Ergonomics, Monitoring, and Medical Emergencies

What is hypoxia?

Inadequate oxygen supply to body tissues.

What are the causes of hypoxia?

1. Airway obstruction (aspirated material/choking)

2. Laryngeal edema from anaphylaxis

3. Emphysema or other respiratory diseases.

What should a radiographer do in response to respiratory distress?

1. Perform the Heimlich maneuver if appropriate.

2. Summon the code team.

3. Check the oxygen flow if oxygen is already being administered.

Why is oxygen important?

Oxygen is carried by the blood to all body tissues; lack of oxygen can cause permanent tissue damage or death.

What conditions require oxygen supplementation?

1. Severe anemia

2. Pneumonia

3. Pulmonary edema

4. Shock.

What are signs and symptoms of inadequate oxygen supply?

1. Dyspnea (difficulty breathing)

2. Cyanosis (bluish skin/lips)

3. Diaphoresis (excessive sweating)

4. Distended neck veins.

What should you do if hypoxia is suspected?

1. Call for help.

2. Place the patient in a sitting or semi-Fowler position.

3. Have oxygen and emergency drugs available.

4. Do not leave the patient unattended.

How is oxygen delivered?

1. Wall oxygen outlets provide 60–80 psi.

2. A flowmeter regulates oxygen administration.

3. Oxygen should be humidified to prevent drying and irritation of respiratory mucosa.

What do oxygen tanks have?

1. A valve to regulate flow.

2. A gauge indicating the amount of oxygen remaining.

What are conditions often requiring oxygen therapy?

1. Chronic obstructive pulmonary disease (COPD)

2. Pneumonia

3. Severe asthma

4. Cystic fibrosis

5. Sleep apnea

How are oxygen delivery devices classified?

Oxygen delivery devices are classified as low-flow or high-flow.

• COPD patients require low-flow oxygen therapy.

• High-flow oxygen in COPD patients can cause apnea (cessation of breathing).

What is a Nasal Cannula?

The most commonly used oxygen delivery device.

• Short prongs extend about 1 cm into the nares.

• Supplements oxygen in room air.

• Low-flow device.

• Comfortable and convenient but can be easily displaced.

What is a Venturi Mask?

A device that mixes oxygen with room air.

• Delivers specific oxygen concentrations.

• Usually a high-flow device.

What is a Simple Face Mask?

A low-flow device used for short-term oxygen therapy.

• Must be removed for meals.

• Makes communication difficult and can be easily displaced.

What is a Partial Rebreathing Mask?

A low-flow device that delivers more precise oxygen concentrations than a simple mask.

What is a Nonrebreathing Mask?

A low-flow device that also delivers more precise oxygen concentrations than a simple mask.

What are Mechanical Ventilators?

A high-flow device used when a patient cannot breathe independently.

• Commonly found in critical care units.

• Requires an artificial airway in place.

• Ventilator controls respiratory rate and volume.

What is the purpose of suction?

Maintains a patient's airway by removing:

• Secretions

• Blood

• Other fluids

What are the indications for suction?

1. Patient is unconscious.

2. Secretions are excessive or very thick (high viscosity).

3. Coughing is ineffective.

4. Patient is unable to clear the airway independently.

What suction equipment is available?

Available through:

• Wall outlets

• Mobile suction units

What is the radiographer's role in suctioning procedures?

May assist with suctioning procedures and should know:

• The location of suction equipment.

• How to replace disposable suction catheters.

What are important equipment considerations for suction?

Suction tubing requires a disposable catheter for collecting airway secretions. The correct catheter diameter must be used.

What are the complications of using a catheter that is too large?

1. Airway occlusion (blockage)

2. Hypoxia

3. Atelectasis (collapse of lung tissue) when suction is applied.

What is the purpose of chest tubes?

Used after thoracic surgery or thoracotomy to treat:

• Pneumothorax (air in pleural space)

• Hemothorax (blood in pleural space)

What is an important rule regarding chest drainage systems?

Chest drainage system must always remain below the level of the patient's chest.

What are the three compartments of a chest drainage system?

1. Suction control chamber

2. Collection chamber

3. Water seal chamber (prevents atmospheric air from entering the chest cavity)

What are the radiographer responsibilities regarding chest tubes?

1. Avoid dislodging or disturbing chest tubes.

2. Be careful during patient movement and mobile radiography.

3. Report immediately:

   • Sudden changes in patient condition

   • Chest pain

   • Patient discomfort

What types of GI tubes are there?

1. Nasogastric (NG)

2. Nasointestinal (NI)

3. Nasoenteric (NE)

What are nasogastric (NG) tubes used for?

Used as feeding tubes for patients unable to swallow normally.

• Example: Dobhoff tube

What are nasointestinal (NI) / nasoenteric (NE) tubes used for?

Used for decompression to remove gastric fluids and air after digestive tract surgery.

• Examples: Levin tube, Salem-Sump tube

What is the lumen information for NG and NI/NE tubes?

NG and NI/NE tubes may be:

• Single-lumen

• Double-lumen

What is the responsibility of a radiographer regarding GI tubes?

Do not disturb the placement of GI tubes.

What are important tube examples?

1. Cantor tube — Single-lumen NE tube

2. Harris tube — Single-lumen NE tube

3. Miller-Abbott tube — Double-lumen NE tube

4. Sengstaken-Blakemore tube — Triple-lumen tube used to treat bleeding esophageal varices

What are the components of a Sengstaken-Blakemore tube?

1. Gastric balloon

2. Esophageal balloon

3. Gastric suction port

What are the uses of Central Venous Catheters (CVCs/Central Lines)?

1. Dialysis

2. Blood transfusions

3. Chemotherapy

4. Parenteral nutrition

5. Blood draws

6. Central venous pressure (CVP) monitoring

What are examples of Central Venous Catheters?

1. Port-A-Cath

2. Hickman catheter

3. Raaf catheter

What distinguishes Peripherally Inserted Central Catheters (PICC)?

Classified based on purpose and duration:

• Short-Term, External/Nontunneled:

  • Administer medications

  • Draw blood

  • Monitor right atrial blood pressure

  • Examples: PICC, CVC

• Long-Term, External/Nontunneled:

  • Administer medications

  • Draw blood

  • Example: PICC

• Long-Term, Tunneled:

  • Parenteral nutrition

  • Dialysis

  • Examples: Hickman, Raaf

• Long-Term Implanted Venous Access:

  • Chemotherapy

  • Blood transfusions

  • Example: Port-A-Cath

How is placement verification done for central lines?

Central lines usually have a radiopaque distal tip.

• The distal tip should be located in the superior vena cava (SVC) or inferior vena cava (IVC) near the right atrium.
• During mobile chest radiography, move external radiopaque wires when possible to prevent artifacts.

What are the uses of urinary catheters?

1. Postsurgical tissue healing
2. Assisting incontinent patients with urine elimination

What are important infection control points for urinary catheters?

1. Sterile equipment must be used.
2. Proper catheter care is necessary to prevent infection.
3. Urinary tract infections (UTIs) are the most common nosocomial infections.

What are the materials used for urinary catheters based on duration?

• Short-Term Use:

  • Plastic
  • Rubber

• Long-Term Use (up to 3 months):

  • Polyvinyl chloride (PVC)
  • Silicone

What are important rules regarding urinary catheter usage?

1. Urine collection bag must remain below the level of the bladder to prevent backflow of urine, which can cause infection.
2. During transport or transfer, prevent the catheter from:
   • Becoming entangled
   • Becoming dislodged.