Medical Emergencies

Shock Definition

• Failure of the circulatory system to support vital body functions

• Dangerous, potentially fatal

Signs and Symptoms of Shock

• Restlessness

• Apprehension

• Anxiety

• Tachycardia - may be as rapid as 150 bpm

• Decreasing blood pressure

• Decreased urination

• Increased and shallow respirations

• Cold and clammy skin

• Pallor accompanied by weakness and change in thinking ability

Radiographer’s Response to Shock

• Stop the procedure

• Call for help

• Maintain the patient’s body temperature

• Measure patient’s vital signs while waiting for help

• Be ready to perform CPR and administer oxygen

• Chart the occurrence

• Call code if necessary

Classifications of Shock

• Hypovolemic

• Cardiogenic

• Distributive

  • Neurogenic

  • Septic

  • Anaphylatic

• Obstructive

Hypovolemic Shock

• Loss of blood or tissue fluid

• Occurs when a large amount of blood or plasma has been lost

• External hemorrhage, lacerations, plasma loss from burns, or severe dehydration from vomiting, diarrhea, or diuresis, and internal bleeding

• Treat with fluid replacement, oxygen administration, and medications to promote vasoconstriction

Signs and Response to Hypovolemic Shock

• Signs:

  • Excessive thirst due to fluid loss

  • Cold extremities

  • Cold and clammy skin

  • Cyanosis starting with lips and nails

  • Blue discoloration of tongue and soft palate

• Radiographer’s Response

  • Do not offer fluids

  • Place in Trendelenburg if no spinal injury

  • Apply pressure to open wound with blood loss

Cardiogenic Shock

• Cardiac failure caused by interference with heart function

• Results from cardiac failure or interference with heart function

• Most vulnerable is the patient that has been hospitalized for myocardial infarction, cardiac tamponade, dysrhythmias, or other cardiac pathology

• (Cardiac Tamponade - A blow to the chest that causes hemorrhage into the pericardium, resulting in pressure that interferes with the heart’s ability to pump)

Signs and Response to Cardiogenic Shock

• Signs

  • Chest pain radiating to jaws and arms

  • Dizziness

  • Cyanosis

  • Irregular pulse

  • Decreasing blood pressure

  • Cool, clammy skin

• Radiographer’s Response

  • Semi-Fowler’s position

  • Prepare for CPR

  • Be prepared to assist with oxygen and vitals

Distributive Shock

• Poor distribution of blood flow from vassal dilation. Vessel dilated and no pressure, like a water hose with no water pressure

• 3 types

  • Neurogenic - Caused by damage to upper spinal cord

  • Septic - Caused by massive infections

  • Anaphylactic - Allergic reaction

Neurogenic Shock

• Occurs in reaction to an injury to the upper spinal cord and is an acute situation that demands immediate, drastic intervention

• Signs

  • Hypotension

  • Bradycardia

  • Warm dry skin

  • Cool extremities and diminishing peripheral pulses

  • Initial alertness if not unconscious due to head injury

Septic Shock

• Caused by a massive infection, usually by gram-negative bacteria. It produces toxins that increase vasodilation, and causes the blood pressure to drop sharply

• Signs

  • Fever

  • Confusion

  • Nausea, vomiting, diarrhea

  • Drop in blood pressure

  • Rapid heart rate

  • Seizures

• (Gram-negative bacteria do not retain crystal violet dye in the gram staining protocol unlike gram-positive bacteria. Gram-negative bacteria are more resistant against antibiotics, because of their relatively impermeable cell wall

Anaphylactic Shock

• Also known as allergic shock

• The most common causes of anaphylaxis are medications, iodinated contrast agents, and insect venoms. The path of entry may be through the skin, respiratory, or gastrointestinal tract, or through injections

• Usually the more abrupt the onset, the more severe the reaction will be

• (The most frequent type of shock seen in the imaging department due to the use of contrast agents containing iodine that some patients are allergic to. Patients at high risk or prior reaction may be treated prior to the contrast exams with antibiotic and a benadryl injection)

Anaphylaxis and Contrast

A meticulous history of previous allergic responses that the patient may have had to any medication or food, including previous incidents when receiving contrast agents in imaging must be obtained. If any of these responses are reported, the radiologist must be informed prior to injection of contrast media

