RADT 153 C - UNIT 3: Medical Emergencies & Vital Signs

code blue

cardiac arrest: call a code, get the "crash cart"

code grey

security

code pink/secure

infant abduction

code purple

child abduction

code orange

hazardous material spill

code green

incoming cardiac arrest

code triage

internal/external disaster

code yellow

bomb threat

code white

pediatric medical emergency

code silver

person with weapon or hostage situation

glasgow coma scale

-3 behavioral categories: eyes, motor response, verbal response

-each category is worth 1-6 points for a total of 15

-score of 7 or less = dangerous

location of crash carts

procedural/exam rooms where contrast can be administered

assessment- loss of consciousness

-ask patient to state name, date, address, and reason for exam to respond to verbal stimuli and to orient to time, place, person, & situation; note unusual responses

-note patient's ability to follow positioning instructions

-note movements causing pain, difficulty moving or altered behavior or lack of response; establish a baseline

-assess the patient's vital signs & note in chart

-if conditions change later, i.e., patient complains of pain, headache, becomes restless or unusually quiet, or develops slurred speech or a change in level of orientation as procedure progresses, report to MD immediately

RT action- loss of consciousness

-stop the procedure

-stay with patient

-summon assistance

-get emergency cart

-prepare for oxygen & IV administration

shock

the body's physiologic reaction to illness, trauma or stress in which there is a disturbance of blood flow to the vital organs or a decreased ability of the body's tissues to use oxygen & other nutrients needed to maintain a healthy state

stages of shock

compensatory, progressive, irreversible

irreversible stage of shock

-blood pressure remains low

-renal & liver failure results

-release of necrotic tissue toxins & an overwhelming lactic acidosis

determinants of shock

-bleeding

-under physical/emotional stress

-serious injury/infection

-vomiting/diarrhea

-diabetes

-age is very young or very old

-in severe pain

-bowel obstruction

-undergoing procedure that causes rapid decompression of organ/rapid fluid loss from body cavity

-undergone anesthesia

4 cardinal rules when shock worsens

1. heart rate increases

2. respiratory rate increases

3. blood pressure decreases

4. urinary output decreases

normal range of BP

120/80 to 140/90

normal range of HR

60 to 100 bpm

normal range of RR

14 to 20 per minute

types of shock

-hypovolemic

-cardiogenic

-distributive (neurogenic & septic)

-anaphylactic

-obstructive

hypovolemic shock

caused by abnormally low volume of circulating blood in the body

causes of hypovolemic shock

-internal/external

-hemorrhage

-plasma loss from burns

-fluid loss from prolonged vomiting

-diarrhea, medications of heart prostration (stroke)

class I hypovolemic shock

blood loss of 15%

-normal ranges for BP, HR, RR, and UO

-slightly anxious

class II hypovolemic shock

blood loss of 15-30%

-BP within normal range

-HR > 100 bpm

-RR ranges from 20-30 per minute

-UO decreases

-increasingly anxious

class III hypovolemic shock

blood loss of 30-40%

-BP decreases to below normal range

-HR > 120 bpm

-RR increases 30-40 per minute

-UO greatly decreases

-anxious and confused

class IV hypovolemic shock

blood loss of more than 40%

-systolic BP decreases from 90-60 mm Hg

-HH > 140 bpm w/ weak & thready pulse

-RR > 40 per minute

-UO diminishes or ceases

-confused and lethargic

cardiogenic shock

caused by a failure of the heart to pump adequate amounts of blood to vital organs

causes of cardiogenic shock

-myocardial infarction

-cardiac dysrhythmias or other cardiac pathology

distributive shock

occurs when a pooling of blood in the peripheral vessels results in decreased venous return of blood to the heart, decreased BP, decreased tissue perfusion

neurogenic shock

results from loss of sympathetic tone causing vasodilation of peripheral vessels

causes of neurogenic shock

-spinal cord injuries

-severe pain

-neurologic damage

-depressant action of medication

-lack of glucose

-adverse effects of anesthesia

septic shock

has a 40-50% mortality rate for its victims, and within 12 hours; single cause of death ICU's today

causes of septic shock

-bacterial infection

-endotoxins are released

-chemicals that increase capillary permeability & vasodilation

obstructive shock

results from pathologic conditions that interfere with the normal pumping action of the heart (unrelated to heart pathologies and conditions itself)

causes of obsructive shock

-pulmonary embolism

-cardiac tamponade

-pulmonary hypertension

-arterial stenosis

-constrictive pericarditis

-tumors that interfere with blood flow through the heart

-originates in venous circulation & is carried through the vessels to the lungs where it blocks one or more arteries

anaphylactic shock

exaggerated hypersensitivity reaction to an antigen that was previously encountered by the body's immune system

