25. the body's immune system destroys insulin-producing cells in the pancreas (an autoimmune process). Usually occurs in those under age 30 & has an abrupt onset. It is treated through daily insulin injections or by infusion through an implanted insulin pump.
    Type 1 Diabetes
  26. the body develops an impaired sensitivity to insulin or decreased production. Usually occurs in those over age 40 & has a gradual onset (most common type). Associated with obesity, age, family history of the disease, physical inactivity, & ethnicity. It may be controlled through weight loss, diet, & exercise. However, some patients will require oral medication.
    Type 2 Diabetes
  27. hormones secreted by the placenta during pregnancy prevent the action of insulin. This can usually be controlled by diet & often abate after the pregnancy concludes.
    Gestational Diabetes
  28. Symptoms and treatment of diabetic reactions.
    • Symptoms:
    • -Headache
    • -Tachycardia
    • -Blurred or double vision
    • -Extreme thirst
    • -Sweet odor to the breath (ketoacidosis)

    • Response:
    • -Stop the procedure
    • -Have the patient sit down if not already
    • -Do not leave the patient unattended - call for help
    • -Check vital signs
  29. ______ is caused by a blockage of the blood supply to the brain or rupture of a blood vessel in the brain resulting in hemorrhage onto the brain tissue or into the spaces surrounding the brain. Vary in severity – mild transient ischemic attack (TIA) to a massive life-threatening CVA.
    Cerebral Vascular Accident (CVA) : "stroke" or "brain attack"
  30. CVA's are caused by?
    • -Trauma
    • -Embolus
    • -Aneurysms
  31. Symptoms and Treatment of CVA
    • Symptoms:
    • - Severe headache
    • - Numbness
    • - Muscle weakness (face/extremity - one sided)
    • - Confusion & dizziness (vertigo)
    • - Difficulty with speech
    • - Nausea & vomiting
    • - Loss of consciousness

    • Response:
    • - Stop the procedure
    • - Place patient supine if not already
    • - Do not leave the patient unattended - call for help
    • - Check vital signs
  32. Cardiac Arrest & Heart Attack
    When the heart stops beating effectively and/or stops pumping blood

    • Causes:
    • -Complications of shock or PE
    • -Hypothermia
    • -Malfunction of the heart's electrical system (arrhythmia's such as ventricular tachycardia)
    • -Malfunction of the heart's blood flow (myocardial infarction)
  33. Symptoms & Treatments of Cardiac Arrest
    • Symptoms:
    • -Chest & arm pain
    • -Dilation of pupils
    • -Loss of consciousness
    • -Weak or no pulse
    • -Decreased BP

    • Response:
    • -Stop the procedures
    • -Call a code
    • -Initiate CPR (if no pulse)
    • -Get the crash cart and prepare to assist (possible defibrillation)
    • -Check vital signs
  34. _______ - the patient has difficulty breathing for a variety of reasons. Quick treatment for respiratory distress is important in preventing respiratory arrest, whereas the patient stops breathing altogether. The human brain typically cannot survive intact without oxygen for more than 4 minutes.
    Respiratory distress (or dysfunction)

    • Causes:
    • -Trauma
    • -Asthma
    • -Drug overdose
    • -Allergic reaction
    • -Airway obstruction
    • -Aspiration of food or liquid into lungs
  35. Symptoms & Treatment of Respiratory Distress & Arrest
    • Symptoms:
    • -Labored, noisy breathing
    • -Wheezing
    • -Using muscles of neck, abdomen, or chest on inspiration
    • -Neck vein distention
    • -Diaphoresis
    • -Cyanosis
    • -Unresponsiveness, loss of pulse, no air movement (arrest)


    • Response:
    • -Stop the procedure
    • -If an asthma attack, sit patient up & allow to use bronchodilator
    • -Place patient in semi-Fowler position or one that facilitates breathing
    • -Do not leave the patient unattended - call for help
    • -Prepare to administer O2 (suction may be needed)
    • -If patient in arrest - call a code, get the crash cart and prepare to assist, check vital signs.
  36. Partial or complete blockage of the trachea & bronchi
    Airway Obstruction & Choking

