Transcript RT A Infection control & Medical Emergencies

Patient Vital Signs
Medical Emergencies
and
Infection Control
Fall 2009
Week 13
Homeostasis
•
A constancy in the internal environment of the
body
• Naturally maintained by adaptive responses
that promote healthy survival
• Primary mechanisms:
–
–
–
–
–
Heartbeat
Blood pressure
Body temperature
Respiratory rate
Electrolyte balance
Vital Signs
•
•
•
•
•
Body Temperature
Respiratory Rate
Pulse / Heart Rate
Blood Pressure
Sensorium (mental alertness)
Importance of Vital Signs
• Indicates the patient’s immediate condition
• Can show improvement due to treatment
• Can show a decline in condition
Body Temperature
• Normal temperature: 98.6 ° F
– 1° - 2°F daily variation
– Still considered normal: 97.7 °F – 99.5 °F
• Human body functions within a narrow
range of temperature variations
– Humans can survive between 93.2 ° F
and 106 ° F
Thermoregulation
Shivering when cold
Sweating when hot
Measuring Body Temperature
– Oral
– Rectal
– Axillary
– Tympanic
– Temporal
Abnormalities in Body
Temperature
Hyperthermia
– Fever, febrile
– Temperature higher than
99.5 °F
Hypothermia
– below normal range of 97.7
°F
– Due to
• Environment
• Medically induced
• Damage to hypothalamus
Respiratory Rate
• Respiratory System delivers oxygen to the
body’s tissues & eliminates carbon dioxide
– Pt will die without the removal of CO2 and addition
of O2
• Major muscle of ventilation: diaphragm
• Measured in
• “breaths per minute”
– Adults: 12 – 20 bpm
– Children: 20 – 30 bpm
– Newborns: 30 – 60 bpm
Abnormalities of Respiratory Rate
• Tachypnea
– Greater than 20 breaths per minute (adult)
• Bradypnea – decrease is breathing
• Dyspnea- difficulty breathing
• Apnea- no breathing
Methods of Delivering Oxygen
Nasal
Cannula
Masks
Ventilators
Oxyhood
Pulse Oximeter
• Normal Pulse Oximeter = 95% to 100%
Pulse
• Adult
– 60 to 100 beats
per minute
• Children under 10
– 70 to 120 beats
per minute
Measurement
•
•
•
•
Radial artery
Brachial
Carotid artery
Apical pulses
Abnormalities of Pulse Rate
• Tachycardia
– Pulse rate increases by more than
20 bpm in resting adult
– Greater than 100 bpm
• Bradycardia
– Decrease in heart rate
Blood Pressure
• Measure of the force exerted by blood on
the arterial walls during contraction &
relaxation.
• Measured pressure when the heart is
relaxed: Diastolic
• Measured pressure when the heart is
contracted: Systolic
• Measured with a Sphygmomanometer
Blood Pressure cont’d
•
Recorded in millimeters
of mercury
(mm Hg) with systolic
over diastolic
•
Normal adult systolic:
95-140 mm Hg
Normal adult diastolic:
60-90 mm Hg
•
•
120/80 mmHg
considered normal
Abnormalities of Pulse Rate
• Hypertension
– Persistent elevation above 140/90 mmHg
• Hypotension
– Persistent less than 95/60 mmHg
RTA
Medical Emergencies
and Infection Control
Week 13
Caution – some images may be disturbing to the viewer
…but this is what we may see in the course of our work
TRAUMA- X-RAY READY
2 PROJECTIONS ARE BEST FOR THE
PATIENT
SPINAL INJURY PT
X-TABLE LATERALS
CERVICAL SPINE
Dislocation of the C3 and C4
articular processes
Note that C7 is not well
demonstrated
Some studies of
spinal trauma have
recorded a missed
injury rate as high
as 33%.
C1 c2 sublux
c4 wedge fx
GSW TO ABD
QSW
MARKING ENTRANCE /EXIT WOUNDS
Fractured Forearm
Trauma and Surgical
Radiography
Blast wave injury
NEAR DROWING
Compound Fx of Femur
Medical Emergencies
Medical Emergencies
• What a Radioilogic
technologist should
know
• Common Radiology
Emergencies
Medical Emergencies
• Sudden change in medical status
requiring immediate action.
• For RT’s medical emergencies are rare
– Recognize emergencies
– Remain calm and confident
– Avoid additional harm to the patient
– Obtain appropriate medical assistance quickly
– Know where crash cart is, emergency phone
and code blue buttons
Emergency Cart (crash cart)
• Know where it is in your
department
• Familiarize yourself with
its contents
– Have BLS with AED
training
• Have one in the room
when an iodinated
