(1) General Info

What is the common term used for Universal Precautions established by the Center for Disease Control?

Standard Precautions

What is the purpose of Universal Precautions?

To prevent infection and confine germs while protecting both the patient and the caregiver

According to Standard Precautions, how should all human blood and certain body fluids be treated?

As if they were known to be infectious for HIV, HBV and other blood borne pathogens

What are examples of Personal Protective Equipment (PPE) used when blood or body fluid exposure is anticipated?

Gowns, goggles, masks, and gloves

Give an example of an engineering and work practice control used in sonography.

Sanitizing equipment between patients or using probe covers during endocavity ultrasound

When is probe sanitization required?

After each patient

How often should exam table linens and pillowcases be changed?

After each patient

In what order should PPE be put on after washing hands?

Gown first, then mask, then goggles, and end with gloves

What is the required duration for hand hygiene according to Standard Precautions?

$20+$ seconds

What two songs are suggested to assist in timing hand washing?

The ABCs or Happy Birthday

What immediate actions should follow contamination of an area with blood or body fluids?

Wash with soap and water, notify your supervisor, and report to occupational health to file an exposure report

When must hand hygiene be performed in relation to glove use?

Before gloves are put on and immediately after they are removed

When should gloves be worn during phlebotomy?

When there is potential contact with blood, body fluids, mucous membranes, or nonintact skin

Is it acceptable to wash gloves for the purpose of reuse?

No, never wash gloves for reuse; discard them after one use

What should be done with the open end of gloves when wearing a protective gown?

The open end should be pulled over the wrist cuffs of the gown

What is the first step in removing the first glove to avoid contamination?

Pull the wrist section toward the fingers, turning the glove inside out as it is removed

In what state should gloves be for disposal?

Both gloves should be inside out and rolled together

What items must be removed before putting on a protective gown?

All watches and jewelry

When removing a protective gown, how should it be pulled off the arms?

Pull it forward from the shoulders using the neck strings and grab the inside shoulder seams

How should a gown be turned as it is removed?

Turned inside out

What should be avoided when handling the part of a facemask that touches the face?

Do not touch that part of the mask

What is the sequence for untying facemask strings after an exam?

Remove gloves first, untie bottom strings, then untie top strings

Are personal eyeglasses or contact lenses considered adequate eye protection?

No

How should goggles be handled during removal to avoid contamination?

Touch only the sides of the goggles; do not touch the front

Which isolation precaution is used for stool incontinence or draining wounds?

Contact Precautions

What are examples of Enteric pathogens requiring isolation?

C. difficile, rotavirus, or norovirus

Identify pathogens associated with Wound and Skin Contact Precautions.

MRSA, VRE, scabies, and impetigo

When is a gown required specifically under Contact Precautions?

If substantial contact with the patient or their environment is expected

What is the primary goal of Droplet Precautions?

To protect others from germs in the patient's nose, mouth, throat, and lungs

List three infections that require Droplet Precautions.

Pneumonia, influenza, and mumps

What type of mask should be worn for close contact with a patient under Droplet Precautions?

A surgical facemask

What must a patient do when exiting their room if they are under Droplet or Airborne Precautions?

Wear a facemask

What is the defining characteristic of Airborne Precautions?

Strict isolation for pathogens transmitted by the airborne route

List three pathogens requiring Airborne Precautions.

Tuberculosis, measles, and chickenpox (varicella)

What specific PPE is required for entry into a room with Airborne Precautions?

A fit-tested N-95 or higher level disposable respirator

When should an N-95 respirator be put on and removed?

Put on before entering the room and removed after exiting

What is Protective Environment Precautions also known as?

Reverse protective isolation

For which patients is Reverse Isolation used?

Patients with extremely impaired immune systems or recent organ transplants

How should equipment be handled for a patient in a Protective Environment?

Cleaned and disinfected before and after leaving the patient room

What does the AIUM recommend regarding the length of ultrasound studies?

Do not prolong studies without reason

The potential benefit of an ultrasound should always outweigh what?

The risk of ultrasound exposure

What is the ALARA principle?

Always use minimum output power and highest receiver gain required to produce optimal images

Which procedures require the use of sterile technique?

Intraoperative, intravascular, angioplasty and catheter based procedures

What blood tests are assessed prior to invasive procedures to evaluate clotting?

PT and INR levels

What is the normal INR range for a patient not on blood thinners?

$$0.9 - 1.3$$

What is the targeted INR range for a patient on blood thinners?

$$2 - 3$$

What must occur before a patient signs an informed consent form?

The physician must answer any questions or concerns

By signing informed consent, what does the patient indicate?

