Medical Emergencies in Radiology Department

Initial baseline

Assess the patient's neurological and cognitive functioning upon

admission

Monitoring

Continuous observation to detect sudden changes in mental status

or physical condition

Sensitivity to pain

Recognizing and addressing patient discomfort, even if not

directly responsible for long-term pain managemen

- Shock & Anaphylaxis

- Respiratory & Cardiac Issues

- Neurological & Metabolic Crises

Common Non-Trauma Emergencies

Shock & Anaphylaxis

Rapid-onset systemic failures often related to contrast or

physical stress.

Respiratory & Cardiac aissues

Pulmonary emboli, respiratory failure, or cardiac

arrest.

Neurological & Metabolic crises

Cerebrovascular accidents (strokes), seizures,

syncope (fainting), and diabetic reactions.

Crash cart

- Contains the medications and equipment that are needed when a patient's

condition suddenly becomes critical.

- Maintain knowledge of its location.

- Know who is responsible for its upkeep (supplies and medication).

radiographer

The ... is often the first member of the healthcare team to witness a

reaction. Immediate recognition and initiation of treatment are critical to patient survival.

Glasgow Coma Scale

The ... a simple, reliable tool used to provide a quick overview of

responsiveness.

15 points

GCS: A maximum score is ... points. Any drop in this score is a red flag that must be reported immediately.

intracranial pressure (ICP) or systemic failure

Baseline vitals are essential to track changes in ... or ...

- Rising systolic blood pressure.

- Widening pulse pressure.

- Slowing pulse rate

Indications of increasing Intercranial Pressure:

- Increased respirations.

- Decreased blood pressure.

- Further pulse rate decline

Indications of Brain compression:

1.Stop the procedure immediately.

2.Stay with the patient and ask for help.

3.Call for the "crash cart."

4.Prepare for intervention, specifically oxygen and IV fluid administration

If a patient's condition changes (e.g., they develop a headache, become restless, or

their speech slurs), the radiographer must:

Shock

is the body's pathological reaction to illness, trauma, or severe

physiologic or emotional stress.

Shock

is a life-threatening condition that may occur rapidly and without warning. It may be reversible if it is not allowed to progress.

Shock syndrome

The ... may progress as a continuum in the patient's struggle to

survive and return to a normal physiologic state.

cellular level

Shock continuum: Changes begin at the ... and are often not detectable through standard observation.

increase in heart rate

Early Warning Sign: The only measurable clinical indicator at the onset may be a slight ... as the body tries to compensate for the lack of

oxygen.

Systemic Shunting

Shock continuum: As the condition progresses, the body realizes it cannot maintain full circulation,

and it prioritizes survival through ...

- lungs

- skin

- kidneys

- GI tract

Sacrificed areas of Systemic shunting: blood is diverted away from:

- Heart

- Brain

Protected areas of Systemic shunting: Blood is concentrated in the organs most critical for immediate life:

compensatory

Shock continuum: At the ... stage, a host of symptoms are noticeable:

Skin is cold and clammy.

Urine output decreases.

Respirations increase.

Bowel sounds are hypoactive.

Blood pressure is normal.

Anxiety level increases; the patient may begin to be uncooperative.

- Skin is cold and clammy.

- Urine output decreases.

- Respirations increase.

- Bowel sounds are hypoactive.

- Blood pressure is normal.

- Anxiety level increases; the patient may begin to be uncooperative.

Shock continuum: At the compensatory stage, a host of symptoms are noticeable:

Mean Arterial Pressure (MAP)

The average pressure of blood moving through

the vasculature falls below the level required to sustain life.

Cardiac Failure

The heart muscle itself becomes inadequately perfused, leading

to a weakened and ineffective pump.

Systemic Malperfusion

All body systems are deprived of necessary oxygen and

nutrients.

Progressive stage

Shock continuum: As the continuum advances, specific organ systems begin to shut down, this stage is called the ...

acute respiratory distress syndrome or shock

lung.

Severe pulmonary edema results from leakage of fluid from the pulmonary

capillaries. This is referred to as ... or ...

150 beats per minute

In the progressive stage, Tachycardia results and may be as rapid as ...

Irreversible stage

Shock continuum: Shock processes beyond the progressive stage, it is called the ...

Irreversible stage

Shock continuum: The organ systems of the body suffer irreparable damage, and recovery is

unlikely.