    • Causes:
    • -Trauma
    • -Foreign bodies (food, liquid, or object)
    • -Allergic reactions
    • -Severe spasm
  37. Symptoms and Treatment of Airway Obstruction
    • Symptoms:
    • -Clearing the throat
    • -Coughing and gagging
    • -Inability to speak
    • -Universal choke sign (clutching throat)

    • Response:
    • -Encourage patient to cough
    • -If foreign body seen in mouth, do a finger sweep
    • -Heimlich maneuver - forces air up through the trachea
    • ---------Abdominal thrusts (supine)
    • ---------Back blows (infants)
  38. Uncontrolled electrical activity in the brain, whereas neurons discharge unsystematically. Usually appear with little or no warning - lasts a few seconds to several minutes. Accompanied by a change in LOC
    Seizures

    • Causes:
    • -Trauma
    • -Extreme stress
    • -Flashing lights, odors, or other stimuli
    • -Brain tumors
    • -Genetic defects (epilepsy)
    • -Vascular disease
    • -Structural changes in the brain
  39. Symptoms & Treatments of Seizures
    • Symptoms:
    • -Jerky body movements
    • -Loud verbal outbursts
    • -Rigid muscles
    • -Eyes wide open
    • -Vomiting
    • -Urinary and/or fecal incontinence
    • -Loss of consciousness

    • Response:
    • -Stop the procedure
    • -Prevent the patient from falling off the x-ray table/stretcher or out of a wheelchair
    • -Place a pillow under the patient's head if supine
    • -Do not leave the patient unattended - call for help
    • -Turn the patient to their side if they vomit (prevents aspiration)
    • -Check vital signs
  40. A temporary loss of consciousness
    Syncope (Fainting)

    • Causes:
    • -Heart disease
    • -Hunger
    • -Poor ventilation
    • -Extreme fatigue
    • -Emotional trauma
    • -Orthostatic hypotension - Low BP resulting when a person gets up too quickly from a lying position (pooled blood in the extremities does not have enough time to circulate to the upper body)
  41. Symptoms and Treatment of Syncope
    • Symptoms:
    • -Dizziness
    • -Cold and clammy skin
    • -Nausea
    • -Pallor (pale skin tone)

    • Treatment:
    • -If the patient shows symptoms, lie them down
    • -If a standing patient begins to fall, do not attempt to "catch" them or hold them up. Get the patient to the floor by placing your knee behind theirs & your arm around their waist - gently slide to the floor.
    • -If the patient has already fainted, place them in a supine position with legs elevated
    • -Do not leave patient unattended - call for help
  42. Epistaxis
    Bleeding from nose.

    • Causes:
    • -Trauma
    • -Elevated BP
    • -Drugs that thin the blood
    • -Post-surgical complications
    • -Foreign body inserted into the nose (children)

    • Response:
    • -Stop the procedure
    • -Have the patient lean forward and pinch nostrils
    • -Do no lie patient down or have them tilt their head back (blood goes down throat and could choke the patient)
    • -Moist compress or ice can be applied if gentile pressure does not stop the bleeding
  43. A critical or serious injury, wound, or shock to the body
    Trauma

    "trauma patient usually done portable"

    • Common causes of trauma:
    • -Motor vehicle accidents (MVA)
    • -Assaults
    • -Choking, suffocation, & smoke inhalation
    • -Industrial/job-related accidents
    • -Suicides
    • -Drowning
    • -Sports injuries

    "trauma is the leading cause of death for all persons under age 44"
  44. General Rules for Trauma Radiography
    • - Always consult with members of the emergency team before moving the patient
    • - Do not remove dressings or immobilization devices such as limb splints, pneumatic anti-shock garments or cervical collars
    • - Do not move a patient from a backboard until medically cleared by a physician
    • - Do not disturb penetrating or impaled objects
    • - Position the patient carefully as to not make their injury worse
    • - Always assume that you may be exposed to blood & body fluids - practice standard precautions
    • - Utilize plastic covers for image receptors
    • - Provide radiation protection equipment (e.g., lead aprons) to emergency team members in the area during exposure if portable
    • - Work quickly, efficiently, & accurately to avoid repeat images
  45. Any injury of the skull, brain, or both that requires medical attention.
    Head Trauma

    -When referring specifically to the brain, it is called traumatic brain injury (TBI)

