Unit 4 (Emergency)
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. What would you like to do?
how long can the central nervous system do without oxygen without causing irrepairable brain damage?
list the types of shock and identify characteristics of each:
- hypovolemic: loss of blood from injury for internal hemorrhage (burns, severe dehydration)
- septic: massive Infection, usually by gram-negative bacteria
- neurogenic: injury to the nervous system caused by head or spinal trauma
- cardiogenic: cardiac failure caused by interference with heart function (embolism, cardiac tamponade, or anesthesia)
- vasogenic: due to deep anasthesia, trauma to spinal cord
- anaphylactic: contact with foreign substances, usually proteins to which the individual has become sensitized
- psychologic: mental trauma caused by psychological events (shellshock, PTSD)
what is the vital sign that most accurately indicates a change in LOC or shock?
a patient whose glucose level has dropped may demonstrate what types of symptoms?
- a sudden onset of weakness
- loss of consciousness
what is the heimlich maneuver performed for?
to clear the airway/ to dislodge an object in the throat
what flow rate of oxygen should patients with COPD or emphysema be administered?
never more than 2 L/min
if a patient's throat or upper trachea begins to swell, what may result if not treated quickly?
- respiratory arrest, cardiac arrest, or seizures.
- may be fatal if not treated promptly.
an unconscious patient who is vomiting should be placed in what type of position?
lateral recumbent with the head turned to the side and airway cleared
A sensation that feels as if the room is spinning and is often accompanied by nausea, is referred to as:
what condition would be responsible for vertigo?
- an inner ear disturbance or a lesion in the brain or spinal cord
- sudden onset may be because of TIA or CVA
what should you do to care for a patient who is experiencing a seizure?
notify a physician, request assistance, do not leave the patient, remove hazardous objects, place padding under patient's head, do not restrain patient, and do not force objects into patient's mouth.
the type of fracture that results in the crushing of a bone in at least three places is referred to as a ____________ fracture.
an emergency drug given to relieve anaphylactic reaction is:
asthma patients usually carry a ___________ containing bronchodilation medication.
nebulizer/metered dose inhaler
patients with massive trauma are not removed from the backboard until __________ fracture has been ruled out.
list items that should be found on a crash cart:
- blood pressure cuff
- ET tubes
- suction catheters
- suction bottle
- tracheostomy tubes
- bag valve mask
- ambu bag
- tongue blades
- protective gowns, eyewear, masks
- cut down tray
- IV solutions/tubing
- IV canulas
- blood collection tubes
- drugs (according to institutional protocol)
- pen/paper checklist of inventory
Some emergency cart medications:
- Adrenaline (epinephrine)
- Aminophylline: reverse bronchospasm
- Atropine: respiratory stimulant
- Benadryl: antihistamine
- Caffeine sodium benzoate: diuretic
- calcium chloride: combats tetany
- Decadron (dexamethasone): antiinflammatory
- Digoxin (digitalis): increases cardiac output
- Dilantin (phenytoin): anticonvulsant
- Glucagon: increases blood sugar
- Heparin: inhibits blood coagulation
- Inderal (propranolol): cardiac antidysrythmic
- Isoptin (verapamil) cardiac antidysrythmic
- Isuprel (isoproterenol): relieves bronchospasm
- Lasix (furosemide): diuretic
- Levophed (norepinephrine, levarterenol): raises blood pressure
- Narcan (naloxone): opioid antagonist
- Nitrostat (nitroglycerin): vasodilator, increases circulation
- Sodium Bicarbonate: combats acidosis
- Solu-Medrol (methylprednisolone): antiinflammatory
- Sterile water: diluent
- Theophylline: stimulate respiratory, mild diuretic
- Valium (diazepam): tranquilizer
- Xylocaine (lidocaine): anesthetic
foreign body obstruction in small children or infants should be suspected if there is a sudden onset of ____________ and/or ______________.
