Goal The RT student will be able to recognize lifethreatening emergencies and initiate appropriate medical action Objectives After completing this lesson the student will be able to List the visible symptoms of shock ID: 248721
Download Presentation The PPT/PDF document "Medical Emergencies in Diagnostic Imagin..." is the property of its rightful owner. Permission is granted to download and print the materials on this web site for personal, non-commercial use only, and to display it on your personal computer provided you do not modify the materials and that you retain all copyright notices contained in the materials. By downloading content from our website, you accept the terms of this agreement.
Slide1
Medical Emergencies in Diagnostic ImagingSlide2
Goal
The RT student will be able to recognize life-threatening emergencies and initiate appropriate medical action.Slide3
Objectives
After completing this lesson the student will be able to:
List the visible symptoms of shock.
List the visible symptoms of an anaphylactic reaction.
List the observable symptoms of diabetic ketoacidosis, hypoglycemia, hyperosmolar coma and describe the actions the RT must take if he observes these symptoms in his patient.
List the early symptoms of cerebral vascular accident and describe the action the RT should take if these symptoms are observed.
List the symptoms of respiratory failure and describe the action that an RT must take if this emergency occurs in his department.
List the symptoms of cardiac failure and describe the actions that the RT must take if this emergency occurs
List the symptoms of mechanical airway obstruction and describe the action an RT should take if this emergency occurs.
List the emergency action that the RT must take if a patient is having a convulsion or is fainting.Slide4
Medical emergency?
The abnormal physiologic reactions, especially of patients whose physical condition is poor, that, occur quickly, with little or no warning, and often life threatening are called medical emergencies. Slide5
Common medical emergencies
The most common medical emergencies in x-ray departments are:
Shock
Anaphylaxis
Diabetic reactions
Cerebral vascular accidents
Cardiac failure
Respiratory failure
Fainting
ConvulsionsSlide6
What is the RT’s action?
The RT’s first action is
:
Call the hospital/departmental emergency team, the physician /radiologist conducting the procedure, and colleagues for assistance.
Then obtain the emergency trolley/crash cart immediately.
Emergency trolley/crash cart
is a trolley that contains medications and equipment
needed when a patient’s condition becomes suddenly critical.Slide7
Shock?
Shock is a physiologic reaction to illness or trauma, in which,
there is a disturbance of blood flow to the vital organs, or
a decreased ability of the body tissues to use oxygen and other nutrients needed to maintain them in a healthy state.
It can occur quickly and without warning.Slide8
who are affected? & causes?
Shock is most frequently seen in:
Very young children
Elderly persons
Generally debilitated (weak) people
Shock may be caused by :
Injury
Disease
Intense emotional reactionSlide9
Signs & symptoms of shock
Increased temperature
Weak, thready pulse
Rapid heartbeat
Rapid shallow respiration
Hypotension
Skin pallor
Cyanosis
Increased thirstSlide10
Development of signs & symptoms
In the early stages, because of an inadequate supply of oxygen to the brain, the patient will display signs of:
Restlessness
Confusion
Anxiety
Later, (if allowed to progress), the patient will become
Apathetic (droopy, unconcerned)
Confused (puzzled, bewildered)
Comatose (exhausted)Slide11
Categories of Shock
Hypovolemic shock
Septic shock
Cardiogenic shock
Neurogenic shock
Anapylactic shockSlide12
Hypovolemic shock
This is caused by an abnormally low volume of circulating blood in the body.
It May be due to:
Internal or external haemorrhage
Loss of plasma because of burns
Fluid loss from prolonged vomiting or diarrhea
Heat prostration (weakness)
Insufficient release of antidiuretic hormone (ADH)Slide13
Signs & symptoms
Restlessness; thirst; cold, clammy skin
Pallor, sweating
Falling blood pressure; weak, thready pulse
Rapid respirations
Extreme weakness; lethargy
Cold extremities
Semiconsciousness, coma
Systolic blood pressure lower than 60 mm Hg
Oliguria to anuriaSlide14
Action to take
Place the patient in a flat, supine position and allow him to rest.
