Patient Vital Signs Medical Emergencies and Infection Control Fall 2011 Week 13

Homeostasis A constancy in the internal environment of the body Naturally maintained by adaptive responses that promote healthy survival Primary mechanisms: –Heartbeat –Blood pressure –Body temperature –Respiratory rate –Electrolyte balance

Vital Signs Body Temperature Respiratory Rate Pulse / Heart Rate Blood Pressure Sensorium (mental alertness)

Importance of Vital Signs Indicates the patient’s immediate condition Can show improvement due to treatment Can show a decline in condition

Body Temperature Normal temperature: 98.6 ° F –1° - 2°F daily variation –Still considered normal: 97.7 °F – 99.5 °F Human body functions within a narrow range of temperature variations –Humans can survive between 93.2 ° F and 106 ° F

Thermoregulation Shivering when cold Sweating when hot

Measuring Body Temperature –Oral –Rectal –Axillary –Tympanic –Temporal

Abnormalities in Body Temperature Hyperthermia –Fever, febrile –Temperature higher than 99.5 °F Hypothermia –below normal range of 97.7 °F –Due to Environment Medically induced Damage to hypothalamus

Respiratory Rate Respiratory System delivers oxygen to the body’s tissues & eliminates carbon dioxide –Pt will die without the removal of CO2 and addition of O2 Major muscle of ventilation: diaphragm Measured in “breaths per minute” –Adults: 12 – 20 bpm –Children: 20 – 30 bpm –Newborns: 30 – 60 bpm

Abnormalities of Respiratory Rate Tachypnea –Greater than 20 breaths per minute (adult) Bradypnea – decrease is breathing Dyspnea- difficulty breathing Apnea- no breathing

Methods of Delivering Oxygen Ventilators Nasal Cannula Oxyhood Masks

Pulse Oximeter Normal Pulse Oximeter = 95% to 100%

Pulse Adult –60 to 100 beats per minute Children under 10 –70 to 120 beats per minute

Measurement Radial artery Brachial Carotid artery Apical pulses

Abnormalities of Pulse Rate Tachycardia –Pulse rate increases by more than 20 bpm in resting adult –Greater than 100 bpm Bradycardia –Decrease in heart rate

Blood Pressure Measure of the force exerted by blood on the arterial walls during contraction & relaxation. Measured pressure when the heart is relaxed: Diastolic Measured pressure when the heart is contracted: Systolic Measured with a Sphygmomanometer

Blood Pressure cont’d Recorded in millimeters of mercury (mm Hg) with systolic over diastolic Normal adult systolic: mm Hg Normal adult diastolic: mm Hg 120/80 mmHg considered normal

Abnormalities of Blood Pressure Hypertension –Persistent elevation above 140/90 mmHg Hypotension –Persistent less than 95/60 mmHg

RTA Medical Emergencies and Infection Control Week 13 Caution – some images may be disturbing to the viewer …but this is what we may see in the course of our work

TRAUMA- X-RAY READY

2 PROJECTIONS ARE BEST FOR THE PATIENT

SPINAL INJURY PT

X-TABLE LATERALS CERVICAL SPINE

Dislocation of the C3 and C4 articular processes Note that C7 is not well demonstrated

Some studies of spinal trauma have recorded a missed injury rate as high as 33%.

GSW TO ABD

QSW MARKING ENTRANCE /EXIT WOUNDS

Fractured Forearm

Trauma and Surgical Radiography

NEAR DROWING

Compound Fx of Femur

General Priorities 1.Ensure an open airway (ABC’s) 2.Control Bleeding 3.Take Measures to Prevent shock 4. Attend to wounds or fractures 5.Provide emotional support 6. Continually reevaluate and follow up

Medical Emergencies

What a Radioilogic technologist should know Common Radiology Emergencies

Medical Emergencies Sudden change in medical status requiring immediate action. For RT’s medical emergencies are rare – Recognize emergencies –Remain calm and confident –Avoid additional harm to the patient –Obtain appropriate medical assistance quickly –Know where crash cart is, emergency phone and code blue buttons

Emergency Cart (crash cart) Know where it is in your department Familiarize yourself with its contents –Have BLS with AED training Have one in the room when an iodinated contrast media will be used

General Priorities 1.Ensure an open airway (ABC’s) 2.Control Bleeding 3.Take Measures to Prevent shock 4. Attend to wounds or fractures 5.Provide emotional support 6. Continually reevaluate and follow up

ABC and D A = Air Way B = Breathing C = Circulation D = Defibrillation

Major Medical Emergencies 1.ALOC 2.Shock 3.Anaphylactic shock 4.Diabetic Crisis 5.Respiratory Distress 6.Cardiac Arrest 7.Cerebrovascular accident

Head Injuries Levels of consciousness 1.Least severe –Responsive 2.More serious –Can be roused, but drowsy 3.Even more serious –Responds to pinches or pinpricks 4.Most serious –Comatose, non-responsive

Shock Hypovolemic –Loss of blood or tissue Cardiogenic –Cardiac disorders Neurogenic –Spinal anesthesia or damage to spinal cord Vasogenic –Caused by sepsis, deep anesthesia or anaphylaxis

Anaphylactic Shock An allergic reaction to contrast media –Iodinated Can happen quickly or have a delayed reaction –Requires prompt recognition and treatment from the technologist –More severe usually have quick onset –Less severe takes longer for reaction

Water Soluble Iodine High atomic # 53 Radiopaque Used to radiograph –Vessels –Arteries –Veins –Function of internal organs

Prevention and Signs - Symptoms Maintain normal body temperature Handle pt’s gently RT should work calmly and confidently Restlessness Apprehension –Anxiety Tachycardia Sudden blood pressure drop Cold –clammy skin –pallor

Diabetic Crisis 1.Hypoglycemia 2.Hyperglycemia

Hypoglycemia Excessive insulin Can result from normal dose of insulin & no food Need carbohydrate

Hyperglycemia Excessive sugar Usually seen in diabetics Pt. needs insulin

Respiratory Distress 1.Asthma 2.Choking

Asthma 1.Stressful situations 2.Inhaler or medical assistance 3.Remain calm and confident

Choking 1.Cannot speak 2.Universal distress signal 3.Encourage to cough 4.Heimlich Maneuver

Cardiac Arrest 1.Crushing pain in chest 2.Pain down arm 3. Begin CPR and use AED

Cerebrovascular Accident 1.Paralysis on one or both sides 2.Slurred or loss of speech 3.Dizziness 4.Loss of vision 5.Complete unconsciousness

Minor Medical Emergencies 1.Nausea and vomiting 2.Epistaxis 3.Vertigo and syncope 4.Seizures 5.Falls 6.Wounds 7.Burns

Nausea and Vomiting Tell pt to breath deeply and slowly Turn on side if possible or turn head Get emesis basin and moist cloths

Epistaxis - nosebleed

Vertigo and Syncope 1.Lack of blood flow to brain 2.Feel dizzy after laying down or standing for awhile 3.Lay patient down 4.Orthostatic hypotension 5.Loosen tight clothes and put moist cloth on head

Seizures Minor –Brief LOC –Stare into space –Slightly confused and weak Severe –Muscle contractions on one or both sides –Drool –Aura may occur and you must lay them on floor Pillow under head and move all objects around them –Afterwards ABC check Clear mucus PT is weak, disoriented and has no memory of seizure

Falls, wounds and burns Falls –Get appropriate help as needed and report incident to supervisor and get a medical assessment of pt Wounds –Do not remove dressing –Pay attn to any changes in dressing –Place extremity above level of heart –Apply pressure Burns –Maintain sterile precautions –Be extra gentle

Radiologic Technology You never know when a medical emergency may occur. Helping your patients depends on your abilities to stay calm and perform you duties!

Zoomed lower pelvis demonstrating multiple fractures (arrows).