contrast media will be
used
General Priorities
1. Ensure an open
airway (ABC’s)
4. Attend to wounds
or fractures
2. Control Bleeding
5.Provide emotional
support
3. Take Measures to
Prevent shock
6. Continually
reevaluate and
follow up
Medical Emergencies
Medical Emergencies
• What a Radioilogic
technologist should
know
• Common Radiology
Emergencies
Medical Emergencies
• Sudden change in medical status
requiring immediate action.
• For RT’s medical emergencies are rare
– Recognize emergencies
– Remain calm and confident
– Avoid additional harm to the patient
– Obtain appropriate medical assistance quickly
– Know where crash cart is, emergency phone
and code blue buttons
Emergency Cart (crash cart)
• Know where it is in your
department
• Familiarize yourself with
its contents
– Have BLS with AED
training
• Have one in the room
when an iodinated
contrast media will be
used
General Priorities
1. Ensure an open
airway (ABC’s)
4. Attend to wounds
or fractures
2. Control Bleeding
5.Provide emotional
support
3. Take Measures to
Prevent shock
6. Continually
reevaluate and
follow up
ABC and D
• A = Air Way
• B = Breathing
• C = Circulation
• D = Defibrillation
Major Medical Emergencies
1.
2.
3.
4.
5.
6.
7.
ALOC
Shock
Anaphylactic shock
Diabetic Crisis
Respiratory Distress
Cardiac Arrest
Cerebrovascular accident
Head Injuries
Levels of consciousness
1. Least severe
–
2.
Responsive
More serious
–
3.
Can be roused, but drowsy
Even more serious
–
4.
Responds to pinches or
pinpricks
Most serious
–
Comatose, non-responsive
Shock
• Hypovolemic
– Loss of blood or tissue
• Cardiogenic
– Cardiac disorders
• Neurogenic
– Spinal anesthesia or damage to spinal cord
• Vasogenic
– Caused by sepsis, deep anesthesia or anaphylaxis
Anaphylactic Shock
• An allergic reaction to contrast media
– Iodinated
• Can happen quickly or have a delayed
reaction
– Requires prompt recognition and treatment
from the technologist
– More severe usually have quick onset
– Less severe takes longer for reaction
Water Soluble Iodine
• High atomic # 53
• Radiopaque
• Used to radiograph
–
–
–
–
Vessels
Arteries
Veins
Function of internal
organs
Prevention and Signs - Symptoms
• Restlessness
• Maintain normal body
temperature
• Apprehension
• Handle pt’s gently
• Tachycardia
• RT should work calmly
and confidently
• Sudden blood pressure
drop
– Anxiety
• Cold –clammy skin
– pallor
Medical Emergencies
Medical Emergencies
• What a Radioilogic
technologist should
know
• Common Radiology
Emergencies
Medical Emergencies
• Sudden change in medical status
requiring immediate action.
• For RT’s medical emergencies are rare
– Recognize emergencies
– Remain calm and confident
– Avoid additional harm to the patient
– Obtain appropriate medical assistance quickly
– Know where crash cart is, emergency phone
and code blue buttons
Emergency Cart (crash cart)
• Know where it is in your
department
• Familiarize yourself with
its contents
– Have BLS with AED
training
• Have one in the room
when an iodinated
contrast media will be
used
General Priorities
1. Ensure an open
airway (ABC’s)
4. Attend to wounds
or fractures
2. Control Bleeding
5.Provide emotional
support
3. Take Measures to
Prevent shock
6. Continually
reevaluate and
follow up
Medical Emergencies
Medical Emergencies
• Sudden change in medical status
requiring immediate action.
• For RT’s medical emergencies are rare
– Recognize emergencies
– Remain calm and confident
– Avoid additional harm to the patient
– Obtain appropriate medical assistance quickly
– Know where crash cart is, emergency phone
and code blue buttons
Emergency Cart (crash cart)
• Know where it is in your
department
• Familiarize yourself with
its contents
– Have BLS with AED
training
• Have one in the room
when an iodinated
contrast media will be
used
General Priorities
1. Ensure an open
airway (ABC’s)
4. Attend to wounds
or fractures
2. Control Bleeding
5.Provide emotional
support
3. Take Measures to
Prevent shock
6. Continually
reevaluate and
follow up
ABC and D
• A = Air Way