Allergic Reaction to Contrast

• Nasal congestion, itching sneezing, swelling

• Tingling at site

• Tight chest, mouth, or throat

• Anxiety

• Flush, warm fleeing

• Dyspnea, coughing, wheezing

• Weak

• Decrease blood pressure

• Seizures, respiratory, or cardiac arrest

Response to Allergic Reaction

• When iodinated contrast agents are being used for diagnostic procedures, observe the patient continuously for sign of allergic reaction. Quick action must be taken if symptoms are observed

• Stop injecting

• Get help

• Monitor vitals

Latex Allergic Reactions

• Reaction to substances in natural latex. Rubber gloves are the main source of allergic reaction

• About 5-10% of health care workers have some form of allergy to latex

• Certain medical conditions or circumstances increase some groups risk for developing an allergy

Routes of Latex Exposure

• Skin - Wearing rubber gloves

• Mucous Membranes - Eyes, mouth, vagina, rectum

• Inhalation - Powder from rubber gloves inhaled

• Blood - When some medical devices containing rubber are used

• (Health care items that may contain latex are items such as tourniquets, EKG pads, some adhesive bandages, catheters, plunger of syringe. Important to ask patient if they have a latex allergy. If you are exposed to a lot of latex, you can develop an allergy over time)

Types of Latex Reaction

• Irritant Contact Dermatitis

  • Non-allergenic skin reaction. Dryness, itching, burning, scaling, and skin lesions

• Allergic Contact Dermatitis

  • Delayed reaction. Same as above, but more severe. Lasts longer and spreads

• Immediate Allergic Reaction

  • Latex hypersensitivity. Most serious. Rhinitis, conjunctivitis, cramps, hives, and severe itching. It can increase to rapid heartbeat, tremors, chest pain, difficulty breathing, anaphylactic shock, or even death

Treating Latex Allergy

• Treat by removing the latex product and drug treatment according to the type of symptoms developing

• Irritant contact dermatitis - use antihistamine and/or corticosteroid (Epipen)

• Severe reaction - May also need epinephrine, iv fluids, and other emergency support

• *If you or a pt experience severe symptoms, call 911 immediately or alert the emergency team

Obstructive Shock

• Blocking blood flow

• Extracardiac obstruction to blood flow

• Common causes: Tension pneumothorax, tamponade, pulmonary embolism

Diabetic Emergencies

• Diabetes Mellitus

  • Caused when the body does not produce enough insulin or it cannot use its own insulin, causing sugars to build up in the blood. Insulin is a hormone normally produced in the pancreas in response to food intake

• Resulting in hypoglycemia or hyperglycemia

Hypoglycemia

• Also known as insulin shock

• Occurs when insulin treatment is given and not accompanied by adequate food intake

• It is usually linked with diabetes, but many other conditions can cause low blood sugar in people who do not have diabetes

• If patient is still alert, you can treat with a small amount of candy or fruit juice. If severe, treat with injection of glucagon or IV of dextrose solution

Hyperglycemia

• Insufficient insulin prevents the use of glucose by the muscles, causing the glucose level in the blood to rise

• Treat with insulin

• Has a slow onset and may cause coma when untreated. It is treated with insulin administration or oral hypoglycemic agents

Hyperglycemia Complications - Diabetic Ketoacidosis

• Occurs when you fail to treat hyperglycemia. When your body breaks down fats, waste product called ketones are produced. Your body cannot tolerate large amounts of ketones and will try to get rid of them through the urine. Unfortunately, the body cannot release all the ketones and they build up in your blood which can lead to ketoacidosis

• (Production of ketones to reach a level of ketosis is the basis of ketogenic and low carb diets)

Hyperglycemia Complications - Hyperglycemic Hyperosmolar Nonketotic Syndrome (HHNK)

• Also known as “diabetic coma” develops when the blood sugar reaches such a high level that the blood becomes thick and syrupy

• Excess sugar passes from your blood into your urine, triggering a filtering process that draws tremendous amounts of fluid from your body

• Left untreated, it can lead to life threatening dehydration. LOC varies from confusion to coma or seizures. Treat with fluid to increase circulation and urine output