Zoomed bony thorax shows rib fractures

FX RADIAL HEAD

greenstick

comminuted Open fracture

Rt leg torn off after patient hit by a car

Third Degree Burn

INFECTION CONTROL

Infection Control Microorganisms Infectious Disease Chain of Infection Nosocomial Infection Disease Control Environment

Microorganisms that cause disease: BacteriaVirusesFungiProtozoa

Microorganisms Can grow in or on an animal or plant and cause diseases. Host: animal or plant that provides life support to another organism. Disease: Any change from the normal structure or function in the human body. Infection: Growth of a microorganism on or in a host.

Varicella Zoster (Shingles)

Disease Disease occurs only when the microorganism causes injury to the host Disease occurs only when the microorganism causes injury to the host

Pathogen A disease producing microorganism. –Multiply in large numbers and cause an obstruction –Cause tissue damage –Secrete substance that produce effects in the body Exotoxins ( high body temp, nausea, vomiting)

Bacteria  Strep Throat  Bacterial Pneumonia  Food Poisoning

Viruses Common cold MononucleosisWarts

Oral Warts

Smallpox

Fungi  Athlete’s Foot  Tinea pedis  Ringworm

Protozoan Trichomonas VaginalisTrichomonas Vaginalis –STD Plasmodium VivaxPlasmodium Vivax –Malaria

6 Steps of Infection EncounterEntrySpreadMultiplicationDamageOutcome

Chain of Infection  Host  Infectious Microorganism  Mode of Transmission –Vector/ Fomite  Reservoir

Chain of Infection

Nosocomial Infections  Iatrogenic Infection  Compromised Patients  Patient Flora  Hospital Environment  Blood borne Pathogens

Types of Nosocomial Infections  Iatrogenic Infection – related to physician activities  Compromised Patients - weakened resistance; immunosuppressed  Patient Flora - microbes in healthy people  Contaminated Hospital Environment  Blood borne Pathogens – Hepatitis B and HIV

Blood borne Pathogens  Disease-causing microorganisms that may be present in human blood. Ex: Hepatitis, Syphilis, Malaria, HIV.  Two most significant blood borne pathogens: Hepatitis B and HIV

Syphilis

Syphilis in the eye

How Blood borne Pathogens are Transmitted: You must make contact with contaminated fluids and permit them a way to enter your body. Contaminated body fluids can be saliva, semen, vaginal secretions, or other fluids containing blood (urine).

Controlling the spread of Disease Chemotherapy Immunization Asepsis –Medical –Surgical Disinfectants

Physical Methods of Controlling Diseases Handwashing Standard Precautions –Gloving –Gowns –Face masks –Eyewear

Handwashing Single most important means of preventing the spread of infection. 7 to 8 minutes of washing to remove the microbes present, depending on the number present. Most effective portion of hand washing is the mechanical action of rubbing the hands together.

Personal Protective Equipment (PPE) GlovesMasksGowns Protective Eyewear Caps

Universal Precautions Since there is no way you can know if a person is infected, you should ALWAYS use universal precautions: Wash your hands Wear gloves Handle sharp objects carefully Properly clean all spills Wear mask, eye protection, and apron if splashing is a possibility.

Airborne Precautions Patients infected with pathogens that remain suspended in air for long periods on aerosol droplets or dust. TB, Chickenpox, Measles Respiratory protection must be worn when entering pt room. Pt should wear mask.

Droplet Precautions Patients infected with pathogens that disseminate through large particulate droplets expelled from coughing, sneezing, or even talking. Rubella, Mumps, Influenza Surgical mask must be worn when within 3 feet of the pt. Pt should wear a mask.

Contact Precautions Patients infected with pathogens that spread by direct contact with the pt or by indirect contact with a contaminated object (bedrail, pt dressing). Methicillin-resistant staphylococcus aureus (MRSA), Hepatitis A, Varicella, Flesh-eating Virus All PPE should be used and equipment must be disinfected after use.

So What, and Who Cares? Students and Techs are challenged both physically and mentally by the microbial world. In this world of newly found, life-threatening diseases, education has become the key to survival. Health care providers must be committed to infection control so that diseases can be conquered!