• B = Breathing
• C = Circulation
• D = Defibrillation
Major Medical Emergencies
1.
2.
3.
4.
5.
6.
7.
ALOC
Shock
Anaphylactic shock
Diabetic Crisis
Respiratory Distress
Cardiac Arrest
Cerebrovascular accident
Head Injuries
Levels of consciousness
1. Least severe
–
2.
Responsive
More serious
–
3.
Can be roused, but drowsy
Even more serious
–
4.
Responds to pinches or
pinpricks
Most serious
–
Comatose, non-responsive
Shock
• Hypovolemic
– Loss of blood or tissue
• Cardiogenic
– Cardiac disorders
• Neurogenic
– Spinal anesthesia or damage to spinal cord
• Vasogenic
– Caused by sepsis, deep anesthesia or anaphylaxis
Anaphylactic Shock
• An allergic reaction to contrast media
– Iodinated
• Can happen quickly or have a delayed
reaction
– Requires prompt recognition and treatment
from the technologist
– More severe usually have quick onset
– Less severe takes longer for reaction
Water Soluble Iodine
• High atomic # 53
• Radiopaque
• Used to radiograph
–
–
–
–
Vessels
Arteries
Veins
Function of internal
organs
Prevention and Signs - Symptoms
• Restlessness
• Maintain normal body
temperature
• Apprehension
• Handle pt’s gently
• Tachycardia
• RT should work calmly
and confidently
• Sudden blood pressure
drop
– Anxiety
• Cold –clammy skin
– pallor
Diabetic Crisis
1. Hypoglycemia
2. Hyperglycemia
Hypoglycemia
• Excessive insulin
•
Can result from normal dose of insulin & no food
• Need carbohydrate
Hyperglycemia
•
Excessive sugar
•
Usually seen in diabetics
•
Pt. needs insulin
Respiratory Distress
1. Asthma
2. Choking
Asthma
1. Stressful situations
2. Inhaler or medical assistance
3. Remain calm and confident
Choking
1. Cannot speak
2. Universal distress signal
3. Encourage to cough
4. Heimlich Maneuver
Cardiac Arrest
1. Crushing pain in chest
2. Pain down arm
3. Begin CPR and use AED
4.
5.
Cerebrovascular
Accident
1. Paralysis on one or both sides
2. Slurred or loss of speech
3. Dizziness
4. Loss of vision
5. Complete unconsciousness
Minor Medical Emergencies
1.
2.
3.
4.
5.
6.
7.
Nausea and vomiting
Epistaxis
Vertigo and syncope
Seizures
Falls
Wounds
Burns
Nausea and Vomiting
• Tell pt to breath deeply and slowly
• Turn on side if possible or turn head
• Get emesis basin and moist cloths
Epistaxis - nosebleed
Vertigo and Syncope
1. Lack of blood flow to brain
2. Feel dizzy after laying down or standing for awhile
3. Lay patient down
4. Orthostatic hypotension
5. Loosen tight clothes and put moist cloth on head
Seizures
• Minor
– Brief LOC
– Stare into space
– Slightly confused and weak
• Severe
– Muscle contractions on one or both sides
– Drool
– Aura may occur and you must lay them on floor
• Pillow under head and move all objects around them
– Afterwards
• ABC check
• Clear mucus
• PT is weak, disoriented and has no memory of seizure
Falls, wounds and burns
• Falls
– Get appropriate help as needed and report incident to
supervisor and get a medical assessment of pt
• Wounds
–
–
–
–
Do not remove dressing
Pay attn to any changes in dressing
Place extremity above level of heart
Apply pressure
• Burns
– Maintain sterile precautions
– Be extra gentle
Radiologic Technology
• You never know
when a medical
emergency may
occur.
• Helping your
patients depends
on your abilities to
stay calm and
perform you duties!
• Zoomed lower
pelvis
demonstrating
multiple fractures
(arrows).
Zoomed bony thorax shows rib fractures
FX RADIAL HEAD
greenstick
Open fracture
comminuted
Rt leg torn off after patient hit by a car
Third Degree Burn
INFECTION CONTROL
Infection Control
• Microorganisms
• Infectious
Disease
• Chain of Infection
• Nosocomial
Infection
• Disease Control
• Environment
Microorganisms that cause
disease:
Bacteria
Viruses
Fungi
Protozoa
Microorganisms
Can grow in or on an animal or plant and
cause diseases.
Host: animal or plant that provides life
support to another organism.
Disease: Any change from the normal
structure or function in the human body.
Infection: Growth of a microorganism on or
in a host.
Varicella Zoster (Shingles)
Disease