- stridor (a harsh sound on inspiration)
The Glascow Coma Scale can be used to measure:
changes in LOC (levels of consciousness) over time
after contrast administration, if the patient begins to feel nauseated, this would be classified as a _________ reaction.
what should be done for the patient who experiences a mild reaction to contrast media?
provide emesis basin, alert radiologist, and continue to observe patient carefully, but no treatment is needed because symptoms will resolve on their own
a vasovagal reaction is a response born of ___________.
tachycardia would be a _________ reaction to contrast media.
moderate to severe
the medical term for hives is:
laryngeal edema is classified as a __________ reaction and should be treated immediately.
what should you do if wound evisceration occurs?
- ease the patient into a recumbent position or semirecumbent position (FOWLERS) to take the strain off the abdominal area
- cover wound with moist, sterile towel
- and summon a surgeon immediately (surgery required)
should you remove an abdominal binder from a post surgery patient?
what are the two basic methods used to measure hypoxia?
- blood gases
- pulse oximeter
is oxygen flammable?
no, but it is combustible
describe the procedure used when transferring a patient from one oxygen source to another:
- check flow rate of oxygen
- turn on and adjust the source you will be transferring the patient to before removing the patient from their current source
- remove the patient from their current source and place on the new source as quickly as possible
when is a Venturi oxygen mask used?
- when the patient needs a mixture of oxygen and room air
- the concentration of oxygen can be precisely controlled (ex. COPD patients)
how is a nasal catheter used?
a tube goes in the nose and directly into the trachea, delivering oxygen
the purposes of a mechanical vent are:
to regulate the amount of air inhaled, amount of oxygen supplied, and the rate of respiration to patients unable to breathe on their own
what type of tube is used with a ventilator?
ET tube (endotracheal tube)
why should contaminated materials be quickly discarded when treating patients on oxygen?
because infections spreads easily in oxygenated environments
should you administer oxygen to a patient who has asthma?
- no, it won't help. the objective is to relieve the bronchospasm.
- have them use their medication (nebulizer) or call respiratory therapy
what is an MI?
- myocardial infarct
- the most common cause of cardiac arrest
- "heart attack"
what is a pulmonary embolism?
a blood clot that suddenly blocks one of the main arteries of the lung
describe a contrecoup injury:
a severe blow to the head causes the brain to bounce from side to side, resulting in an injury on the side opposite the below
list the four levels of consciousness:
- alert and conscious
- drowsy but responsive
- unconscious but reactive to painful stimuli
- an injury that does not disrupt the integrity of the skin
- caused by a blow to the body and characterized by swelling, discoloration, and pain
- commonly called a bruise
a serious, unexpected event that demands immediate attention
it has been proven that trauma victims stabilized within ________ have a greater chance of recovery.
an hour of injury (the"golden hour")
what are the first three functions checked for a trauma patient?
- cardiac function
- respiratory function
- spinal function
what are the first three x-rays performed on a trauma patient?
- x-ray chest
- x pelvis
- cross table lateral c-spine
what do you call a condition in which three or four ribs are broken on the same side causing lack of stability?
trauma patients are transported _______________ until spinal fracture has been ruled out.
on a backboard
what are the main reasons to perform a chest x-ray on a trauma patient?
- to check for a flail chest
- to check for ET tube placement
what is the main reason to perform a pelvis x-ray on a trauma patient?
pelvic fractures can cause internal damage or internal bleeding
what is the main reason to perform an x-ray of the c-spine on a trauma patient?
at what level should the ET tube be placed?
just superior to the carina (T4-T5)
what technique is most often used for a cross table lateral c-spine?
- 70 to 80 kvp
- 20 mAs with grid
- 5 to 7 mAs without grid
where do you center for a cross table lateral c-spine?
why is a grid optional for a cross table lateral c-spine?
air gap diverts scatter
in what order do you prioritize patients when you have multiple emergencies?
