Chapter 11 - In depth copy

Sonographers must be capable of doing what?

dealing with patients who are in poor physical condition.

Even outpatients may present what?

unique challenges. For example knowing if the patient does have diabetes and knows how to manage it while still maintaining sonogram needs.

Emergency situations may result from what

physiologic reactions that occur rapidly and without warning.

A baseline assessment should be done when?

should be performed prior to the examination, of the patient's neurologic and cognitive function

A baseline assessment should allow the sonographer to recognize when..

alterations in a patient's neurologic or cognitive functions occur.

Typically, your first response will be to

notify the emergency response team.

In most institutions notifying the emergency response team is called - "calling a code" or "Code Blue."

You will most likely be required to perform CPR when

before the team arrives.

You must also know the location of what?

The emergency crash cart.

How are adults and kids different when getting the emergency crash cart?

There may be different pediatric and adult carts. (sometimes they will have pediatric tools on a adult crash cart or vice versa)

When the emergency team arrives, you may be asked to do what?

Assist with CPR or move out of the way. (Do what they tell you to do)

An outpatient office setting may require that you instead call___ in the case of an emergency

911

Ultimately, it is your responsibility to know what about your facility?

your facility's procedures and protocol

Before a sonographic examination, you should do what?

Perform a basic assessment of the patient's neurologic and cognitive function.

Performing a basic assessment is essential for what?

Providing adequate individualized care.

Complex neurologic assessment

is beyond the scope of your role as a sonographer.

What scale do you use to perform a basic assessment

Use the ACDU scale to perform a basic assessment.

ACDU scale

Alert, Confused, Drowsy, Unresponsive

The Glasgow Coma Scale is used to grade what

consciousness (This is typically used by nurses)

When should you get help

If you notice any drastic changes in a patient's level of consciousness during an examination, get help immediately.

ACDU scale (4)

1. (A) Is the patient alert? Look at the patient. Is she awake and taking in her surroundings? If so, she is alert.

2. (C) Is the patient confused? Listen to the patient. Does he speak clearly? Does he understand instructions? Does he know who he is? Does he know where he is? Does he know what day it is? If so, he is oriented. If not, he is confused.

3. (D) Is the patient drowsy? A patient with some level of consciousness can respond with her voice or by moving her eyes or part of her body. Does the patient fall asleep as soon as voice stimulation stops? If so, the patient is drowsy. (Know if they are on medication that can cause them to be drowsy) 4. (U) Is the patient unresponsive? If the patient makes no response, he is considered unresponsive. (Check patient chart/with nurse to see if patient is purposely sedated)

Shock

is the body's response to a pathologic condition or severe physiologic or emotional stress.

Hypovolemic shock

Results from loss of blood or other body fluids

Cardiogenic shock

Failure of the heart's left ventricle (Heart not pumping enough blood to the organs)

Neurogenic shock

Often caused by dysfunction of the nervous system (Usually seen in spinal cord injuries)

Septic shock

Results from the immune system's reaction to an invasion of bacteria in the body

Anaphylactic shock:

Results from an extreme allergic reaction (Can see this specifically with patients who have contrast, because they may not know they are allergic to it)

Cardiogenic examples

Myocardial infarction

myocarditis

cardiac tamponade

pulmonary embolus

Hypovolemic examples

Hemorrhage, diarrhea, dehydration, burns

Septic example

Severe infection

Anaphylactic examples

Type 1, Hypersensitivity reaction

Neurogenic examples

brain damage, spinal cord injury

3 stages of shock

Compensatory stage

progressive stage

irreversible stage

Compensatory stage

Stage one Cold, clammy skin, nausea and dizziness, shortness of breath (rapid respirations), increased anxiety, decreased blood pressure, and increased pulse

Progressive stage

Stage two Reduction in fluid circulations, significantly decreased blood pressure and increased pulse, rapid and shallow respirations, tachycardia(Fast heart rate), chest pain, confusion and lethargy, renal, hepatic, gastrointestinal, and hematologic failure symptoms

Irreversible stage

Stage three Low blood pressure, complete renal and liver failure, lactic acidosis, recovery unlikely

Reported adverse reaction to contrast agent

anaphylactic reactions

Sonographers must closely monitor patients, and there must be procedures for what?

quick response to emergency situations. (Be aware of possible side effects)

Your response to any form of shock should be to do what?

immediately call for emergency assistance or 911.

Response to forms of shock (4)

1. Do not leave the patient.

2. Place the patient in a position that best facilitates breathing. (Semi fallure/ semi erect position)

3. Monitor the patient's vital signs, and be prepared to assist the emergency team.

4. Make note of the time and assistance provided. (Let them know what you have already done)

Syncope

(fainting) is the temporary loss of consciousness.

Syncope typically results from what?

deficient blood supply to the brain.

Syncope can also be caused by (7)

heart disease

hunger

poor ventilation

extreme fatigue

emotional distress or trauma lying flat for a long period of time

Clinical manifestation of syncope includes (6)

pallor (Pale)

dizziness

nausea

hyperpnea

tachycardia

and cold or clammy skin.