-histamine (red flush in a burn) -bradykinin (influence smooth muscle to contraction-respiratory tract in this case; inducing hypotension; increasing permeability of small blood capillaries; and inciting pain)

vasodilation (results in peripheral blood pooling)

causes of anaphylactic shock

-medications

-iodinated contrast

-insect venoms

transient response to iodine contrast

-warm flushed feeling from rapid bolus injection

-nausea/vomiting usually passes quickly

-headache

-pain/burning at injection site

-metallic taste

pre-medicated drugs prior to iodine contrast

Benadryl & Solu-cortef

normal blood glucose level

80 to 115 mg/dL

type I diabetes

-"insulin dependent"; body stops producing insulin

-abrupt onset, under age 30, genetic condition

-insulin producing beta cells are destroyed by an autoimmune process & the affected person must receive insulin by injection to control blood glucose levels & prevent ketoacidosis

type II diabetes

-gradual onset, over 40 who are obese

-caused by obesity, hereditary factors, or environmental conditions

-impaired sensitivity to insulin or from a decreased production of insulin

-may be controlled by weight loss, dietary control, and exercise

-must take oral hypoglycemic agents to prevent hyperglycemia if diet & exercise don't work

-diabetic ketoacidosis does not occur b/c there is enough insulin present in the body to prevent the breakdown of fat, unless resulted by stress or infection

ketoacidosis

serious condition that can lead to diabetic coma (passing out for a long time) or even death

-when ketones build up in the blood, they make it more acidic

-acidosis results in difficulty breathing which may lead to heart attack and respiratory failure (and lung damage)

vasovagal reaction

-occurs when patient faints because the body overreacts to certain triggers, such as the sight of blood or extreme emotional distress

-occurs when patient experiences high anxiety about procedure and its result

-pallor, cold sweats, syncope (HR & BP drop), bradycardia, hypotension, vasodilation

CVA

cerebrovascular accident/stroke

causes of CVA

-occlusion of blood supply to brain

-rupture of blood supply to brain

-rupture of cerebral artery; resulting in hemorrhage directly into brain tissue or into spaces surrounding the brain

clinical manifestations of CVA

-severe headache

-numbness

-muscle weakness/flaccidity of face or extremities (one-sided)

-eye deviation, possible loss of vision (one-sided)

-confusion

-dizziness or stupor (near-unconsciousness or insensibility)

-difficult speech (dysphasia) or no speech (aphasia)

-ataxia

-stiff neck

-nausea/vomiting

-loss of consciousness

seizure

an unsystematic discharge of neurons of the cerebrum that results in an abrupt alteration in brain function

-lasts for only seconds or several minutes

-accompanied by a change in LOC

-syndrome or symptom of a disease

RT actions of seizures

-stay w/ pt & gently secure them to prevent injury

-call for assistance

-do not insert hard objects into the pt's mouth

-do not put fingers in pt's mouth

-remove dentures & foreign objects from pt's mouth

-place blanket or pillow under pt's head

-do not restrain arms or legs

-do not move pt to floor

-do not allow pt to fall on floor

-observe pt carefully & keep track of time of seizure

-provide pt privacy

-position the pt to prevent aspiration or secretions and vomitus

concussion

blow to the head that may not show external signs of trauma

-serious damage may occur with or without skull fracture

-minimal damage characterized by "seeing stars" or very brief LOC

temperature

a measurement of the state of metabolism of the body; a physiologic balance between the heat produced in body tissues and heat lost to the environment

-controlled by the hypothalamus

-CNS damage can occur if fever prolongs

factors that affect temperature

-time of day

-environmental temperature

-age

-weight

-physical exercise

-injury

-chewing gum/smoking

4 areas of body for temp measurement

oral, axillary, rectal, tympanic

most reliable area for temp measurement

rectal

common places for pulse

apical, radial, carotid, femoral, popliteal, temporal, pedal

uncommon places for pulse

posterior tibial & brachial

creatine labs

used to determine whether kidneys are functioning normally

-normal level = low

-increased levels = irregular kidney function

scope of practice as radiographer

insert contrast & provide CPR