Disease occurs
only when the
microorganism
causes injury
to the host
Pathogen
A disease producing microorganism.
– Multiply in large numbers and cause an
obstruction
– Cause tissue damage
– Secrete substance that produce effects in
the body
Exotoxins ( high body temp, nausea, vomiting)
Bacteria
 Strep Throat
 Bacterial
Pneumonia
 Food Poisoning
Viruses
Common cold
Mononucleosis
Warts
Oral Warts
Smallpox
Fungi
 Athlete’s Foot
 Tinea pedis
 Ringworm
Protozoan
• Trichomonas
Vaginalis
– STD
• Plasmodium Vivax
– Malaria
6 Steps of Infection
Encounter
Multiplication
Entry
Damage
Spread
Outcome
Chain of Infection



Host
Infectious
Microorganism
Mode of
Transmission
– Vector/ Fomite

Reservoir
Chain of Infection
Nosocomial Infections





Iatrogenic Infection
Compromised
Patients
Patient Flora
Hospital
Environment
Blood borne
Pathogens
Types of Nosocomial Infections

Iatrogenic Infection – related to
physician activities

Compromised Patients - weakened
resistance; immunosuppressed

Patient Flora - microbes in healthy
people

Contaminated Hospital Environment

Blood borne Pathogens – Hepatitis B
and HIV
Blood borne Pathogens
 Disease-causing
microorganisms that
may be present in human blood. Ex:
Hepatitis, Syphilis, Malaria, HIV.
 Two most significant blood borne
pathogens: Hepatitis B and HIV
Syphilis
Syphilis in the eye
How Blood borne Pathogens
are Transmitted:
• You must make contact with contaminated
fluids and permit them a way to enter your
body.
• Contaminated body fluids can be saliva,
semen, vaginal secretions, or other fluids
containing blood (urine).
Controlling the spread of Disease
• Chemotherapy
• Immunization
• Asepsis
– Medical
– Surgical
• Disinfectants
Physical Methods of
Controlling Diseases
• Handwashing
• Standard
Precautions
– Gloving
– Gowns
– Face masks
– Eyewear
Handwashing
Single most important means of
preventing the spread of infection.
7 to 8 minutes of washing to remove the
microbes present, depending on the
number present.
Most effective portion of hand washing is
the mechanical action of rubbing the
hands together.
Personal Protective Equipment
(PPE)
Gloves
Masks
Gowns
Protective Eyewear
Caps
Universal Precautions
Since there is no way you can know if a person
is infected, you should ALWAYS use universal
precautions:
Wash your hands
Wear gloves
Handle sharp objects carefully
Properly clean all spills
Wear mask, eye protection, and apron if
splashing is a possibility.
Airborne Precautions
• Patients infected with pathogens that remain
suspended in air for long periods on aerosol
droplets or dust.
• TB, Chickenpox, Measles
• Respiratory protection must be worn when
entering pt room.
• Pt should wear mask.
Droplet Precautions
• Patients infected with pathogens that
disseminate through large particulate
droplets expelled from coughing,
sneezing, or even talking.
• Rubella, Mumps, Influenza
• Surgical mask must be worn when within 3
feet of the pt.
• Pt should wear a mask.
Contact Precautions
• Patients infected with pathogens that spread by
direct contact with the pt or by indirect contact
with a contaminated object (bedrail, pt dressing).
• Methicillin-resistant staphylococcus aureus
(MRSA), Hepatitis A, Varicella, Flesh-eating
Virus
• All PPE should be used and equipment must be
disinfected after use.
So What, and Who Cares?
• Students and Techs are challenged both
physically and mentally by the microbial world.
• In this world of newly found, life-threatening
diseases, education has become the key to
survival.
• Health care providers must be committed to
infection control so that diseases can be
conquered!