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Patient Vital SignsMedical Emergencies
andInfection Control
Fall 2011
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
Ventilators
Nasal Cannula
Oxyhood
Masks
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 Blood Pressure
• Hypertension– Persistent elevation above 140/90 mmHg
• Hypotension– Persistent less than 95/60 mmHg
RTA Medical Emergenciesand 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 LATERALSCERVICAL 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%.
GSW TO ABD
QSWMARKING ENTRANCE /EXIT WOUNDS
Fractured Forearm
Trauma and Surgical Radiography
NEAR DROWING
Compound Fx of Femur
General Priorities
1. Ensure an open airway (ABC’s)
2. Control Bleeding
3. Take Measures to Prevent shock
4. Attend to wounds or fractures
5.Provide emotional support
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)
2. Control Bleeding
3. Take Measures to Prevent shock
4. Attend to wounds or fractures
5.Provide emotional support
6. Continually reevaluate and follow up
ABC and D• A = Air Way
• B = Breathing
• C = Circulation
• D = Defibrillation
Major Medical Emergencies
1. ALOC2. Shock3. Anaphylactic shock4. Diabetic Crisis5. Respiratory Distress6. Cardiac Arrest7. Cerebrovascular accident
Head Injuries
Levels of consciousness1. Least severe
– Responsive
2. More serious– Can be roused, but drowsy
3. Even more serious– Responds to pinches or
pinpricks
4. 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
• Maintain normal body temperature
• Handle pt’s gently
• RT should work calmly and confidently
• Restlessness
• Apprehension– Anxiety
• Tachycardia
• Sudden blood pressure drop
• 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 speak2.Universal distress signal3.Encourage to cough4.Heimlich Maneuver
Cardiac Arrest
1. Crushing pain in chest
2. Pain down arm
3. Begin CPR and use AED
Cerebrovascular Accident
1.Paralysis on one or both sides2.Slurred or loss of speech3.Dizziness4.Loss of vision5.Complete unconsciousness
Minor Medical Emergencies
1. Nausea and vomiting2. Epistaxis3. Vertigo and syncope4. Seizures5. Falls6. Wounds7. 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
comminutedOpen fracture
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 Microorganisms that cause disease:disease:
BacteriaBacteria
VirusesViruses
FungiFungi
ProtozoaProtozoa
MicroorganismsMicroorganismsCan grow in or on an animal or plant and Can grow in or on an animal or plant and cause diseases.cause diseases.
HostHost: animal or plant that provides life support : animal or plant that provides life support to another organism.to another organism.
Disease:Disease: Any change from the normal structure Any change from the normal structure or function in the human body.or function in the human body.
InfectionInfection: Growth of a microorganism on or in : Growth of a microorganism on or in a host.a host.
Varicella Zoster (Shingles)Varicella Zoster (Shingles)
DiseaseDisease
Disease Disease occurs only occurs only when the when the microorganismicroorganism causes m causes injury to the injury to the hosthost
PathogenPathogen
A disease producing microorganism.A disease producing microorganism.
– Multiply in large numbers and cause an Multiply in large numbers and cause an obstructionobstruction
– Cause tissue damageCause tissue damage– Secrete substance that produce effects in Secrete substance that produce effects in
the body the body Exotoxins ( high body temp, nausea, vomiting)Exotoxins ( high body temp, nausea, vomiting)
BacteriaBacteria
Strep ThroatStrep Throat
Bacterial Bacterial PneumoniaPneumonia
Food PoisoningFood Poisoning
VirusesViruses
Common coldCommon cold
MononucleosisMononucleosis
WartsWarts
Oral WartsOral Warts
SmallpoxSmallpox
FungiFungi
Athlete’s FootAthlete’s Foot Tinea pedisTinea pedis
RingwormRingworm
ProtozoanProtozoan
• Trichomonas Trichomonas VaginalisVaginalis– STDSTD
• Plasmodium Plasmodium VivaxVivax– MalariaMalaria
6 Steps of Infection6 Steps of Infection
EncounterEncounter
EntryEntry
SpreadSpread
MultiplicationMultiplication
DamageDamage
OutcomeOutcome
Chain of InfectionChain of Infection
HostHost
Infectious Infectious MicroorganismMicroorganism
Mode of Mode of TransmissionTransmission– Vector/ FomiteVector/ Fomite
ReservoirReservoir
Chain of InfectionChain of Infection
Nosocomial InfectionsNosocomial Infections Iatrogenic InfectionIatrogenic Infection
Compromised Compromised PatientsPatients
Patient FloraPatient Flora
Hospital Hospital EnvironmentEnvironment
Blood borne Blood borne PathogensPathogens
Types of Nosocomial InfectionsTypes of Nosocomial Infections Iatrogenic Infection – related to Iatrogenic Infection – related to
physician activitiesphysician activities
Compromised Patients - weakened Compromised Patients - weakened resistance; resistance; immunosuppressedimmunosuppressed
Patient Flora - microbes in healthy Patient Flora - microbes in healthy peoplepeople
Contaminated Hospital EnvironmentContaminated Hospital Environment
Blood borne Pathogens – Hepatitis B Blood borne Pathogens – Hepatitis B and HIVand HIV
Blood borne PathogensBlood borne Pathogens
Disease-causing microorganisms that Disease-causing microorganisms that may be present in human blood. Ex: may be present in human blood. Ex: Hepatitis, Syphilis, Malaria, HIV.Hepatitis, Syphilis, Malaria, HIV.
Two most significant blood borne Two most significant blood borne pathogens: Hepatitis B and HIVpathogens: 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
HandwashingHandwashing
Single most important means of Single most important means of preventing the spread of infection.preventing the spread of infection.
7 to 8 minutes of washing to remove the 7 to 8 minutes of washing to remove the microbes present, depending on the microbes present, depending on the number present.number present.
Most effective portion of hand washing is Most effective portion of hand washing is the mechanical action of rubbing the the mechanical action of rubbing the hands together.hands together.
Personal Protective Equipment Personal Protective Equipment (PPE)(PPE)
GlovesGloves
MasksMasks
GownsGowns
Protective EyewearProtective Eyewear
CapsCaps
Universal PrecautionsUniversal Precautions
Since there is no way you can know if a person Since there is no way you can know if a person is infected, you should ALWAYS use universal is infected, you should ALWAYS use universal precautions:precautions:
Wash your handsWash your handsWear glovesWear glovesHandle sharp objects carefullyHandle sharp objects carefullyProperly clean all spillsProperly clean all spillsWear mask, eye protection, and apron if Wear mask, eye protection, and apron if splashing is a possibility.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!