Notify the physician & call for assistance
Make certain that the patient is able to breath without obstruction (release any tight clothing and clear the airway)
Note any visible discharge of bodily fluids (blood, vomitus, faeces, urine) and wipe them away.
Keep any blood out of patient’s view.
If there is loss of blood from open wound apply pressure to stop it.
Be prepared to assist with administration of oxygen, IV fluids or medications.
Keep the patient warm and dry.
Check blood pressure, pulse, and respirations every 10 minutes.
Observe the pt’s skin colour and body temperature
Do not offer food or fluids
Do not leave the patient unattended.Slide15
Septic shock
A shock caused by severe systemic infections and bacteremia (bacterial endotoxins released in the bloodstream).
Symptoms progress somewhat differently from those of other types of shock.Slide16
Signs & symptoms
In early stages, the skin is warm, dry, and flushed.
Urine output may be normal or excessive.
The patient may have chills.
As the shock progresses, there may be an abrupt personality change or a decrease in the level of consciousness.
There is an increase in pulse and respiration and a decrease in urinary output.
The skin becomes cold and clammy.
Seizures, circulatory collapse, and cardiorespiratory failure will follow if the course is not reversed. Slide17
Cardiogenic shock
A shock caused by a failure of the heart to pump an adequate amount of blood to the vital organs.
This causes inadequate tissue perfusion.
The onset of cardiogenic shock is sudden and often occurs in patients hospitalized for acute myocardial infarction, cardiac tamponade (excessive pressure on the heart), or pulmonary embolus.
It may follow cardiac surgery.Slide18
Signs & symptoms
Restlessness, anxiety, falling blood pressure, and falling pulse pressure.
Weak, rapid pulse
Shallow, labored respirations
Decreased urinary output
Cool, clammy skin
Possible semiconsciousness or comaSlide19
Action to be taken
Summon emergency assistance and place the emergency cart ready.
Notify the physician in charge of the patient.
Place the patient in a semi-Fowlers position or a position of comfort.
Keep the patient warm and quiet.
Take the vital signs every 5 to 10 minutes.
Do not give the patient anything to eat or drink.
Do not leave the patient alone.
Be prepared to assist with oxygen and intravenous fluids, and medication administration.
Be prepared to begin CPR.Slide20
Neurogenic shock
A shock occurs when concussion (limited period of unconsciousness), spinal cord injury, psychic trauma, or spinal anesthesia causes abnormal dilatation of the peripheral blood vessels.
This dilatation in turn causes a fall in blood pressure as blood pools in the veins. This leads to reduced cardiac output and shock.Slide21
Signs & symptoms
Hypertension and bradycardia
Warm, dry, skin and subnormal body temperature.
Initial alertness unless the patient is unconscious because of head injury.
Initially good, but deteriorating, tissue perfusion.
Visible signs of poor tissue perfusion – coolness of extremities and diminishing peripheral pulse.Slide22
Action to take
Notify the physician in charge of the patient.
Summon assistance and stay with the patient.
Keep the patient flat, and monitor vital signs every 10 minutes.
Do not move the patient if there is a possible spinal injury.
Prepare to assist with oxygen, intravenous fluid, and medication administration.Slide23
Anaphylactic shock
Anaphylactic shock is the result of an exaggerated hypersensitivity reaction (allergic reaction) to an antigen that was previously encountered by the body’s immune system.
When this occurs, vasodilator substances (histamine and histaminelike compounds) which may produce massive vasodilatation and peripheral pooling of blood, are released in the body.
This reaction is accompanied by contraction of nonvascular smooth muscles, particularly the smooth muscles of the respiratory system.
This reaction can produce shock, respiratory failure and death within minutes following exposure to the agent that produces the reaction.
