chapter 11

Chapter Objectives

Appreciate the importance of assessing the patient’s cognitive and neurologic state prior to performing and during a sonographic procedure.
Describe terminology related to medical emergencies.
Recognize the signs and symptoms of various medical emergencies.
Understand the steps that are appropriate for sonographers to take in cases of medical emergencies.

Sonographers need to be equipped to manage patients in poor physical condition.
Emergency situations can occur rapidly due to physiological changes.
Outpatients may present unique challenges, necessitating awareness and readiness.
It is essential to perform a baseline assessment of the patient’s neurologic and cognitive functions prior to examination, as this helps in identifying any alterations during the procedure.

The first response in an emergency is typically to notify the emergency response team (commonly referred to as "calling a code" or "Code Blue").
CPR may be required before the emergency team arrives.
Sonographers must be aware of the location of emergency crash carts, which may differ for adults and pediatric patients.
Upon the emergency team's arrival, assistance may be needed, or sonographers may need to clear the area.
In an outpatient setting, calling 911 may be necessary; hence, familiarity with institutional procedures is vital.

A basic assessment of the patient's neurologic and cognitive functions is critical before any sonographic examination to tailor care effectively.
Complex evaluations of neurologic status exceed the sonographer's role; hence, a simplified approach is needed.
The ACDU scale provides a basic framework for these assessments.
The Glasgow coma scale can measure levels of consciousness.
If there's a notable change in consciousness during the examination, immediate help should be sought.

Shock is the result of a pathological condition or extreme physiological or emotional stress.
The stages of shock evolve along a continuum and can be classified into various types:
- Hypovolemic Shock: Caused by the loss of blood or bodily fluids.
- Cardiogenic Shock: Results from the failure of the heart’s left ventricle.
- Neurogenic Shock: Often caused by nervous system dysfunction.
- Septic Shock: Arises from the immune system's reaction to bacterial invasion.
- Anaphylactic Shock: Results from an extreme allergic reaction.

Report any signs of shock by immediately calling for emergency assistance.
Do not leave the patient unattended; keep them in a position that supports breathing.
Regularly monitor vital signs and document time and types of assistance provided.

Syncope is defined as a temporary loss of consciousness due to insufficient blood supply to the brain.
It can result from various causes including heart disease, hypoglycemia, fatigue, and emotional distress.
Clinical symptoms may manifest as:
- Pallor
- Dizziness
- Nausea
- Hyperpnea
- Tachycardia
- Cold or clammy skin
Certain groups, such as older patients or those on specific medications, are more susceptible to syncope.

In case of syncope:
1. Call for assistance immediately.
2. Place the patient in a supine position and slightly elevate their legs to promote blood flow to the brain.
3. Ensure patient safety to prevent injury during the fall.

Seizures occur due to abnormal neuron activity in the cerebral cortex and can affect consciousness.
They may last seconds to several minutes and can be triggered by factors such as:
- Stress
- Trauma
- Flashing lights
- Odors
Seizures can vary in severity, including:
- Grand Mal Seizures: Involves the total body.
- Complex Seizures: May not be visually apparent.

Call for help immediately.
Stay with the patient throughout the event.
Avoid placing anything in the patient's mouth during the seizure.
Protect the patient's head by cushioning it to prevent injury.
Do not restrain any limb but rather protect them from potential harm.
Do not relocate the patient unless necessary.
Maintain the patient's privacy during the event.
Once the seizure subsides, position the patient in the Sims position or recovery position to facilitate drainage of fluids from the mouth.

A pulmonary embolus refers to a blood clot in a pulmonary artery, obstructing blood flow to the lungs.
This condition carries a mortality rate approaching 50% when untreated.
Risk factors include:
- Age
- Sedentary lifestyles
- Prolonged immobilization
- Recent physical trauma
- Pregnancy
- Hormonal therapies (e.g., estrogen)
- Recent surgical procedures (e.g., hip or abdominal)
- History of Deep Vein Thrombosis (DVT)

A cerebrovascular accident (stroke) arises from obstruction or occlusion of a cerebral artery, leading to hemorrhaging.
Strokes may occur spontaneously and their severity can vary widely.
A transient ischemic

• Diabetes mellitus can produce clinical symptoms including polyuria, polydipsia, and polyphagia.
• There are three types of diabetes:

Type 1: insulin dependent and diagnosed before the age of 30
Type 2: has a gradual onset and usually occurs in people over 40 years of age
Type 3: gestational diabetes, occurs in pregnant women
• Complications include hypoglycemia, diabetic ketoacidosis, HHNS, and coma.
• To prevent a diabetic emergency, patients should be a scheduling priority for early morning examinations that require fasting.
• Inadequate food intake can lead to complications.
• Diabetic ketoacidosis is an acute complication that results from insufficient insulin and hyperglycemia.
• In cases of suspected hypoglycemia, some employers may advise the sonographer to provide a sugary snack, while others strictly prohibit this practice.
• If a patient faints, follow emergency response procedures for syncope.