    • ---Open head injury- associated with a skull fracture due to force trauma or some type of puncture. Meninges may be torn with leakage of CSF. Brain vulnerable to damage and infection.
    • ----Closed head injury- associated with a severe blow to the head without skull fracture. Brain collides with the skull, resulting in varying levels of damage, such as swelling or bleeding in & around the brain tissue. A concussion is one type of a closed head injury.
  46. Symptoms of Head Trauma
    • Closed:
    • - Varying levels of consciousness from drowsiness to coma
    • - Loss of reflexes
    • - Changes in vital signs
    • - Headache, vision problems, dizziness
    • - Unequal pupil dilation
    • - Seizures & vomiting
    • - Hemiparesis

    • Open:
    • - Varying levels of consciousness from drowsiness to coma
    • - Abrasions, contusions, or lacerations on the skull
    • - Fluid (CSF) & blood leaking from skull, nose, and/or ear
    • - Difficulty with vision & hearing
    • - Periorbital ecchymosis (raccoon's eyes)
    • - Facial paralysis
  47. Response to Head Trauma
    • - Keep the patient's head & neck immobilized until the physician rules out injury to the spinal cord
    • - Do not remove sandbags, collars, dressings, or jewelry for initial images
    • - If spinal cord injury ruled out, elevate the head 15°-30°
    • - Check vital signs & observe the patient carefully for changes in status
  48. Associated with injury to the soft tissues & bones of the face.
    Facial Trauma

    - Most by themselves are not life-threatening, but can seem quite traumatic to a patient due to the fact that they can potentially be disfiguring

    • Common areas of injury:
    • -Zygoma
    • -Nasal bones
    • -Mandible
    • -Orbits
  49. Symptoms and Response to Facial Trauma
    • Symptoms:
    • - Profuse bleeding (face highly vascular)
    • - Misalignment of the face and/or teeth
    • - Edema & bruising
    • - Inability to close the jaw (mandible Fx)
    • - Flatness of the cheek (zygoma Fx)
    • - Epistaxis
    • - Diplopia
    • - Paresthesia (numbness & tingling of the skin)
    • - Black eyes

    • Response:
    • - Observe the patient for airway obstruction
    • - Apply a sterile pressure dressing if bleeding is profuse
    • - If you find dislodged teeth, place them in a container moistened with gauze soaked in sterile water
    • - Check vital signs & observe the patient for signs of shock
  50. Any injury to the spine could be a potential spinal cord injury

    - Most spinal cord injuries occur in the cervical & lumbar regions

    - Slight movement of a patient may cause pressure on the spinal cord & nerves, resulting in paralysis or death.
    Spinal Cord Trauma
  51. Symptoms of Spinal Cord Trauma
    • - Partial or complete paralysis of the extremities or skeletal muscles below the site of injury
    • - Loss of sensation (numbness) below the site of injury
    • - Respiratory distress
    • - Bradycardia
    • - Fluctuations in BP
    • - Bowel and/or bladder incontinence
    • - Loss of reflexes
  52. Response to Spinal Cord Trauma
    • - Keep the patient's head, neck, & back immobilized until physician rules out spinal cord injury
    • - Do not remove sandbags, jewelry, & cervical collars for images
    • - Observe the patient for airway obstruction & signs of shock
    • - Keep the patient warm.
    • - Check vital signs & observe the patient carefully for changes in status

    "Traumatic spinal cord injuries are evaluated using cross-table lateral radiographic images & computed tomography (CT)"
  53. A ____ is a complete or incomplete break in a bone
    Fracture
  54. A visible wound between the skin & fractured bone. The bone may protrude through the skin with little or profuse bleeding.
    Open (compound) fracture
  55. No break in the skin. There may be swelling & misalignment at the fracture site.
    Closed (simple) fracture
  56. A _____ is a displacement or misalignment of one or more bones that form a joint.
    Dislocation
  57. Symptoms of Fractures & Dislocations
    • - Pain & swelling
    • - Functional loss
    • - Limb deformity
    • - Grating sound when moved (crepitus)
    • - Discoloration of surrounding tissue (closed Fx)
    • - Bleeding (open Fx)
  58. Response to Fractures & Dislocations
    • - Keep the body part completely immobilized & do not remove splints or other supportive devices for images
    • - If movement for positioning is required, clear this with the physician & use extreme care
    • - When moving a fractured limb, support it with both hands above & below the fracture site - move it as a single unit. (Two persons may be required.)
    • - Do not move body parts where dislocations are suspected
  59. _____ _____ is associates with a wide variety of medical conditions that can cause symptoms.

