/
Medical Emergencies in Diagnostic Imaging Medical Emergencies in Diagnostic Imaging

Medical Emergencies in Diagnostic Imaging - PowerPoint Presentation

lois-ondreau
lois-ondreau . @lois-ondreau
Follow
403 views
Uploaded On 2016-03-09

Medical Emergencies in Diagnostic Imaging - PPT Presentation

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

shock patient blood symptoms patient shock symptoms blood signs pulse body amp action coma insulin emergency cardiac pressure skin

Share:

Link:

Embed:

Download Presentation from below link

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.


Presentation Transcript

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