An understanding of the procedure, complications, and expected outcomes

Who must give consent for a patient under the age of 18 or not of sound mind?

A guardian or HIPAA-approved family member

When can a patient revoke consent?

At any time for any reason

If consent is revoked mid-procedure, when should the sonographer stop?

At a point that maintains patient health and safety

What determines the sterile zone on a sterile gown?

The front, from chest to waist and from the hands to slightly above the elbow

Where are tables considered sterile?

At or above the level of the table

How should personnel pass each other in a sterile exam room?

Back to back

What should personnel with colds do when working in a sterile field?

Avoid working or apply a double mask

Which part of a sterile field or package is generally considered non-sterile?

The outer inch edges

What should be done with an item of doubtful sterility?

Discard the item and begin again

When should trays and instruments for a sterile procedure be opened?

At the start of the procedure, NOT before

What is the AHA CPR compression-to-breath ratio for a single rescuer?

$30$ compressions to $2$ breaths

What is the AHA CPR ratio for a child with multiple rescuers?

$15$ compressions to $2$ breaths

What is the recommended CPR compression rate?

At least $100$ compressions per minute

Where should hands be positioned for the Heimlich maneuver on a pregnant patient?

Above the uterus at the base of the sternum

How should a patient experiencing syncope be positioned?

Supine with legs elevated

What are common symptoms of a vasovagal reaction?

Heart rate and blood pressure drop

What are common symptoms of an anaphylactic reaction?

Hives, feeling flush, nausea, vomiting, and shortness of breath

What is the primary goal of ergonomics in sonography?

To design and arrange things so the Sonographer interacts most efficiently and safely with equipment

What does WRMSD stand for?

Work-Related Musculoskeletal Disorders

Where do sonographers most typically suffer from musculoskeletal issues?

Shoulder and neck

What should be the limit for sonographer arm abduction angle?

A small angle

What is the recommended maximum reach distance for a sonographer?

$30\,cm$ or less

What is the minimum weight a sonographer should be able to lift or push?

$$50\,lbs$$

Why are adjustable height tables preferred in ergonomics?

To allow the Sonographer to sit during the exam

What is the ergonomic benefit of adjustable chairs with spinal support?

Reduces spinal disc compression

Where should the ultrasound monitor be positioned relative to the Sonographer?

Level with the line of sight allowing a neutral neck position

What is the maximum recommended angle for wrist flexion or extension?

Less than $15$ degrees

What time of day is preferred for NPO exams like Stress Echoes?

The morning, especially for diabetic patients

What scheduling practice helps prevent repetitive injuries?

Not scheduling the same type of exam back to back

What three pieces of information verify an inpatient's identity?

Birth date, wristband, and medical record number

What must be done to confirm the identity of an unconscious patient without a wristband?

Contact the patient's nurse

What is the Sonographer's role if a patient's identity cannot be verified?

Reschedule the exam until verification is accomplished

Who should receive an easy-to-understand explanation and demonstration of the probe?

A child and their parent

How can communication with a dementia patient be improved during an exam?

Check with the nurse for tips or have a family member present

What physiological measurement should be obtained prior to a resting echo?

Systemic blood pressure

What specific patient information must be entered into the ultrasound system?

First and last name, medical record number, date of birth, gender and sonographer name

Why is a Social Security Number prohibited as an identifier on imaging exams?

State and federal regulations prohibit its use for security

When are higher frequency transducers typically selected?

For thinner or smaller patients

How should a sonographer handle an irregular EKG rhythm during recording?

Set the machine to record $3 - 5$ beat clips

Where should the IV bag be placed during patient transport?

Above the level of the patient's heart

Where should a urinary catheter bag be placed during transport?

Below the level of the patient's bladder

What is the typical NPO requirement for a Stress Echo?

$4$ hours before the test

How long should patients avoid caffeine before a stress test?

$24$ hours

What common foods/drinks contain caffeine that patients must avoid before stress tests?

Soda, chocolate, coffee, and tea

Why is smoking prohibited on the day of a stress test?

Nicotine can disrupt the results

What class of heart medications should be avoided on the day of a stress test?

Beta blockers

List three specific Beta blockers mentioned in the protocol.

Atenolol, carvedilol, and metoprolol

Why must the stress test be rescheduled if nitrates or beta blockers were taken?

The results will be inaccurate

How long is each stage of a treadmill stress test?

$3$ minutes

When is blood pressure assessed during each stage of a stress test?

At the end of each stage while on the treadmill

What is the Borg scale used for?

To report pain or perceived exertion

How is the skin prepared for electrode site placement?

Rub with alcohol, dry, and abrade with a skin prep strip