Chapter 16 - Lecture

Medical emergency

A sudden and serious illness or injury that requires immediate medical attention to prevent death or long-term harm

BLS (Basic Life Support)

A level of medical care used in emergencies that includes CPR (cardiopulmonary resuscitation), using an AED, and helping someone who is choking

ACLS (Advanced Cardiovascular Life Support)

A higher level of emergency care for people with severe heart or breathing problems, involving advanced airway management, medications, and heart rhythm monitoring

Anaphylaxis

A severe and potentially life-threatening allergic reaction that can cause trouble breathing, swelling, and a drop in blood pressure

Syncope

A brief loss of consciousness, also known as fainting, usually caused by a drop in blood flow to the brain

Cyanosis

A bluish color of the skin or lips due to low oxygen levels in the blood

Arrhythmia

An abnormal heart rhythm—either too fast, too slow, or irregular

Tachycardia

A fast heart rate, usually more than 100 beats per minute

Bradycardia

A slow heart rate, usually fewer than 60 beats per minute

Supraventricular

Refers to abnormal heart rhythms that start in the upper chambers of the heart (atria)

Ventricular tachycardia

A dangerously fast heart rhythm that starts in the lower chambers of the heart (ventricles)

Ventricular fibrillation

A life-threatening heart rhythm where the ventricles quiver instead of pumping blood effectively

Angina

Chest pain or discomfort caused by reduced blood flow to the heart muscle

Ischemia

A lack of blood flow and oxygen to a part of the body, often affecting the heart or brain

Myocardial infarction (Heart Attack)

When blood flow to part of the heart is blocked, causing heart muscle damage or death

Bronchoconstriction/Bronchospasm

Narrowing of the airways in the lungs, making it hard to breathe; common in asthma

Chronic Obstructive Pulmonary Disease (COPD)

A long-term lung disease that makes it hard to breathe, including conditions like emphysema and chronic bronchitis

Hypoxia

A condition where not enough oxygen reaches the body's tissues

Oxygen saturation

The percentage of oxygen in the blood; a normal level is usually 95–100%

Pulmonary embolism

A blood clot that travels to the lungs and blocks blood flow, which can be life-threatening

Hypoglycemia

 Low blood sugar, which can cause shaking, confusion, and even loss of consciousness

Hyperglycemia

High blood sugar, often seen in people with diabetes; can cause thirst, frequent urination, and fatigue

Vasovagal

A sudden drop in heart rate and blood pressure, often causing fainting, usually triggered by stress or pain

Hypotension

Abnormally low blood pressure, which can cause dizziness or fainting

Orthostatic hypotension

A sudden drop in blood pressure when standing up, leading to lightheadedness or fainting

Defibrillator

A device that delivers an electric shock to the heart to restore a normal rhythm in cases of life-threatening arrhythmias

AED (Automated External Defibrillator)

A portable defibrillator used by bystanders to help someone in cardiac arrest; it gives voice prompts and instructions

Intubation

The process of inserting a tube into a person’s airway to help them breathe

Scope of practice

The specific tasks and responsibilities that a healthcare provider is legally allowed to perform based on their training and certification

Good Samaritan Law

A law that protects people from legal liability when they help someone in an emergency, as long as they act in good faith and without gross negligence

What is a medical emergency?

Unforeseen event or serious condition that needs immediate attention

What are 6 examples of a medical emergency?

• Syncopal episode

• Heart attack 

• Trauma 

• Strokes 

• Respiratory distress 

• Mental health emergency

Why is it important for NM technologists to respond to a medical emergency?

We are the first to respond as time matters and the patients with NM are never left alone and are always in our view

What are 3 things that are useful to do in recognizing an emergency?

• Be observant to changes in your patient 

• Important to be alert and trust your instincts – better to act sooner

• Important to understand the protocols in the facility

What are 4 things you should physically recognize as an emergency in your patient?

• Changes in appearance

• Altered consciousness

• Respiratory distress

• Unresponsiveness

What are the 3 emergency action principles?

• Assess 

• Call

• Provide

In emergency action principles, what is assess?

Assessing the situation by ensuring scene safety

In emergency action principles, what is call?

Calling for help using the emergency call systems to get proper personnel

In emergency action principles, what is provide?

Providing the appropriate care according to your scope of practice and protocols

Why is it important to specifically follow the order of emergency action principles?

It ensures your safety and the patient’s safety

What is the role of the NM technologist, with respect to their training, in an emergency? (3 things)

• CPR

• Positioning 

• Administration of oxygen

What is the role of the NM technologist after the code team takes over? (6 things)

• Provide situation and history and answer questions

• Stand by and follow their directions 

• Record keeping – times, medication amounts 

• Fetch other equipment or personnel 

• Limit unnecessary bystanders 

• Care for family members in an appropriate location

What are the 5 common emergency situations?

• Cardiac

• Respiratory distress

• Allergic reactions 

• Diabetic emergencies

• Syncope 

Why are cardiac emergencies more likely to occur in NM?