- STAT orders at once
- highest priority - respiratory distress or unstable vital signs
- in moments of equal distress, radiograph the patient that can be done quicker
name some aspects of the upkeep of a crash cart:
- must be kept locked
- the inventory must be updated regularly
- usually one person is in charge of it on a daily basis
where are most crash carts for radiology departments located?
- in or close to CT
- due to the fact that they often handle critical patients and administer contrast via high-power injectors
decreased level of oxygen in the blood:
the state of receiving no oxygen:
name some things the body does to compensate for hypoxia:
- respiratory rates increase
- depth of breathing (SOB)
- blood pressure increases
- heart rate increases
- nail beds, lips, mucous membranes turned blue
at what point should oxygen administration be considered?
when the oxygen saturation level of the blood goes below 95%
blood gases are measured in blood drawn from:
name two places oxygen is usually obtained in healthcare facilities:
- a wall outlet
- a compressed oxygen tank
name some aspects included in both a wall outlet or a compressed oxygen tank:
- a method for humidifing the oxygen
- a length of tubing
- method of administration
portable oxygen tanks may contain up to ___________ of pressure and should be handled with care.
2000 pounds per square inch
who is in charge of checking that oxygen tanks in a facility are full?
name three main types of oxygen administration methods:
- nasal prongs or nasal cannula
- nasal catheter
- oxygen mask
name five different types of oxygen masks:
- face mask (fits over nose and mouth)
- Venturi mask (for half oxygen, half room air)
- face tent ( blows oxygen upward, not fitted)
- non-rebreather mask(on patient exhale, CO2 goes out a valve)
- tracheostomy collar (fits over trachea opening in the neck)
give some characteristics of nasal prongs or nasal cannula:
- half inch or less in length
- fits into nostrils
- administers 1 to 6 L/m
give some characteristics of a nasal catheter:
- approximately 16 inches long
- goes into the trachea through the nose
- for administering greater than six L/m
which method of oxygen administration is most commonly used in pediatric units?
give an alternate name for a mechanical ventilation system:
what can happen if an ET tube is placed too low into the bronchi?
- can cause atelectasis (lung collapse)
- can cause pneumothorax
- can cause damage to the wall of the trachea, bleeding
name some things that must occur for a patient that must be transported while on a respirator:
- should be accompanied by a respiratory therapist and a nurse
- must be put on manual (ambu bag) not mechanical
name an often overlooked danger associated with suctioning:
it can interfere with arterial oxygenation
if performing suctioning when should you oxygenate?
before and after
concerning suctioning, what is a radiographer authorized to do?
never go more than halfway into the mouth, call the nurse for help
when is the only time suctioning should be used?
when the patient cannot discharge secretions by coughing
what is the universal distress signal for choking?
clutching at the throat with both hands
a common disease of the bronchial tubes:
asthma attacks are frequently brought on by:
a condition in which the coronary arteries are unable to supply the heart with sufficient oxygen due to constriction:
angina pectoris chest pain is usually brought on by _________ or ___________ and is relieved by _________ or ____________.
- stress or exertion
- relaxing or sublingual nitroglycerin
what must you always assume if a patient complained of chest pain?
that he is having a heart attack until proven otherwise
a heart attack or cardiac arrest is often precipitated by what type of pain?
ischemic pain: lack of oxygen, becomes necrotic
name some common symptoms that go along with cardiac arrest:
- become extremely diaphoretic
- irregular heartbeat
- shortness of breath
what should you do if a patient suffers shortness of breath?
elevate the head and administer a low flow of oxygen (3-5 L/m)
name some symptoms of cardiac arrest associated more with women versus men:
- women: pain in the back, gastrointestinal pain
- men: pain in the jaw, pain in the left arm
what can often give the same symptoms as a heart attack:
what does cardiac arrest technically define?
loss of heart function/no heartbeat
what type of CPR should be administered to a patient in cardiac arrest?
what type of CPR should be administered to a patient in cardiopulmonary arrest?
compressions and breaths
name the steps you should go through in a case where you must administer CPR:
- first shake the patient and shout, trying to rouse them
- check the carotid artery for a pulse/check for breathing
- call a code
- 30 compressions/2 breaths/repeat
in the case of a myocardial infarct how many patients die before they reached the hospital?