This is the type of shock seen most often in radiology departments.Slide24
Common causes of anaphylaxis
Drugs
Iodinated contrast agents
Chemotherapeutic agents
Anesthetics
Certain foods
Insect venomsSlide25
Early signs & symptoms
Itching at the site of injection and/or around the eyes and nose.
Sneezing and coughing
Apprehensiveness; a feeling of doom
Nausea, vomiting, and diarrhea (usually related to food)Slide26
Late symptoms
Angioneurotic edema of the face, hands, and other body parts
Urticaria (an itchy rash resulting from the release of histamine)
Chocking, wheezing, or dyspnea and cyanosis
Hypotension, weak rapid pulse and dilated pupilsSlide27
Precautions & Actions to take
Keep the emergency trolley ready and correctly prepared whenever an iodinated contrast medium is being administered.
Before starting any procedure that involves the use of iodinated contrast medium, ask the patient the following questions.
“
Are you allergic to any food or medicine?” “Which ones?”
“Do you have asthma or hay fever?”
“have you ever had an x-ray examination that involved the use of contrast medium?”. “If so, did you have a reaction during or following that examination?”Slide28
If the answer for any question is positive, the radiologist should be informed for necessary precautions
Never leave a patient who is receiving an iodinated contrast agent unattended.
If he complains itching, if swelling or redness of the skin is noted, or if the patient seems unduly anxious notify the radiologist.
Monitor the vital signs and observe for respiratory distress.
If the patient is in anaphylactic shock, call the emergency team
Keep the patient in semi Fowler’s position or sitting position if possible.
Prepare to assist with the administration of oxygen, intravenous fluids, and medications. Slide29
Medications given for anaphylaxis
Epinephrine (Adrenaline)
Diphenhydramine
Hydrocortisone
Aminophylline
If the patient stops breathing start pulmonary resuscitation.
If the patient becomes breathless and pulseless, administer Cardiopulmonary resuscitation (CPR)Slide30
Diabetic emergencies
Diabetic mellitus(DM) is a chronic disease involving a disorder of carbohydrate, protein, and fat metabolism, which also affects the structure and function of the blood vessels.
The underlying cause is a disturbance in the production, action, or utilization of insulin, a hormone normally secreted by the islands of langerhans located in the pancreas.
Medical treatment consists of diet therapy, insulin injections, or use of oral hypoglycemic drugs.Slide31
Types of diabetes and diagnosis
Type 1 ;- Insulin-dependent form:- There is no production of insulin and therefore depend on outside sources of insulin for the entire life.
Type 2 :- Noninsulin-dependent form:- The production of insulin is less than necessary or the insulin does not have the desired effect on the body. They are treated with diet control and drugs that increase the carbohydrate metabolism.
DM is diagnosed by laboratory measurement of blood glucose levels.
A normal adult blood glucose level should range from 80 to 115 mg/dl.Slide32
Complications of DM
Hypoglycemia
Diabetic ketoacidosis
Nonketotic hyperosmolar comaSlide33
Hypoglycemia
Hypoglycemia or insulin reaction occurs when patients who have diabetes mellitus have an excess amount of insulin in their blood stream, an increased rate of glucose utilization, or an inadequate diet to utilize the insulin.
A patient who has DM may come to the imaging department after he has taken insulin or some other hypoglycemic agent, but before his body has had sufficient nourishment to utilize the medication. The result may be a hypoglycemic reaction. The onset of symptoms is rapid, and immediate action is necessary in order to prevent coma.Slide34
Signs & symptoms
Shaking, nervousness, and irritability
Dizziness and hunger; may complain of headache
Profuse perspiration; cold, clammy skin
Blurred vision
Tremor, numbness of lips or tongue, slurred speech
Impaired motor function; convulsions
Diminishing level of consciousness; quick lapse into comaSlide35
Actions to take
Notify the Radiologist
Administer some type of sugar immediately
Call for help
Do not leave the patient unattended
Monitor vital signs
if the patient is unconscious prepare to assist with administration of oxygen, intravenous fluids, and medication
usually in this type of coma, 20 to 50 % glucose in solution is administered intravenously.Slide36
Diabetic ketoacidosis
When a patient has insufficient insulin available to metabolize the glucose that is present, his body begins to mobilize fatty acids, and the result is an acidotic state called diabetic ketoacidosis.