    examples: appendicitis, ulcers, ectopic pregnancy, cholecystitis, pancreatitis, & bowel obstructions. Patient who have just had abdominal surgery will also be in distress due to pain.
    Abdominal Distress
  60. ____ ____ is associated with blunt or penetrating injury.

    examples: Motor vehicle accidents, bicycle accidents, assaults (gunshots, stabbing, fights, child abuse), & falls.
    Abdominal Trauma
  61. Symptoms of Abdominal Distress & Trauma
    • - Severe, intractable pain (patient may be in a fetal position)
    • - Nausea & vomiting
    • - Extreme thirst
    • - Hard, rigid abdomen
    • - Abrasions, lacerations, entry & exit wounds, contusions (trauma)
    • - Signs of shock
  62. Response to Abdominal Distress & Trauma
    • - Do not give the patient anything to eat or drink
    • - Expect the patient to vomit - have an emesis basin or pan ready
    • - Assist the patient to move as they will be in a lot of pain – turn them on their side first before attempting to sit up
    • - Observe the patient for signs of shock

    "Abdominal trauma & distress are initially evaluated using radiographic images, sonography, & computed tomography (CT)"
  63. Patients in Pain
    - Many of the patients undergoing imaging procedures will have some degree of pain. This may impair their ability to follow instructions & generally assist with the procedure. The degree to which a person feels pain will vary from patient to patient. Most facilities & physicians utilize some type of pain assessment tool with a scale from 1 (least pain) to 10 (intense pain).

    - When dealing with patients in pain, your goal as a radiographer is to make them feel as comfortable as possible, both physically & psychologically. Patients who are in pain & then are made to feel even more uncomfortable are not likely to cooperate with you for the procedure! Use empathy & critical thinking to determine how best to assist the patient in this regard.
  64. Responses to Patients in Pain
    • Do:
    • - Assess the patient's physical & psychological needs before starting the procedure
    • - Tell the patient what is to be done & what you need them to do
    • - Tell the patient to let you know if they feel any abrupt changes in their pain during the procedure
    • - Stop the procedure immediately & asses the patient if they have a sudden onset of increased pain
    • - Notify the patient's physician or nurse if there is a notable increase in the patient's pain level


    • Do Not:
    • - Assume to know the degree to which a patient is feeling pain
    • - Dismiss a patient's complaints or expressions of pain
    • - Manipulate a patient into a position that markedly increases their pain.
  65. Agitated or Confused Patients
    Patients may become agitated & even combative while under your care for a variety of reasons. It is hard to be a "cheerful" patient when you are perhaps cold, hungry, in pain, or simply frightened about your medical situation. Patients often have to wait for medical procedures, which typically increases their anxiety level. Some patients will be agitated or confused due to physical or mental conditions that impair their behavior.
  66. Dealing with Agitated or Confused Patients
    • - Stay calm & reassuring in your tone
    • - Do not make the situation worse by confronting or arguing with the patient
    • - If the patient speaks irrationally, it is best not to become involved in the conversation or try & reason with them
    • - Use simple instructions & be kind
    • - If the patient appears threatening, do not become isolated in a room with them – keep the door open or have another person in the room with you. If a family member is available to assist, allow them to do so.
    • - If a patient who is agitated or confused refuses to proceed with an exam, stop immediately & return them to their place of origin. However, if the radiographic images are essential to their treatment, the patient will have to be sedated and/or immobilized. A physician would have to make this determination & order the appropriate methods.
  67. Impaired Patients
    - Patients under the influence of drugs & alcohol may exhibit erratic behaviors, which may interfere with the radiographic examination. Such patients may also be a danger to themselves, as their perception & judgment is impaired.

    - When dealing with an intoxicated patient, use many of the same tactics as that for agitated & confused patients: speak calmly, use simple instructions, & do not argue with them. Do not leave an intoxicated patient by themselves. If the patient refuses the exam, call for assistance.
Author
Marc817
ID
343339
Card Set
Unit7MedicalEmergencies&Trauma
Description
Unit 7 Medical Emergencies & Trauma
Updated