1. Blood pressure remains low.

2. Renal and liver failure result.

3. There is a release of necrotic tissue toxins and an overwhelming lactic acidosis.

Irreversible stage involves the following:

Intracellular

Fluid contained within the individual cells

Extracellular

Fluid outside the cell

- Intravascular

- Interstitial

Extracellular fluid can be subdivided into:

Intravascular

Fluid located specifically within the blood vessels (plasma).

Interstitial

Fluid surrounding the body tissues

3 to 4

The interstitial spaces hold ... to ... times more fluid than the vasculature.

15% to 25%

Shock occurs when the intravascular volume drops significantly:

Percentage Threshold: A loss of ... to ... of total blood/plasma volume.

750 to 1300 milliliters (mL)

Shock occurs when the intravascular volume drops significantly:

Volume Threshold: A loss of approximately ... to ...

- Hemorrhage

- Plasma loss

- Systemic fluid loss

Hypovolemia can result from various types of fluid depletion:

Hemorrhage

Active bleeding, whether internal (organ damage) or external

(trauma).

Plasma loss

Often seen in severe burn victims, where the skin barrier is lost.

Systemic Fluid Loss

- Prolonged vomiting or diarrhea.

- Dehydration caused by specific medications (e.g., diuretics)

15%

Class I: A blood loss of ...

15% to 30%

Class II: A blood loss of ...

30% to 40%

Class III: A blood loss of ...

40% or more

Class IV: A blood loss of ...

BP - normal limits

Heart rate per minute - <100

Respiration per minute - 14-20

Class I:

BP -

Heart rate per minute -

Respiration per minute -

BP - normal limits

Heart rate per minute - >100

Respiration per minute - 20-30

Class II:

BP -

Heart rate per minute -

Respiration per minute -

BP - below normal limits

Heart rate per minute - >120

Respiration per minute - 30-40

Class III:

BP -

Heart rate per minute -

Respiration per minute -

BP - Systolic blood pressure decreases from 90 to 60 mm Hg.

Heart rate per minute - Tachycardia, weak and threads pulse

Respiration per minute - >40

Class IV:

BP -

Heart rate per minute -

Respiration per minute -

Cardiogenic shock

is caused by a failure of the heart to pump an adequate

amount of blood to the vital organs.

Distributive shock

occurs when a pooling of blood in the peripheral blood vessels

results in decreased venous return of blood to the heart, decreased blood

pressure, and decreased tissue perfusion.

Distributive shock

It is characterized by the blood vessels' inability to constrict and their resultant

inability to assist in the return of the blood to the heart.

- Neurogenic

- Septic

- Anaphylactic

3 types of distributive shock:

Neurogenic shock

results from loss of sympathetic tone, causing vasodilation of

peripheral vessels.

Causative agents

Primarily Gram-negative bacteria, though Gram-positive

bacteria and viruses can also be responsible.

Vasodilations

Blood vessels widen significantly, causing a massive drop in

blood pressure.

First phase

Septic shock, ... phase:

- Hot, dry, and flushed skin

- Increase in heart rate and respiratory rate

- Fever, but possibly not in the elderly patient

- Nausea, vomiting, and diarrhea

- Normal to excessive urine output

- Possible confusion, most commonly in the elderly patient

Second phase

Septic shock, ... phase:

- Cool, pale skin

- Normal or subnormal temperature

- Drop in blood pressure

- Rapid heart rate and respiratory rate

- Oliguria or anuria

- Seizures and organ failure if the syndrome is not reversed

Anaphylactic shock

Is the result of an exaggerated

hypersensitivity reaction (allergic reaction) to re-exposure to an antigen that was

previously encountered by the body's immune system.

- Medications

- Iodinated contrast agents

- Insect venoms

Most common causes of anaphylaxis are ...

1. Patient chart

2. Radiographic history

3. Department file

4. Supervisor Records

If an anaphylactic or adverse reaction occurs, it must be recorded in four distinct

places:

30 minutes

Patients must remain in the department for at least ...

following contrast administration to monitor for immediate or slightly

delayed reactions.

- The patient should be asymptomatic.

- They should ideally be accompanied by another person.

Discharge requirements:

Obstructive shock

results from pathological conditions that interfere with the

normal pumping action of the heart; however, the heart itself may be free of

pathological conditions.