In this condition, acid and ketone bodies accumulate in the blood. If this accumulation is not corrected quickly, the patient will become comatose and may die. Slide37
Signs & symptoms
Weakness, drowsiness, and dull headache
Sweet odor to the breadth, hypotension
Warm, dry skin; parched tongue; dry mucous membranes; extreme thirst
General weakness, lethargy, and fatigue
Flushed face, deep and rapid respirations
Tachycardia, weak, thread pulse and, ultimately, comaSlide38
Actions to take
Check patient chart to identify him as a diabetic.
Stop treatment/examination
Notify the physician
Call for assistance
Do not leave the patient unattended
Monitor vital signs
Give fluids by mouth if possible
Prepare to assist with administration of intravenous fluids, and oxygenSlide39
Hyperosmolar coma
Hyperosmolar coma(hyperglycemic, nonketoic coma) is a complication of diabetes mellitus that usually occurs in the elderly diabetic patient.
It is frequently mistaken for a stroke or drunkeness and is extremely serious, life-threatening problem
Factors that cause this condition are
diagnostic procedures that require changes in diet, especially fasting for long hours,
hyperglycemic-inducing agents and resistance to insulin.
The blood glucose level in patients with this problem is grater than 600 mg/dl; there is little or no ketosis and the plasma is hyperosmolar.Slide40
Signs & symptoms
Extreme patient dehydration; dry skin; sunken eyes
Increased body temperature; polyuria; extreme thirst
Muscle twitching; difficult, slurred speech
Mental confusion; convulsion
ComaSlide41
Actions to take
Stop treatment
Notify the physician
Call for assistance
Do not leave the patient unattended
Monitor vital signs
Give fluids by mouth if possible
Prepare to assist with administration of intravenous fluids, and oxygenSlide42
Respiratory failure, cardiac arrest, airway obstruction
Respiratory failure or severe respiratory dysfunction may result from airway obstruction caused by
the patient’s position,
the tongue, a foreign object, vomitus lodged in the throat,
disease,
drug overdose,
injury, or coma.
Whatever the cause, gas exchange is no longer adequate to maintain normal arterial blood gases.Slide43
Symptoms of a partially obstructed airway
Labored, noisy breathing
Wheezing
Use of accessory muscles of the neck, abdomen and chest for breathing
Neck-vein distention
Anxiety
Cyanosis of the lips and nail beds
Productive cough with pink-tinged, frothy sputumSlide44
………………….continued
If the patient lapses into complete respiratory failure, his pulse will continue to beat for a brief period of time. However, the pulse becomes weak and then ceases. Chest movement stops and eventually cardiac arrest will result.Slide45
Action to take
1. Clear and open the airway
Check the larynx and trachea to make certain that the patient’s tongue, epiglottis, or a foreign body is not blocking the airway.
Tilt the head by placing one hand on the patient’s forehead and applying firm backward pressure with the palm to tilt the head back.
Keep the fingers of the other hand under the lower jaw near the chin and lift so that the chin is brought forward.
The lips should remain apart
If the patient does not resume breathing, rescue breathing must be begun.Slide46
2. Rescue Breathing
Move the patient to a supine position
Check the carotid pulse
Squeeze the nostrils together
Cover his mouth tightly with yours
Inflate the patient’s lungs by giving two full breaths in succession into his mouth.
Allow the patient time to exhale these breaths as you inhale between each.
Recheck the carotid pulse
If present continue pulmonary resuscitation by breathing into patient’s mouth at the rate of 12 breaths per minute.
Check the carotid pulse each minute.
If the pulse is absent cardiac compression must be started immediately.Slide47
3. Application of External cardiac compression
External cardiac compression is effective only if the patient is lying on a firm surface.
