RADTC101: Ch. 20 - Medical Emergencies

Hypoglycemia Characteristics

- *Excessive insulin* is present (thus, lack of sugar in blood). - Can occur if patient takes normal dose of insulin and does not eat (exam preparation). - Signs of insulin shock include: *intensely hungry, weak and shaky, may sweat excessively*, and may become *confused and irritable*. - Patients need a *quick form of carbohydrate* or take a glucose tablet.

Hyperglycemia Characteristics

- *Excessive sugar in the blood* and characteristic of *diabetes*. - Develops *gradually* over a period of hours or days. - *Excessive thirst and urination, dry mucosa, rapid and deep breathing, drowsiness, and confusion*. - Insulin required - leads to *diabetic coma* if left untreated.

Anaphylactic Shock

- *Vasogenic* shock. - Most *common* type of shock encountered *in medical imaging*. - May occur with administration of* iodinated contrast media*. - Signs and symptoms must be monitored. *Mild symptoms* include: localized itching and urticaria, and nausea or vomiting. *Severe symptoms* include: laryngeal edema, shock, and cardiac arrest. - Alert physician when signs occur.

Levels of Consciousness (LOC)

- Alert and conscious: Patient can respond fully to questions and other stimuli. - Drowsy: Can be roused to response with loud speaking or gentle physical contact. - Unconscious: Typically do not respond to verbal stimuli but react to stimuli such as pinches and pinpricks. - Comatose: Unresponsive to virtually all stimuli. (ADUC - Only a conscious person would yell, "A duck!")

Respiratory Distress

- Asthma - Choking If a patient is choking, you should ask them, "Can you speak?" If they can't, encourage them to cough. If that does not dislodge the obstruction, perform the Heimlich maneuver. Remember, you must use a different technique for women in late stages of pregnancy and for infants. If the patient is unconscious, you can either perform a finger sweep (only if object is visible), or begin CPR and check for the foreign object between ventilations.

Cerebrovascular Accident

- Called a *stroke*. - More likely to occur in *older patients* (75+). - May develop *gradually or suddenly*. - Warning signs include: *paralysis, slurred speech or complete loss of speech, extreme dizziness, loss of vision, and complete loss of consciousness*. - Patient needs to be *placed in recumbent position* ASAP.

Hypovolemic Shock Classes

- Class I (15% blood loss) - Class II (15% - 30% blood loss) - Class III (30% - 40% blood loss) - Class IV (more than 40% blood loss)

Two-Person Rescue

- Each rescuer independently performs compressions or ventilations with periodic switches of position. - Compressions are delivered at the rate of approximately 100/min., with cycles of 30 compressions and two breaths. - Breaths are given during pauses in compression and should be of approximately 1-second duration.

List general priorities for working with patients in acute situations.

- Ensure open airway. - Control bleeding. - Take measures to prevent or treat shock. - Attend to wounds or fractures. - Provide emotional support. - Continually reevaluate and follow up appropriately.

Discuss factors that contribute to the development of hypoglycemia.

- Excessive insulin is present. - Can occur if patient takes normal dose of insulin and does not eat (exam preparation). - Signs of insulin shock include: intensely hungry, weak and shaky, may sweat excessively, and may become confused and irritable. - Patients need a quick form of carbohydrate or take a glucose tablet.

Response to Deteriorating Situations

- If their condition shows deterioration, be sure to maintain an open airway and move the patient as little as possible. - Stop the procedure and call for assistance quickly. - Take the patient's vital signs while waiting for help.

Discuss methods of avoiding the factors that contribute to shock.

- Maintain normal body temperature. - Avoid overheating. - Manage or reduce pain, stress, or anxiety.

How Can Shock Be Prevented?

- Maintain normal body temperature. - Avoid overheating. - Manage or reduce pain, stress, or anxiety.

CPR

- Medical imaging professionals should be familiar with an institution's protocol for cardiac emergencies. - The professional technologist is encouraged to become familiar with all required skills and to achieve certification in all CPR procedures. - On realization that a patient has experienced cardiac arrest, the appropriate alert should be initiated before CPR is begun.

CPR (Cont.)

- Must be initiated *immediately* on thorough verification that cardiopulmonary distress exists. - Remember *CAB: compressions (30 compressions alternated with 2 ventilations), airway, breathing*.