Pulmonary embolus

is an occlusion of one or more pulmonary arteries by a

thrombus or thrombi.

venous circulation, right

Pulmonary embolus: The thrombus originates in the ... or in the ... side of the heart

and is carried through the vessels to the lungs, where it blocks one or more

pulmonary arteries.

Sudden

Onset of pulmonary embolism

Pulmonary embolus

... is associated with trauma, orthopedic and abdominal

surgical procedures, pregnancy, congestive heart failure, prolonged immobility,

and hypercoagulable states

arterial hypoxemia

Pulmonary embolus: The end result is ..., which may be a life-threatening emergency.

Diabetes mellitus

A chronic disorder of carbohydrate metabolism.

It is caused by either insufficient production of insulin or inadequate utilization

of insulin by the cells of the body.

Insulin

Produced by the islets of Langerhans in the pancreas.

diabetes mellitus

In ..., the pancreas either fails to produce insulin or the body's

cells stop responding to it

Hyperglycemia

The hallmark sign of diabetes; an abnormal buildup of glucose in

the blood because it cannot enter the cells.

Type 1 diabetes mellitus

- Occurs in persons younger than 30 years old and has an abrupt onset

- The affected person must receive insulin by injection to control blood glucose

levels in the body and prevent ketoacidosis.

Type 2 diabetes mellitus

- Occurs in persons older than 40 years of age and has a gradual onset

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

Gestational diabetes

- Occurs in the later months of pregnancy

- Usually treated with diet, but insulin may be prescribed to maintain blood

glucose levels.

Hypoglycemia

... occurs when persons who have diabetes mellitus have an excess

amount of insulin or an oral hypoglycemic drug in their bloodstream, an

increased metabolism of glucose, or an inadequate food intake with which to

utilize the insulin.

Diabetic ketoacidosis

... occurs when insufficient insulin causes the liver to produce

more glucose, resulting in hyperglycemia.

Hyperglycemic hyperosmolar nonketotic syndrome (HHNS) (Coma)

may be a

complication of mild type 2 diabetes mellitus, or it may occur in the elderly

person with no known history of diabetes mellitus.

- Hypoglycemia

- Diabetic Ketoacidosis

- Hyperglycemic hyperosmolar nonketotic syndrome (HHNS)

There are three complications of diabetes mellitus that may occur when caring for a

patient:

Cerebral vascular accidents

are caused by occlusion of the blood supply

to the brain, rupture of the blood supply to the brain, or rupture of a cerebral

artery, resulting in hemorrhage directly into the brain tissue or into the spaces

surrounding the brain.

Strokes

... vary in severity from mild transient ischemic attacks to severe, life-

threatening situations.

brain attacks

Strokes are now being termed "..." A stroke is now recognized as an event that is as great a medical crisis as heart attack

2 to 4 minutes

The human brain can only survive ... to ... minutes without a fresh

supply of oxygen.

CPR (Cardiopulmonary Resuscitation)

Providing manual chest compressions

and ventilations to maintain circulation.

Abdominal Thrusts (Heimlich Maneuver)

Used specifically for clearing foreign

body airway obstructions.

Ambu-bags

Manual resuscitation bags

Cardiac arrest

When the heart ceases to beat effectively, the blood can no longer circulate

throughout the body, and the person no longer has an effective pulse

ventricular fibrillation or ventricular tachycardia

The electrical activity of the heart may be disrupted, causing the heart to beat too

rapidly, as in ... or ...

bradycardia or atrioventricular block

The heart may beat too slowly, as in ... or ...

Respiratory dysfunction

... may precede respiratory arrest.

It can be the result of airway obstruction caused by positioning, the tongue falling

backward into the throat of an unresponsive person, a foreign object lodged in

the throat, disease, drug overdose, injury, or coma.

chest thrust

The ... is used to dislodge a foreign object only if the patient is in the

advanced stages of pregnancy or is excessively obese, and the abdominal

thrust cannot be used effectively.

weight, age, and size.

The method of dealing with foreign body airway obstruction for infants and

children also varies with their ..., ..., and ...

Seizure

... is an unsystematic discharge of neurons of the cerebrum that results in

an abrupt alteration in brain function. It usually begins with little or no warning

and may last only seconds or for several minutes.

Generalized and partial

Two types of seizures