RADT 153 UNIT 3

compensatory stage

which shock stage has the following:

-skin is cold and clammy

-urine output decreases

Code Blue

Cardiac Arrest: call a code, get the "crash"

crash cart

contains emergency medicines, supplies, and other life sustaining equipment

rooms with contrast studies (iodinized contrast material)

where are crash carts usually found?

epinephrine

for severe anaphylaxis. Vasoconstrictor which increases contractility and BP. Make heart more sensitive to electrical conduction.

vasopressin

maintains water, constricts blood vessles

sodium carbonate

maintain pH balance

atropine

indicated for cardiac arrest patient suffering from bradycardia or worst case, asystole

lidocaine

V-tach, PVCs

Dopamine

vasodilator, increases contractility, and blood flow

shock, anaphylaxis, diabetes, pulmonary emboli, CVA, cardiac and respiratory, fainting, seizures

medical emergencies in the radiology department

levels of consciousness

glasgow coma scale shows the :

levels of consciousness

need to be to evaluate levels of consciousness. A person who is ill can deteriorate quickly from being aware to a state where he responds inappropriately, or not at all to sights, sounds or physical stimuli

1-4 (no response - open)

what is the scale score for eye response in Glasgow Coma Scale?

1-5 (no response - oriented & alert)

what is the scale score for verbal response in Glasgow Coma Scale?

1-6 (no response - follows command/movement)

what is the scale score for motor response in Glasgow Coma Scale?

leave patient alone

what should you NEVER do?

instructions, movement, behavior (lack of response)

based on the initial assessment, what three things you should note?

Report to MD immediately

what should you do if the patient develops slurred speech?

RT action

stop the procedure, stay the patient, summon assistance, get the emergency cart, prepare for oxygen & IV administration

contrast media

30% of procedures done in Rad Tech requires some form of:

Iodinated contrast

is a risky type of media to the patient because it can cause an allergic reaction

Anaphalactoid

iodine that mimics an allergic reaction (can be unpredictable)

-1st time given may not have an allergic reaction, but the 2nd time they will OR vice versa

universal precaution for iodine

treat patient as if they will have an allergic reaction

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 bodies tissues to use oxygen and other nutrients needed to maintain a healthy state

compensatory, progressive, irreversible

stages of shock

disturbance of blood flow and lack of perfusion

signs of a shock

120/80 to 140/90

normal BP

compensatory stage

which shock stage has the following:

-blood pressure is normal, then decreases

-anxiety level increases; patient may begin to be -----uncooperative

-HR increases

compensatory stage

which shock stage has the following:

-respirations increase

-bowel sounds are hypoactive

60 to 100 bpm

normal HR

14 to 20 per minute

normal RR

RR and HR increases, U.O. (urine output) and BP decreases

4 cardinal signs of compensatory stage

Progressive stage

which shock stage has the following:

-blood pressure falls-systolic pressure <60 mm Hg

-respiration are rapid and shallow

Progressive stage

which shock stage has the following:

-severe pulmonary edema results from leaking of fluid from the pulmonary capillaries

-tachycardia results & may be as rapid as 150 bpm

Progressive stage

which shock stage has the following:

-patient complaints of chest pain

-mental status changes beginning with with subtle behavior alterations such as confusion with progression to lethargy and LOC

-renal, hepatic, GI, and Heme problems occur

RR and HR increases, U.O. (urine output) and BP decreases

4 cardinal signs of progressive stage

irreversible stage

if symptoms progesses, organ systems of the body suffer irreparable damage, and recover is unlikely

irreversible stage

-blood pressure remains low

-renal and liver failure results

-release of necrotic tissue toxins and an overwhelming lactic acid

lactic acidosis

the symptoms include low blood pH, abdominal and stomach discomfort; decreased appetite; diarrhea; fast breathing; a general feeling of discomfort; muscle pain of cramping; and unusual sleepiness, tiredness, or weakness

RR and HR increases, U.O. (urine output) and BP decreases

4 cardinal signs of irreversible stage

Cardiogenic, Hypovolemic, Anaphylactic, Distributive (neurogenic, septic), Obstructive

Types of shock

shock

bleeding, physical & emotional stress, serious injury or infection, vomiting & diarrhea are causes of:

shock

diabetes, very young or old, severe pain, bowel obstruction, under anesthesia, decompression or rapid fluid loss are causes of:

Neurogenic and Septic

2 types of Distributive shock

hypovolemic shock

- amount (mL) of intrvascular fluid is 750 - 1300 mL

-fluid decreses 15 to 25%

-internal/external hemmorhage

-loss of plasma from burns

hypovolemic shock

-fluid loss from prolonged vomiting, diarrhea, medications or heat stroke

15%

initial hypovolemic shock manifestation blood loss of:

120/80 to 140/90

initial hypovolemic shock manifestation blood pressure is within the limit of:

60 to 100 bpm

initial hypovolemic shock manifestation heart rate of:

slightly anxious

initial hypovolemic shock manifestation, patient will feel:

14 to 20 pm

initial hypovolemic shock manifestation respiratory ranges from:

normal

initial hypovolemic shock manifestation urine output is:

15 to 30%

in Class II hypovolemic shock manifestation blood loss of:

greater than 100 bpm

in Class II hypovolemic shock manifestation hear rate is:

normal (within normal limits)

in Class II hypovolemic shock manifestation blood pressure is:

increasingly anxious

in Class II hypovolemic shock manifestation, the patient feels:

20 to 30 pm

in Class II hypovolemic shock manifestation respiratory ranges from:

decrease

in Class II hypovolemic shock manifestation urine output will:

normal

in Class II hypovolemic shock manifestation blood pressure is:

Class III hypovolemic shock- manifestation

-anxious and confused

-respiratory ranges between 30 to 40 pm

-U.O greatly decreased

-heart rate is greater than 120 bpm

-blood loss of 40 to 40%

Class IV hypovolemic shock- manifestation

-urine output: further diminishes (ceases)

-respiratory is greater than 40 pm

-behavior is confused and lethargic

-HR greater than 140 (weak and thready)

-blood loss more than 40%

-BP 90 to 60 mm Hg

Trendelenburg position

lying on back with body tilted so that the head is lower than the feet

DO NOT [LACE THE PATIENT IN THIS POSITION

cardiogenic shock

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

cardiogenic shock-Causes

myocardial infarction (heart attack) and cardiac dysrhythmias

cardiogenic shock

chest pain that radiates to jaw & arms; dizziness & respiratory distress are all complaints of what kind of shock:

cardiogenic shock

Clinical manifestations of this type of shock includes:

-Cyanosis

-Restlessness & anxiety

-pulse change in LOC

-pulse may be irregular & slow; may have tachycardia & tachypnea

cardiogenic shock

Clinical manifestations of this type of shock includes:

-carotid pulse hard to evaluate & indicates decreased stroke volume of the heart

-decreasing blood pressure

-decreasing urinary output

-cool, clammy skin

Semi-Flower's

RT actions during cardiogenic shock requires a patient to be placed in what kind of position?

administer CPR

RT actions during cardiogenic shock requires a med personnel to be prepared to:

benadryl (antihistamine) and steroids

two types of medications to give patient before injecting iodinated contrast media

-will only minimize the reaction, not a cure

relaxes smooth muscles (in respiratory tract & GI tract)

why do we have patient use steroids before injecting them with iodinated contrast media?

Distributive shock

occurs when a pooling of blood in the peripheral vessel results in decreased venous return of blood to the heart, decreased blood pressure & decreased tissue perfusion.

Distributive shock

the blood vessels are unable to constrict& this results in an inability to assist in the return of blood to the heart.

Distributive shock

may also occur when chemicals released by cells cause vasodilation & capillary permeability, which prompts peripheral blood pooling, AKA Vasogenic shock

Vasogenic shock

may also occur when chemicals released by the cells cause vasodilation & capillary permeability, which prompts peripheral blood pooling

Neurogenic shock

results from loss of sympathetic tone causing vasodilation of peripheral vessels

Neurogenic shock

causes of this type of shock includes:

-spinal cord injury

-severe pain

-neurologic damage

-the depressant action of medication

-lack o glucose

-adverse effects of anesthesia

Neurogenic shock

clinical manifestation of this type of shock includes:

-hypotension

-bradycardia

-warm, dry skin

-initial alertness if not unconscious (head injury)

-cool extremities & diminishing peripheral pulses

Septic shock

has a 40-50% mortality rate for its victims, and within 12 hrs.

Septic shock

single cause of death in ICU's today

septic shock

causes of this type of shock includes:

systemic infection by bacteria, endotoxins are released, the body begins its immune response by releasing chemicals that increase capillary permeability & vasodilatation, leading to the shock syndrome

Septic shock

patients are at higher risk to this type of shock which includes:

-advanced age/very young

-recent surgery

-reinsertion of a urinary catheter

-chronic disease-diabetes, COPD, renal failure

Septic shock

patients are at higher risk to this type of shock which includes:

-patients who are immunosuppressed

-malnutrition

-massive burns or other traumatic injury

-indwelling catheter or prosthesis

-surgery-especially GU tract or biliary tree

First phase of septic shock

in which phase & shock does clinical manifestation include:

-hot, dry, & flushed skin

-increase in HR & RR

-fever, possibly not in elder pts.

First phase of septic shock

in which phase & shock does clinical manifestation include:

-nausea, vomiting, & diarrhea

-normal-to-excessive urine output

-possible confusion, most commonly in elderly pts

Second phase of septic shock

in which phase & shock does clinical manifestation include:

-cool, pale skin

-normal or subnormal temp.

-drop in blood pressure

Second phase of septic shock

in which phase & shock does clinical manifestation include:

-rapid HR & RR

-oliguria or anuria

-seizure & organ failure if syndrome is not reverse

Obstructive shock

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

obstructive shocks-Causes

pulmonary embolism (PE) and Cardiac Tamponade

cardiac tamponade

fluid buildup of the heart preventing the heart to pump normally

Pulmonary embolism

usually the only one that we see in RADT

Obstructive shock

causes of this type of shock include:

-pulmonary embolism

-pulmonary hypertension

-arterial stenosis

-constrictive pericarditis

-tumors that interfere w/ blood flow though the heart

Pulmonary embolism

clinical manifestations of this includes:

-chest pain, often substernal

-rapid, weak pulse

-hyperventilation

-dyspnea & tachypnea

Pulmonary emoblism-clinical manifestations

-tachycardia

-apprehension

-cough & hemoptysis

-diaphoresis

-syncope

Pulmonary embolism-clinical manifestations

-hypotension

-cyanosis

-rapidly changing levels of consciousness

-coma; sudden death may result

Anaphylactic shock

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

Anaphylactic shock

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) are released, causing vasodilatation, which results in peripheral blood pooling

Anaphylactic shock

causes of this type of shock include:

-medications

-iodinated contrast

-insect venoms

crash cart is stocked

before beginning a procedure with Iodinated contrast media, make sure the: