Patient Vital Signs Medical Emergencies and Infection Control Fall 2009 Week 13

Patient Vital SignsMedical Emergencies

andInfection 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

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 Pulse Rate

• 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%.

C1 c2 sublux c4 wedge fx

GSW TO ABD

QSWMARKING 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)

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

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

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)

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

4.

5.

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!