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

3. 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

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

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

6. 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

7. Thermoregulation Shivering when cold Sweating when hot

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

9. 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

10. 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

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

12. Methods of Delivering Oxygen Ventilators Nasal Cannula Oxyhood Masks

13. Pulse Oximeter Normal Pulse Oximeter = 95% to 100%

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

15. Measurement Radial artery Brachial Carotid artery Apical pulses

16. 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

17. 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

18. Blood Pressure cont’d Recorded in millimeters of mercury (mm Hg) with systolic over diastolic Normal adult systolic: 95-140 mm Hg Normal adult diastolic: 60-90 mm Hg 120/80 mmHg considered normal

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

20. 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

24. TRAUMA- X-RAY READY

27. 2 PROJECTIONS ARE BEST FOR THE PATIENT

28. SPINAL INJURY PT

31. X-TABLE LATERALS CERVICAL SPINE

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

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

41. GSW TO ABD

42. QSW MARKING ENTRANCE /EXIT WOUNDS

49. Fractured Forearm

53. Trauma and Surgical Radiography

58. NEAR DROWING

59. Compound Fx of Femur

64. 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

65. Medical Emergencies

66. What a Radioilogic technologist should know Common Radiology Emergencies

67. 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

68. 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

69. 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

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

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

72. 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

73. 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

74. 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

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

76. 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

77. Diabetic Crisis 1.Hypoglycemia 2.Hyperglycemia

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

79. Hyperglycemia Excessive sugar Usually seen in diabetics Pt. needs insulin

80. Respiratory Distress 1.Asthma 2.Choking

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

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

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

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

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

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

87. Epistaxis - nosebleed

88. 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

89. 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

90. 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

91. 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!

95. Zoomed lower pelvis demonstrating multiple fractures (arrows).

96. Zoomed bony thorax shows rib fractures

107. FX RADIAL HEAD

109. greenstick

113. comminuted Open fracture

114. Rt leg torn off after patient hit by a car

116. Third Degree Burn

118. INFECTION CONTROL

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

121. Microorganisms that cause disease: BacteriaVirusesFungiProtozoa

122. 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.

123. Varicella Zoster (Shingles)

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

125. 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)

126. Bacteria  Strep Throat  Bacterial Pneumonia  Food Poisoning

127. Viruses Common cold MononucleosisWarts

128. Oral Warts

129. Smallpox

130. Fungi  Athlete’s Foot  Tinea pedis  Ringworm

131. Protozoan Trichomonas VaginalisTrichomonas Vaginalis –STD Plasmodium VivaxPlasmodium Vivax –Malaria

132. 6 Steps of Infection EncounterEntrySpreadMultiplicationDamageOutcome

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

134. Chain of Infection

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

136. 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

137. 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

138. Syphilis

139. Syphilis in the eye

140. 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).

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

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

143. 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.

144. Personal Protective Equipment (PPE) GlovesMasksGowns Protective Eyewear Caps

145. 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.

146. 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.

147. 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.

148. 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.

149. 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!