Signs and Symptoms of Hypoglycemia

• Sweating

• Trembling

• Dizziness

• Mood Changes

• Hunger

• Headaches

• Blurred Vision

• Extreme Tiredness and Paleness

Signs and Symptoms of Hyperglycemia

• Dry mouth

• Extreme Thirst

• Frequent Urge to Urinate

• Drowsiness

• Frequent Bed Wetting

• Stomach Pain

Radiographer’s Response to Diabetic Complications

• Stop procedure

• Notify Radiologist

• Do not leave patient

• Monitor vital signs and prepare to administer IV fluids, medication and oxygen as needed

Cerebrovascular Accident (CVA/Stroke)

• Interruption of blood supply to the brain due to rupture of an artery that causes hemorrhage

• Or an occluded artery impeding circulation.

• It occurs most frequently in the elderly, but can occur at any age

Transient Ischemic Attacts (TIA/Ministrokes)

• Similar symptoms as CVA, but usually only last a few minutes or up to a few hours.

• Frequent precursor to more permanent damage.

• Mostly associated with a partial obstruction of a vessel that temporarily reduces the oxygen level in a part of the brain

Signs and Symptoms of CVA/TIA

• Confusion

• Dizziness

• Numbness, weakness or paralysis (usually on one side of the body)

• Loss of bowel or bladder control

• Impaired vision

• High blood pressure

• Nausea or vomiting

• Seizures

• Unequal pupils

• Headache

• Loss of vision in one eye

• Unconscious (Uncommon)

• Dysphasia (Difficulty speaking, slurred speech)

• Dysphagia (Difficulty swallowing)

• (Requires prompt recognition and treatment with clot dissolving medication for occlusion of cerebral vessels or surgical intervention for hemorrhagic stroke due to leakage of a vessel in the brain)

Seizures

• Occur as a result of a focal or generalized brain function disturbance and are accompanied by a change in the LOC

• Types

  • Grand Mal - “Convulsive” major motor seizure that may be preceded by an aura or premonitory sign

  • Petit Mal/Absence Seizure - “Non Convulsive” brief loss of consciousness during which the patient stares or may lose balance and fall

Response and Treatment of Seizures

• The seizure will run its course. Protect patient from harm

• Patients may take anticonvulsant medications

• Cushion head, remove glasses

• Loosen tight clothing

• Turn on side

• Time the seizure

• Don’t put anything in mouth

• Look for ID

• Don’t hold down

• Offer help as seizure ends

Epitaxis - “Nosebleed”

• Supply the patient with tissues

• Instruct them to breath through the mouth and squeeze firmly against the nasal septum for 10 minutes

• Do not allow them to lie down, blow their nose, or talk

• Advise them to spit out blood that runs down nasopharynx rather than swallow it

Vertigo

Dizziness. Often a precursor to syncope

Syncope

• Fainting

• Loss of consciousness from an insufficient blood supply to the brain

• Assist the patient to a safe position

• If the patient does not respond quickly, administer spirits of ammonia to bring a return to consciousness

• Reasons:

  • Heart Disease

  • Hunger

  • Poor ventilation

  • Emotional trauma

Nausea and Vomiting

• Tends to be psychological and physiological

• Instruct the patient to breathe slowly and deeply through their mouths

• If this does no work, assist patient to a sitting or lateral recumbent position

Postural Hypotension

• Also known as “Orthostatic Hypotension”

• A drop in blood pressure due to a change in body position when a person moves from sitting to standing or lying down to sitting or standing. This normally occurs in the elderly

• The change in position causes a temporary reduction in blood flow and therefore a shortage of oxygen to the brain

• Leads to lightheadedness or a loss of consciousness

• Slow the process of changing from one position to the other to allow the body to adjust

• This is a major cause of elderly patients breaking their hip which is very dangerous. Allow patient to sit up and get their bearings for a minute before having them stand

Asthma

• Condition in which the airways narrow and swell and product extra mucous

• This can make breathing difficult, trigger coughing, wheezing, and shortness of breath

• Severe asthma attack can be life threatening with symptoms such as rapid worsening of sob or wheezing, no improvement after inhaler, sob with minimal activity

• Quick relief inhalers (bronchodilators) quickly open swollen airways that are limiting breathing. In some cases allergy medications are necessary