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UNIT 1: Emergency Trolley

Definition

  • Emergency Trolley: A means of storing and transporting vital equipment and drugs needed during an emergency.

Importance and Location

  • The crash trolley must be placed in an easily accessible position, centrally located to the patient care areas.

Functionality of the Crash Trolley

  • The crash trolley serves as a mobile station within the radiology department containing everything necessary to handle life-threatening situations.

  • Advantage: The primary advantage of the crash trolley is that it facilitates immediate treatment at the patient’s location when needed.

Maintenance and Checks

  • A checklist must be used to document that the crash trolley is checked by:

    • The head nurse,

    • Nursing staff, every shift.

  • Standardization is crucial.

  • Items on the crash trolley should be checked monthly for expiry.

  • The defibrillator must be regularly checked by trained department staff or as needed.

  • Each unit must have a crash trolley placed in an easily accessible location.

General List of Crash Trolley Items

  • Defibrillator for sudden cardiac arrest.

  • Suction Device with bag valve masks.

  • Essential Medications:

    • Epinephrine,

    • Atropine,

    • Dopamine,

    • Vasopressin,

    • Amiodarone,

    • Lidocaine.

  • Equipment for establishing intravenous access, both peripheral and central.

Arrangement of Crash Cart

Top Shelf Items

  • Disposable gloves.

  • Monitoring and life support equipment.

  • Defibrillator (including leads and paddles).

  • Sharp disposal container.

  • Ambu bag (adult) with mask.

  • Oxygen tank.

  • Rigid plastic backboard.

  • Suction mechanism.

Drawer 1: ECG and Electrodes

  • Contents:

    • ECG gel,

    • Five electrodes (suitable for both children and adults).

Drawer 2: Airway Management

  • Contents:

    • Wooden tongue depressors,

    • One endotracheal stylet for both children and adults,

    • Endotracheal tubes in sizes ranging from 2.5 to adult sizes,

    • Disposable airways: sizes 0, 1, 2, 3, 4 (one of each).

    • Two 10 cc syringes,

    • 10 small pieces of Dyna plast (pink sticky tape),

    • Two laryngeal masks (sizes 3 and 4).

Drawer 3: Venipuncture Supplies

  • Contents:

    • Venipuncture tubes,

    • Five IV dressings,

    • 30 spirit swabs,

    • 10 cotton swabs,

    • Two packets of sterile gauze,

    • Disposable kidney trays,

    • Multi-lumen catheter,

    • Micropore plaster (10 strips of 1-inch).

Drawer 4: Medications

  • Store the most common medications ranging from pain relief (e.g., analgesics) to sedation drugs.

Drawer 5: IV Fluids

  • Contents:

    • 1000 ml normal saline (NS),

    • 500 ml normal saline (NS),

    • 100 ml normal saline (NS).

Drawer 6: Suction Catheter Supplies

  • Store two of each catheter size for proper fitting for patients.

Drawer 7: Emergency Tapes

  • Adult (15-gauge) and Pediatric (18-gauge) emergency tape.

Endotracheal Tube (ET Tube)

  • Purpose: The endotracheal tube maintains an open passage through the upper airways to allow air to pass freely to and from the lungs, facilitating ventilation.

Key Tips for Arranging Medical Crash Carts

  1. Ensure all labels on medications are clear and easy to locate.

  2. Clearly distinguish between pediatric and adult items.

  3. Assign one person to restock and manage the medical crash carts.

  4. Place adult and pediatric crash carts in easily accessible areas, preferably in lower traffic zones to minimize obstruction.

  5. Educate hospital staff on patient care and the use, restocking, and location of crash carts in emergencies.

Emergency Medication List

Actions of Select Drugs

  • Adrenaline: Increases cardiac output, constricts blood vessels, raises blood pressure, and relaxes bronchioles, aiding respiration.

  • Aminophylline: Reverses bronchospasm (as in bronchial asthma).

  • Atropine: Acts as a respiratory stimulant and dilates bronchi.

  • Caffeine Sodium Benzoate: Maintains normal blood glucose concentrations (antagonistic to insulin).

  • Diuretics and Anti-Angina Drugs: Used for managing angina and hypertension.