50% of patients
what is the most common cause of cardiac arrest?
what is the most common cause of sudden death?
vfib ( ventricular fibrillation)
when a defibrillator is in use what is the minimal distance you should maintain from the patient?
name four main types of head injuries:
- contrecoup injury
- intracranial pressure (ICP)
a bruise or bleeding of the brain:
how quickly can a patient's level of consciousness change?
in a matter of seconds
what scale of numbers does the glascow coma scale use?
one being the lowest, 15 being the highest
when moving a trauma patient what type of approach should be used?
the "log role" approach (at least 2 people)
the term for blood in the pleural cavity:
the term for fluid buildup in the pleural cavity:
the term for air in the pleural cavity:
how should a patient with a suspected flail chest be positioned?
positioned onto the affected side, allowing a more expansion of the lungs
compression of the heart due to a direct blow, can result in death:
the term for a fracture in which the bone pierces the skin:
- compound fracture
- open fracture
- (open reduction)
a term for a fracture in which the bone does not pierce the skin:
- closed fracture
- simple fracture
- (closed reduction)
what type of bones are more likely to throw blood clots?
long bones, especially those of the lower extremity
an incomplete fracture in which the bone bends until it cracks or bows:
greenstick fracture (common in children)
a fracture that runs across the shaft of the bone, usually complete:
a complete fracture in which one piece of bone shifts up and over the other:
a fracture that runs down the length of the bone, usually from a twisting injury
spiral fracture (common in child abuse)
a fracture located in the spine, in which the body of the vertebrae collapses:
a type of fracture most often caused by a direct blow in which fragments are directed inward:
- depressed fracture
- can also be caused by a plaster cast being too tight
a type of fracture that is seen primarily in the radius from trying to catch a fall:
what changes in technique should be made to compensate for a plaster cast?
increased kv by 10 or double the mAs
what changes in technique should be made to compensate for a fiberglass cast?
increase kv by 3 to 5
a specific transverse fracture of the spinous process of C7:
- Clay Shoveler's fracture
- can cause paralysis
- seen often in car accidents
a specific oblique fracture of the ulna in which fragments override each other:
a fracture in an area of bone weakened by a disease process, usually a cancer tumor or cyst:
a fracture that is specific to the epiphyseal plate of the ankle:
- Salter fracture
- usually accompanied with a bi maleoli fracture
- can affect the growth of the bone
a post-surgical complication in which the suture becomes separated:
- wound dehiscence
- common with abdominal surgery
a post-surgical complication in which the organ can push or fall through where the wound has separated:
name some common symptoms of diabetes:
- extreme hunger
- extreme thirst
- nausea and headache
- seeing halos around lights
- polyuria (excessive urination)
- increased fatigue/irritability
name two distinct types of diabetes:
- diabetes insipidus (DI)
- diabetes mellitus (DM)
which kind of diabetes is further classified into two types? what are the two types?
- diabetes mellitus
- Type 1 (insulin-dependent), Type 2 (common in obesity over age 40 and can run in families)
which type of diabetes is induced by problems with the kidneys or the pituitary gland that causes glucose to be excreted in the urine while blood glucose levels remain normal?
which type of diabetes is usually characterized by a lean individual under age 25 who produces little or no insulin and may develop circulatory impairment of vision, kidneys, or extremities?
diabetes mellitus, type 1
an enzyme produced in the pancreas that helps metabolize sugar:
occurs in persons with diabetes mellitus and is caused by a surplus of insulin in the blood stream:
give some symptoms of hypoglycemia:
- lethargy or slowed reflexes
- sweet or fruity breath
- nausea, vomiting, or abdominal pain
- shock, renal failure, death
what are the two most important questions to ask a patient that could be experiencing complications of hypoglycemia?