Minor Medical Emergencies

- Nausea and vomiting: Should instruct patient to take deep breaths. Provide emesis basin and moist cloths. - Epistaxis (nosebleed): Lean the patient forward, pinch affected nostril, keep patient upright and apply moist compress. - Vertigo and syncope: Assist patient to a seated or recumbent position. Watch for orthostatic hypotension and vertigo when sitting patients up from a recumbent position. - Seizures: Secure patient to prevent injury, call for assistance, do not put your fingers into their mouth, place pillow under patient's head, lay them in Sims' position to prevent aspiration of vomitus, and note the time and characteristics of the seizure. - Falls: Should attempt to minimize the physical impact of the fall to the extent possible. - Wounds: If a dressing becomes saturated, place a clean dressing over it and hold it there until bleeding stops. Place a wounded extremity above the level of the heart. For burns, maintain sterile precautions. For wound dehiscence, do not attempt to replace tissues inside the wound. Place a sterile dressing over the area and get medical assistance.

List the objectives of first aid.

- Preserve life. - Avoid further harm to the patient. - Obtain appropriate medical assistance as quickly as possible. - Must be able to recognize emergency situation and initiate emergency measures.

Indications of Deteriorating Situations

- Quickly assess your patient at the beginning of the procedure. - Note any signs of deterioration, such as: irritability, lethargy, slowing pulse rate, slowing respiratory rate, or change in their LOC. - When working with an intoxicated patient with a head injury, never assume that the patient has passed out merely from inebriation.

Common Signs and Symptoms of Shock

- Restlessness - Apprehension or general anxiety - Tachycardia - Decreasing blood pressure - Cold and clammy skin - Pallor

Explain the purpose of an emergency cart and its contents.

- You must know where the department crash cart is located. - Become familiar with the crash cart contents and their locations. - The ready availability of emergency equipment and drugs reduces the time required to respond to medical crises.

Define terms related to medical emergencies.

...

Describe the general procedure for the use of an automatic external cardiac defibrillator.

1. Determine that the patient is in cardiac arrest. 2. Turn on the AED. 3. Attach the defibrillator cables to the pads and place them on the patient's upper right area of the chest and the other on the lower left ribs. 4. Initiate rhythm analysis using the ANALYZE button. 5. If indicated, deliver shock. 6. If no shock is indicated, continue CPR. 7. After three shocks or three "no shock indicated" messages, CPR should continue uninterrupted.

General Priorities When Working With Patients in Emergency Situations

1. Ensure an open airway. 2. Control bleeding. 3. Take measures to prevent or treat shock. 4. Attend to wounds or fractures. 5. Provide emotional support. 6. Continually reevaluate and follow up appropriately.

One-Person Rescue

1. Establish unresponsiveness by gently shaking and shouting at the victim. If these actions fail to rouse the person, call for help and proceed with CPR. 2. Position the patient on his or her back on a hard surface. 3. Perform chest compression by positioning yourself to one side of the patient and placing the hands properly. The heel of the hand should be along the length of the sternum. Elbows are locked with arms extended directly over the patient's sternum. Applied force should be sufficient to depress the sternum a minimum of 2 inches in an adult. Give 30 compressions and 2 ventilations. The compressions should be given at a rate of approximately 100/min. 4. Open the airway. Place one hand on the victim's forehead and apply firm backward pressure while placing the fingers of the other hand beneath the bony part of the chin and lifting upwards. 5. Establish breathlessness. Listen for breath sounds and look for a rise and fall of the chest. If no breath... 6. Perform rescue breathing. Pinch the victim's nostrils shut, take a deep breath, and seal your lips around those of the victim or place a facemask tightly over the nose and mouth. Blow two deep breaths, each of 1 second duration. 7. Establish circulatory inadequacy by palpating the carotid artery. If no pulse... 8. Continue to perform CPR. 9. Reassess after 5 complete cycles of compressions by taking more than 7 seconds to reevaluate the patient.

The Two Types of Defibrillators Are...

1. Fully automatic: Analyze the patient's cardiac rhythm, determine whether a defibrillation is necessary, and, if necessary, deliver a shock. 2. Semiautomatic: These defibrillators walk you through the procedure.