Several patient populations are more prone to syncope (3)

- Older patients (orthostatic hypotension Low blood pressure drop)

- Patients taking certain medicines

- Obstetric patients (Supine hypertension syndrome - When the baby compresses your IVC, you should roll the pregnant patient on their side when you are scanning them)

If a patient faints, what do you? (3)

1. call for assistance

2. place the patient in a

supine position

3. elevate the patient's legs slightly. (Take care to prevent injuries without injuring yourself.)

A seizure results from what?

The misfiring of neurons within the cerebral cortex.

Seizures typically alter consciousness and may last for how long?

several minutes or only seconds.

Seizures are associated with what? (5)

severe stress

trauma

brain tumors

brain tumor removal

birth trauma.

Seizures can be triggered by what? (3)

odors

flashing lights

may be random

A grand mal seizure

involves the entire body

Complex seizures and simple seizures

may not be as easy to detect with visual examination.

Table 11-3 Page 347 Response to a patient having a seizure (8)

1. Call for help

2. Stay with the patient

3. Do not attempt to insert anything in the patients mouth

4. Protect the patients head from injury by placing a pillow under it

5. Do not restrain the patients limbs, but protect them from injury

6. Do not move the patient

7. Provide the patient with privacy

8. After the seizure, place the patient in the Sims position or the recovery position to allow any fluid within the mouth to drain

Sims position aka

recovery position

PE (pulmonary embolus)

is a blood clot, or thrombus, located within one of the pulmonary arteries.

A PE (pulmonary embolus) obstructs what?

blood flow to the lungs.

The mortality rate of the PE (pulmonary embolus)is nearly what

50%

The risk factors of PE p(ulmonary embolus)include what? (8)

Being older

Living a sedentary lifestyle

Prolonged immobilization

Recent trauma

Pregnancy

Estrogen use

Recent hip or abdominal surgery

Previous DVT (Clot breaking off and going into the lungs)

CVA

is the result of an obstruction or occlusion of a cerebral artery within the brain, resulting in hemorrhage.

Strokes

are often spontaneous events that range in severity.

A transient ischemic attack

is a mini-stroke and the warning sign that a severe stroke may be approaching (Also known as TIA)

A transient ischemic attack that can be an indicator of what?

An imminent, more severe stroke.

Signs of stroke are described in what acronym

FAST acronym

F - Face drooping: One side of the face may droop or feel numb.

A - Arm weakness: One arm may be weak or numb; ask the person to raise both arms.

S - Speech difficulties: Speech may be slurred or strange; ask the person to repeat a simple sentence.

T - Time to call emergency services: If any of these signs are present, it's crucial to call 911 immediately.

If clinical symptoms of a stroke occur what do you do

immediately end the procedure and call for emergency assistance

Diabetes mellitus can produce what 3 symptoms

polyuria (excessive urination)

polydipsia (excessive thirst)

polyphagia (excessive hunger)

There are three types of diabetes

Type 1, Type 2, Type 3

Type 1

insulin dependent and diagnosed before the age of 30

Type 2

has a gradual onset and usually occurs in people over 40 years of age (This is the most common type of diabetes)

Type 3

gestational diabetes, occurs in pregnant women (Usually leads to type 2 diabetes later in life)

Complications of diabetes are what? (4)

hypoglycemia

diabetic ketoacidosis

HHNS

coma

In order to prevent a diabetic emergency what do you do?

patients should be a scheduling priority for early morning examinations that require fasting.

Inadequate food intake can lead to what

complications

Diabetic ketoacidosis

is an acute complication that results from insufficient insulin and hyperglycemia (Hyperglycemia = Too much glucose/sugar in the blood)

In cases of suspected hypoglycemia what should you do?

some employers may advise the sonographer to provide a sugary snack, while others strictly prohibit this practice

Hyperglycemia

Occurs when there is too much glucose in the blood, typically due to insufficient insulin production or the body's inability to use insulin effectively

If a patient faints what do you do?

follow emergency response procedures for syncope.

TYPES OF EMERGENCIES: EMERGENCIES REQUIRING IMMEDIATE CARDIOPULMONARY RESUSCITATION :

1. You must be alert to the signs and symptoms of cardiac arrest, respiratory arrest, and airway obstructions.

2. Be sure not to confuse cardiac arrest with a heart attack.

3. In all situations requiring CPR, you should perform BLS as soon as emergency assistance is notified.

4. Be aware of a DNR order, which is part of a patient's advanced healthcare directive. - You must have a written medical order to follow this request.

5. It is your responsibility to investigate your institution's policies concerning all healthcare directives, especially codes and DNR order.

Cardiac arrest

the heart suddenly stops

Heart attack

loss of blood supply to a certain part of the heart

CVA, what is it and what does it stand for?

A stroke (Cerebrovascular accident stroke)

PE

Pulmonary embolus

Sims position

Lay on your stomach with your knee up (on your side) This will allow anything that it is in the airway to come back up

Vasovagal reaction

Happens when they see blood or a needle or are stressed and start to sweat profusely but are freezing

Postural hypotension

When the patient has been laying flat for a long period of time and gets dizzy when you set them up (Always raise their chair or bed slowly)

Trendelenburg position

Lay the patient all the way back and elevate their feet higher than their head

If the patient is pregnant...

Don't put them in the Trendelenburg position - Set them on their side