Take an adequate amount of time to determine pulselessness (5 to 10 seconds).
Performing cardiac compression on a person whose heart is functioning is extremely dangerous.
Once compressions have started, do not interrupt them for more than 7 seconds at a time.
Place the heel of one hand in the midline of the sternum above the xiphoid process.
Put the other hand on the first.Slide48
For children, land marks are the same , but only one hand is used to prevent excessive pressure.
For adult cardiac compression, the lower half of the sternum is compressed.
Compress the sternum 1 ½ to 2 inches directly downward and then release the compression completely.
Do not apply pressure on the rib cage itself.
Keep your elbows straight and give 15 compressions in a smooth, even rhythm.
Then inflate the patient’s lungs two more times.
Next give 15 more compressions, then two more inflations.
This rhythm must be maintained until help arrives.
Following the initial cycles of compressions and ventilations, pause to reassess the pulse and breathlessness.
If the patient remains breathless and pulseless, continue the cycle of two ventilations and 15 compressions, maintaining 80 to 100 external chest compressions per minute.Slide49
Cerebral Vascular Accident (Stroke)
Cerebral vascular accidents (CVA) are caused by occlusion or rupture of the cerebral arteries directly into the brain tissue or into the subarachnoid space. This is commonly called a stroke. Strokes vary in severity from a mild transischemic attack (TIA) to severe life threatening situations. Slide50
Signs& symptoms
Possible severe headache
Muscle weakness or flaccidity of face or extremities.
Eye deviation, usually one sided, may loose vision
Dizziness or stupor
Difficult speech (dysphasia) or no speech (aphasia0.
Ataxia
May complain of stiff neck.
Nausea or vomiting may occur.Slide51
Actions
Call for emergency aid, do not leave patient alone.
Put patient in resting position with head slightly elevated.
Monitor vital signs every 10 minutes.
Report to the physician
Prepare to administer intravenous medications, fluids, and oxygen
Prepare to administer CPR if the patient becomes breathless or plseless.Slide52
Fainting
Fainting is caused by an insufficiency in the supply of blood to the brain. The possible causes are:
Heart disease
Hunger
Poor ventilation
Fatigue
Emotional shockSlide53
Signs and symptoms
Pallor, dizziness, and possibly nausea
Cold, clammy skin
Actions
Have the patient lie down, if possible
Position his head so it is level with or some what lower than his body.
Summ)on medical assistance.Slide54
Convulsive seizures
Convulsive seizures are associated with many physical disorders, including;
uremia,
eclampsia,
tetanus,
infections characterized by high body temperature,
poisoning,
and increased intracranial pressure caused by a brain tumour
Epilepsy is the most common cause of convulsive seizures.
Children are more susceptible than adults to seizures of all types.Slide55
Classifications of seizures
Grand mal
or
generalized seizures
:-
The patients whole body convulses, and he loses consciousness for a period of minutes.
Partial seizures
:- one focal point is affected
Petit mal
or absence seizures.Slide56
Signs and symptoms
(of
Grand mal
or
generalized seizures)
May utter a sharp cry as air is rapidly exhaled.
Muscles become rigid, and eyes open wide (tonic phase)
May exhibit jerky body movements and rapid, irregular respirations (clonic phase)
May vomit
May froth, and may have blood streaked saliva caused by biting his lips or tongue
May exhibit urinary incontinence.
Usually falls into a deep sleep. Slide57
Action
Prevent the patient from injuring himself during a seizure.
Do not attempt to insert hard objects into the mouth.
Do not place your fingers into the patient’s mouth
Stay with the patient
Protect him from hitting his head or limbs against hard objects.
Restrain him gently.
Call for help
After the seizure, position the patient to prevent chocking or aspiration of secretion and vomitus
Turn the patient to his side or to a prone position.
Prepare to assist in oxygen administration
If possible remove dentures or foreign objects from the mouth.
Note and report to the physician.Slide58
summary