Classes of Shock

1. Hypovolemic shock, caused by loss of blood or tissue fluid. 2. Cardiogenic shock, caused by a variety of cardiac disorders, including myocardial infarction. 3. Neurogenic shock, caused by spinal anesthesia or damage to the upper spinal cord. 4. Vasogenic shock, caused by sepsis, deep anesthesia, or anaphylaxis.

Crash Cart

A wheeled container of equipment and drugs typically required in emergency situations. You must know where the cart is located in your department and be familiar with its contents.

Lethargy

Abnormal drowsiness or stupor; a condition of indifference.

Hypoglycemia

Abnormally diminished concentration of glucose in the blood.

Hyperglycemia

Abnormally increased concentration of glucose in the blood.

Cardiopulmonary Resuscitation (CPR)

Artificial substitution of heart and lung action as indicated for cardiac arrest or apparent sudden death resulting from electric shock, drowning, respiratory arrest, and other causes.

Wounds

Bodily injuries caused by physical means with disruption of the normal continuity of structures.

Shock

Condition of profound *hemodynamic and metabolic disturbance* characterized by *failure of the circulatory system to maintain adequate perfusion* of vital organs.

Cerebrovascular Accident (Stroke or Brain Attack)

Condition with sudden onset caused by acute *vascular lesions* of the brain; often followed by *permanent neurologic damage*.

Automatic External Defibrillators (AEDs)

Devices used for application of external electrical shock to restore normal cardiac rhythm and rate.

Ventricular Fibrillation

Disorganized cardiac rhythm.

Vomiting

Forcible expulsion of the contents of the stomach through the mouth.

Vertigo

Illusion of movement; sensation as if the external world were revolving around the patient or as if the patient were revolving in space.

Pallor

Paleness; absence of skin coloration.

Describe the appropriate procedure for handling patients with various medical emergencies.

Listed in some of the cards above.

Epistaxis

Nosebleed; hemorrhage from the nose.

Describe the correct procedure for administration of cardiopulmonary resuscitation.

See the next 2 cards.

Wound Dehiscence

Separation of the layers of a surgical wound; may be partial, or superficial only, or complete, with disruption of all layers.

Aura

Subjective sensation or motor phenomenon that precedes and marks the onset of a paroxysmal attack, such as an epileptic attack.

Cardiac arrest

Sudden stoppage of cardiac output and effective circulation.

Syncope

Temporary suspension of consciousness as a result of generalized cerebral ischemia; faint or swoon.

Infant Rescue

The procedure is basically the same as adults, with adjustments made in the volume of air delivered during artificial breathing, the placement of the hands, and the depth of depression of the sternum during the external chest compressions. The volume of air should be just enough to cause the rise and fall of the chest. The index finger should be placed on the sternum just under the point here it intersects with the intermammary line. Using the *3rd and 4th fingers, compress the sternum to a depth of 1/2 to 1 inch* at the rate of 100/min.

Emergency

Unexpected or sudden occasion; an urgent or pressing need.

Nausea

Unpleasant sensation, vaguely referred to the epigastrium and abdomen and often culminating in vomiting.

Urticaria

Vascular reaction, usually transient, involving the upper dermis, representing localized edema caused by dilatation and increased permeability of the capillaries and marked by the development of wheals; also called hives.

In working with a patient, which of the following would be the first priority for attention?

a. providing an open airway.

Which of the following is typically associated with shock?

b. decreasing blood pressure.

Syncope is a medical term for which of the following?

b. fainting.

Which of the following actions is the most appropriate in handling a patient who begins a violent seizure?

c. Attempt to prevent the patient from injuring himself or herself.

The Heimlich maneuver is used in response to which of the following situations?

c. choking.

Which of the following signs or symptoms is typically associated with a deteriorating head injury?

c. lethargy.

Where should the heel of the hand be placed when performing chest compressions during cardiopulmonary resuscitation on an adult?

c. two fingers above the xiphoid process.

How long can the brain be deprived of oxygen before cerebral function impairment is likely?

d. 4 to 6 minutes.

Which of the following actions would help prevent a patient from going into shock?

d. minimizing pain; providing emotional support; and maintaining a normal body temperature.

A patient suffering from hypoglycemia needs which of the following?

d. rest and carbohydrates.