  • Glucagon, Lasix, Nitroglycerin, Isorbide Dinitrate, Hydrocortisone, Lignocaine, Diazepam, Calcium Gluconate, and Dopamine: Various roles including treating cardiac arrhythmias or as anti-convulsants.

Common Medical Emergency Situations Seen in Radiology

  1. Anaphylaxis: Severe allergic reaction.

  2. Bradycardia: Heart rate less than 60 beats per minute with a regular rhythm.

  3. Bronchospasm: Contraction of smooth muscles in bronchi causing narrowing of airways.

  4. Diaphoresis: Excessive sweating.

  5. Periorbital Symptoms: Symptoms relating to the periosteum of the orbit, often associated with eye issues.

  6. Psychosis: Impaired mental state affecting reality recognition and communication.

  7. Syncope: Fainting spells.

  8. Tachycardia: Heart rate exceeding 100 beats per minute.

  9. Hypovolemic Shock: Decreased intravascular fluid leading to inadequate blood flow; occurs when fluid volume drops by 15-25% (750-1300 ml).

Hypovolemic Shock Management for Radiographers

  • Stop ongoing radiographic procedures.

  • Position the patient supine with legs elevated 30° (unless head/spinal injuries are present).

  • Notify the physician and request assistance from nursing staff.

  • Ensure airway patency.

  • Prepare to provide oxygen, IV fluids, and medications.

  • Monitor vital signs every five minutes.

  • Do not leave the patient unattended.

Anaphylactic Shock in Radiographic Imaging

  • Definition: An anaphylactic shock is an exaggerated hypersensitivity reaction characterized by the release of histamine and bradykinin, causing widespread vasodilation and smooth muscle contraction, particularly in the respiratory tract. This can lead to shock and respiratory failure, with the severity correlating with the onset speed.

  • Common Triggers: Medications, especially iodinated contrast agents, are frequent causes. A thorough history of previous allergic reactions to such agents is crucial for patient safety prior to imaging procedures.

Complications of Diabetes Mellitus

  1. Hypoglycemia: Low blood sugar usually from inadequate food intake or excessive insulin.

  2. Diabetic Ketoacidosis: Insufficient insulin leading to excessive glucose production and resultant dehydration.

  3. Hyperosmolar Nonketotic Syndrome (Coma): Can occur in elderly individuals with type 2 diabetes mellitus.

Radiographer Responsibilities

  • Stop procedures and notify the radiologist.

  • Monitor vital signs and prepare IV fluids or medications as needed.

Trolley Settings for Barium Series Procedures

  • Before fluoroscopic procedures, prepare the barium trolley with necessary items:

    • Barium (positive contrast media), air or CO2 (negative contrast media).

    • Common supplies include:

      • Tissue for spills or vomiting,

      • Drinking straws,

      • Spoons for stirring barium solutions.

    • Maintenance includes thorough cleaning and sterilization of all barium containers and utensils post-use.

Trolley Preparations for Barium Enema

  • Use diluted solutions at 37°C for rectal administration.

  • Administering warm enemas can stimulate bowel activity, so exercise caution.

Equipment for Barium Enema

  • Rectal catheters, disposable paraphernalia (if applicable), and enema retainers.

  • After each procedure, ensure thorough cleanup and maintenance of the trolley for procedural readiness.

Trolley Setting for Intravenous Injections (IUP)

  • Follow strict asepsis rules during preparation, including:

    • Sterile syringes, needles, and gauzes.

    • Ensure all equipment is pre-sterilized and packed.

  • Non-sterile items include:

    • Contrast medium and cleansing lotions.

Needles and Syringes for Injections

Needles

  • Proper selection based on muscle depth and patient body composition is critical.

  • Needle types include:

    • Intramuscular, hollow needles with specific gauge sizes indicated by color.

Syringes

  • Syringes consist of:

    • Barrel: Holds the medication.

    • Plunger: Moves to draw in or expel the drug.

    • Different types of syringes are available (e.g., regular, luer lock, catheter).

  • Types of Syringes: types of syringe:

    • Regular,

    • Luer Lock,

    • Catheter,

    • Toomey (for irrigation), etc.