- have you eaten?
- have you taken your medication?
an agent administered for several g.i. studies that should not be given to diabetic patients:
a hormone made by the pancreas that increases blood sugar:
explain the difference in insulin shock versus a diabetic coma:
- insulin shock is when the blood sugar drops dangerously low
- a diabetic is too much sugar in the blood
name two occurrences that result from a lack of blood flow to the brain:
- CVA (cardiovascular attack)
name some causes of CVA:
a clot or foreign object that moves through the vascular system:
a clot or foreign object that has become stationary and/or is a blockage:
name some symptoms of CVA:
- slurred or difficult speech
- extreme dizziness
- severe headache
- muscle weakness on one or both sides
- difficulty in vision or deviation in one eye
- temporary loss of consciousness
medication can often reverse the paralyzing effects of a stroke if treated within what length of time?
name three common tips recognizing a stroke quickly:
- ask the patient to Smile
- ask the patient to Talk
- ask the patient to Raise both arms
- (notice, first three letters of the word "stroke")
- (also extreme confusion, ringing in ears, loss of bowel/bladder control)
what presents symptoms similar to a stroke but lasts only a few minutes?
transient ischemic attacks (TIA)
approximately what percent of patients experiencing TIA will have a stroke? within what period of time?
- usually within three months
where do seizures originate and what are they caused by?
- unsystematic neurologic changes in brain function
what is the condition termed when a patient has seizures with no apparent medical reason?
name some common manifestations of seizures:
- jerking, tapping, or rubbing movements
- flutter of eyelids
- facial jerking
- loss of motor activity
- blank facial expression
- tachypnea, apnea, or difficulty breathing
name three types of seizures:
- partial or focal seizure
- petit mal seizure
- grand mal seizure
what is a nickname given to grand mal seizures?
a sudden decrease in blood pressure secondary to rising to an erect position:
the medical term for a nosebleed:
what is the best medical treatment to epitaxis:
- apply pressure; squeeze nostrils firmly
- have patient spit out blood, not swallow it (helps prevent nausea)
a general term that indicates a failure of the circulatory system to support vital body functions:
some signs to look for preceding shock:
- apprehension or general anxiety
- tachycardia or tachypnea
- decreasing blood pressure
- cold and clammy skin
- sudden thirst
- systolic pressure dropping below 95
what should a technologist do in the case of the onset of shock?
- stop the procedure
- ensure maintenance of the patient's body temperature
- call for medical assistance
- assessed vital signs, especially blood pressure
the medical term for fainting:
something that can be done to quickly reduce chances of syncope:
placing the patient in the dorsal recumbent position, trendelenburg position, or with the head between the knees
name some factors that can contribute to syncope:
- prolonged standing
- emotional disturbances
- poor ventilation
what can be done to help revive a patient that has undergone syncope?
waft spirits of ammonia under the nose
how should a radiographer handle a patient going into syncope from a standing position?
break their fall if possible: place arms under the armpits from behind, with a need between their knees, try to gently lower yourself to the floor with the patient
name and describe a helpful acronym for remembering CPR:
- chest compressions
explain the CPR cycle:
begins cycles of 30 chest compressions and 2 breaths. repeat
where and how should chest compressions be administered during CPR:
- on the center of the victims chest on the lower half of the breastbone
- with the heel of one hand on top of the other hand, hard and fast compressions that press down at least 2 inches (5cm)
at what rate should chest compressions be delivered during CPR?
at least 100 compressions per minute
where and how should chest compressions be administered during CPR on an infant?
- on the center of the infants chest just below the nipple line, NOT the bottom of the breast bone
- with two fingers, hard and fast compressions at least one third the depth of the chest (approx. 1 1/2 " or 4cm)
What would you like to do?
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