MEDICAL EMERGENCIES

Medical Emergencies Defined A situation in which the condition of the patient or sudden change in medical status requires immediate action Head Injuries Shock Diabetes Respiratory distress Cardiac arrest Cerebral vascular accident

The Radiologic Technologist Role Preserve life Avoiding further harm Obtaining further medical assistance Knowing when assistance is warranted (most important)

General Priorities Ensure an open airway Control bleeding Take measures to prevent or treat shock Attend to wounds or fractures Provide emotional support Continually re-evaluate and follow-up appropriately

Emergency Cart Know location and contents

HEAD INJURIES It is not the radiology technologist responsibility to diagnose, but it is useful to have basic knowledge for assessment purposes

LEVELS OF CONSCIOUSNESS Alert and conscious Responds fully More serious Drowsy, but can be roused Even more serious does not respond to verbal commands, but can react to painful stimuli Most Serious Unresponsive or comatose

Indications of Deteriorating Conditions Irritability Lethargy Slowing pulse rate Slowing respiratory rate

Responses to Deteriorating Situations Stop the procedure Make sure there is an open airway Obtain assistance Obtain vital signs while waiting

The Intoxicated Patient Inebriated vs. head injury

SHOCK Failure of the circulatory system to support vital body functions

Definition and Types Hypovolemic – due to loss of blood or tissue fluid Cardiogenic – due to a variety of cardiac disorders, including myocardial infarction Neurogenic – due to spinal anesthesia or damage to the upper spinal cord Vasogenic – due to sepsis, deep anesthesia, or anaphylaxis

Prevention Maintain body temperature Avoid pain, if possible Minimize stress and anxiety

Signs and Symptoms Restlessness Apprehension General anxiety Tachycardia Decreasing blood pressure Cold and clammy skin Pallor

Contrast Media Reactions (Anaphylactic Shock) Any medication can be harmful if not administered properly Moderate to severe As a general rule, the longer it takes for a reaction to develop, the less severe it is Typically most severe reactions arise immediately

Anaphylactoid reactions Allergic-like effects Thought to be caused by the release of histamine Mild Warm sensation, metallic taste, sneezing Moderate Nausea, vomiting, itching Severe Respiratory or cardiac crisis

Responses to Deteriorating Situations Stop the procedure Make sure there is an open airway Obtain assistance Obtain vital signs while waiting

The role of the radiology technologist should be established in the procedures in each facility. Very important to document condition of patient before and after event

INFILTRATION or EXTRAVASATION: contrast or medication enters soft tissue instead of vein Signs: swelling, pain, burning, redness Cause: needle displacement STOP EXAM IMMEDIATELY Apply ice if <30min Apply warm, wet compression of >30min

THE DIABETIC PATIENT NPO prep may create problem If patient takes insulin without food, insulin production and excretion may be altered due to lack of carbohydrates adjustment must be made immediately

Hypoglycemia A condition in which excessive insulin is present Taking insulin without food Depletes body’s energy and quickly leads to insulin shock Symptoms include: hungry, weak, shaky, confused, sweaty, irritable

Hypoglycemia (con’t) Solution: Carbohydrates Glucose tablets Orange juice sweetened w/sugar A sugared soft drink Candy bar, etc. No food or drink should be given to an unconscious patient

Hyperglycemia The condition of excessive sugar in the blood and is the characteristic typically associated with diabetes. Symptoms: Excessive thirst and urination Dry mucosa Rapid and deep breathing Drowsiness and confusion

Hyperglycemia (con’t) Solution: Patient needs insulin

RESPIRATORY DISTRESS AND RESPIRATORY ARREST  The Asthma Patient  Anxiety and stress of having the exam may cause reaction  The technologist role is to keep calm, as this will calm the patient  Allow patient to sit and determine if medical assistance is needed

The Choking Patient Evaluate the situation “Can you speak?” Clutching throat Turning red in the face Encourage patient to cough Use Heimlich maneuver if necessary

CARDIAC ARREST Signs and Symptoms Crushing chest pain that may or may not radiate down the left arm

CPR (Cardiopulmonary Resuscitation) Alert the proper personnel before beginning Cerebral function is generally impaired if the brain is deprived of oxygen for more than 4 to 6 minutes

3 Primary Aspects of CPR ABC’s 1. Airway 2. Breathing 3. Circulation

Considerations DNR request Once begun, basic life support should (and for legal reasons, must) be continued until the victim resumes spontaneous respiration and circulation, a physician or other responsible health care professional calls a halt, or the rescuer is too exhausted to continue.

Cerebrovascular Accident Stroke Onset could be sudden or gradual Paralysis Slurred speech Dizziness Vission loss Loss of consciousness

Minor Medical Emergencies Nausea and vomiting Epistaxis Vertigo and syncope Seizures Falls

Nausea and Vomiting Breath slowly and deeply Turn head to side and give patient emesis basin

Epistaxis Defined: nosebleed Lean forward, pinch nostril (do not lean back) If not effective within 15 minutes, get help

Vertigo and Syncope Vertigo: dizziness Allow patient to sit or lie down Syncope: fainting Temporary lack of blood flow to brain Allow patient to lie down with feet elevated, loosen clothing

Seizures Mild to severe Slight confusion or weakness, body trembling and drooling Exam should be postponed Protect patient with pillows, clear airway and summon help

Falls Attempt should be made to minimize impact when possible and then proceed to get assistance

Wounds Hemorrhage: note condition, if bleeding, apply pressure; if extremity, place above heart if possible Burns: maintain sterile precautions, be extra gentle with patient Wound dehiscence: uncommon; a patients sutures come apart and abdominal contents spill out

SUMMARY Be alert and aware that emergencies do happen in the radiology department. Respond in a calm and confident manner.