We do cardiac stress tests where we’re trying to invoke a heart attack/infarction to occur

Why are respiratory distress emergencies more likely to occur in NM?

• We perform perfusion studies that are used to identify a PE

• Used to conduct ventilation but isn’t as often used anymore

What is the relationship between NM and allergic reactions?

Reactions to NM radiopharmaceuticals are extremely rare

What is the relationship between NM and diabetic emergencies?

Common for NM patients to have hypoglycemia due to patient’s needing to fast for these exams

What was the product Neutrospec (Tc-99m Fanolesomab)?

Radiopharmaceutical that was made for infection imaging and diagnosis for appendicitis

Why was the product Neutrospec withdrawn from the market?

Due to reports from NM technologists that there were severe hypersensitivity reactions

What is the crash cart?

Mobile unit that contains virtually all the materials, drugs, and devices needed to perform a code

Would a crash cart be the same in a hospital or facility or small lab?

No, where the cart is located will change the way the cart is set up to suit the needs of the department it’s at

How often does a crash cart need to be checked?

Needs to be checked daily

What are the 2 common types of emergency equipment?

• Defibrillator or cardiac monitor

• AED

What are the 2 common types of supplies in emergency equipment?

• Electrodes and pads

• Paddles

What are the 2 common types of oxygen equipment?

• Wall mounted oxygen

• Portable oxygen tanks

Is oxygen a drug? Does it require a prescription?

• Oxygen is considered a drug and is non-invasive 

• Needs to be prescribed by a physician

What are flow meters?

Device that measures and controls the flow rate of oxygen given to a patient

What are the 4 common types of oxygen administration devices?

• Nasal cannula 

• Simple face mask

• Nonrebreather 

• Venturi mask

What is the flow rate and oxygen concentration provided in a nasal cannula?

• 1-6 L/min

• 24-45%

What is the flow rate and oxygen concentration provided in a simple face mask?

• 1-10 L/min

• 40-60%

What is the oxygen concentration provided in a nonrebreather?

Up to 100% oxygen

What is the oxygen concentration provided in a venturi mask?

Provides controlled oxygen around 24-60%

What oxygen administration device is best suitable for long-term use?

Nasal cannula

What oxygen administration device is best suitable for short-term use?

Simple face mask

What oxygen administration device is best suitable for patients in severe distress?

Nonrebreather

What oxygen administration device is best suitable for COPD?

Venturi mask

What is the recommended oxygen rate of delivering oxygen for COPD patients?

Not to exceed 3 L/min

What are the 2 types of suction devices?

• Wall-mounted 

• Portable

What indications from a patient would have us use a suction device? (4 indications)

• Secretions 

• Blood 

• Vomitus

• Low consciousness

What catheter tube is commonly used for suctions of the mouth and pharynx?

Yankauer

What is the medication, epinephrine, good to use for? (2 things)

• Key in cardiac arrest as it is a vasopressor – constricts blood vessels and raises the blood pressure

• Stimulates the vital organs

What is the medication, amiodarone, good to use for? (2 things)

• Tackle life-threatening arrhythmias

• Stabilizes irregular heart rhythms by restoring and maintaining the stable rhythm after injection

What is the medication, adenosine, good to use for? (2 things)

• Terminates supraventricular tachycardia as it’s a vasodilator

• Blocks AV node – pauses heart temporarily

What is the medication, atropine, good to use for? (1 thing)

Counters bradycardia by blocking the parasympathetic system – increases heart rate

What is the medication, lidocaine, good to use for? (1 thing)

Manages ventricular arrhythmias to keep electrical impulses from being erratic – restores a stable cardiac rhythm

What is a code red?

Fire

What is a code blue?

Cardiac arrest or cessation of respiration

What is a code orange?

Hazardous material spill or release

What is a code grey?

Combative person

What is a code silver?

Weapon or hostage situation

What is a code amber?

Infant or child abduction

What is a code yellow?

Internal or external disaster/triage

What is a code Rapid Response?

Team response for a deteriorating medical condition

What is a code Trauma Team?

Team response for trauma patients

What is a code Sepsis Alert? (what it is and what will be given to the patient)

• Team response for patients who are identified or suspected to be septic

• Patients will be given antibiotics within an hour

What is a code Stroke Alert? How soon should treatment be provided?

• Team response for a patient who’s having a cerebrovascular accident 

• Provide treatment to the patient within 20 minutes

What is the Good Samaritan Laws for Healthcare Professionals?

Helps protect trained healthcare workers who volunteered in medical emergencies from being sued when they were not on duty

What are the key things that should be documented in an emergency event? (3 things)

• Time of the event

• Action taken

• Personnel involved

What are the 3 things that should be noted when taking a patient history?

• Allergies 

• Medications – some agents have adverse reactions with other medications 

• Previous reaction history

What are the 4 post-emergency procedures?

• Document all interventions

• Debrief with team

• Restock supplies and emergency cart 

• Emotional support for patient and staff

To effectively manage these emergencies, NM departments should… (4 things)

• Train staff regularly 

• Maintain emergency equipment 

• Develop protocols 

• Coordinate with emergency services