1

Emergency Skills for Radiology Technologists

Rev. 4/9/13Kristina Hoerl, MSN, RN, CRN, Nurse EducatorChris Rowe, BSN, RN, NCIIM

2

The Learner Will Be Able To: Identify types of emergency situations in radiology.

Identify the appropriate contact for various

emergency situations.

Verbalize the information to provide when calling a

code.

State & demonstrate the roles of technologists,

RN’s and PSC’s in an emergency.

Demonstrate familiarity with the emergency carts

and defibrillator.

3

General concerns that patient “doesn’t look or feel

right” (Concern can come from patient, family or staff)

Change in mental status or loss of consciousness

Heart Rate < 45 or >130

Respiratory Rate < 8 or >30

Oxygen saturations <90% despite 60% O2

New or prolonged (over 5 minutes) seizure

Severe chest pain

Emergencies in Adults

4

Who is a peds patient?◦ Under 21 y/o being treated by pediatric service

Examples of “Triggers” for Calling Team:

◦ General concern that patient “doesn’t look or feel right” (Concern can come from patient, family, or staff)

◦ Worsening respiratory status (change in pattern/rate)

◦ oxygen saturations <90% despite 60% O2

◦ Decrease in blood pressure

◦ Pulse <60 or >220

◦ Seizures with apnea

◦ Acute change in mental status or level of consciousness

◦ Respiratory &/or Cardiac Arrest

Emergencies in Pediatrics

5

Time is critical in an emergency.

Technologists can activate an emergency

team without approval of an RN or MD

based on guidelines learned in CPR

If any question if event could be life

threatening: Call the code team FIRST

Possible Emergency Identified: Now What?

6

Patient Populatio

n

Type of Emergenc

y

Team to Call

PedsAny medical condition needing additional support & cardiac/respiratory arrests.

Peds Rapid Response Team

(RRT)

AdultsAny medical condition needing additional support & cardiac/respiratory arrests.

Adult Code

(Adult RRT does NOT respond to radiology)

AdultsPresent or imminent respiratory failure in patient with known or suspected difficult airway.

Difficult Airway Team

Who Ya’ Gonna Call?

7

8

How Do I Get the Right Team?

Call 5-4444

Answer the 4 W’s

◦ What kind of emergency?

Medical, Fire, Security

◦ Who needs help?

Adult, Child

◦ Where is help needed?

Department, Building, Floor, Room Number

◦ Which emergency team is needed?

Adult Code Team, Peds Rapid Response, Difficult Airway Team

Provide Additional Info

◦ Your name, contact number

9

MEDICAL EMERGENCY – DIAL 5-4444

State: I need the:

PEDS ADULTRapid Response Team Code Team

OR Emergency Airway Team

To ___________________ in ______________________ (department) (building & floor)

in room number _____________. My extension is __________.

Make sure you hang up LAST!

** When activating the ADULT Emergency Airway Team assign someone to get

the Adult Emergency Airway Cart from _____________________________**

10

A system whereby families of pediatric patients

can access the Pediatric Rapid Response Team

If a family requests the Peds RRT be activated:

◦ Contact the radiology nursing staff.

◦ If the family feels they cannot wait for nursing

assistance or they still have concerns after

speaking to the nurse, the radiology staff are to call

5-4444 for the family.

Family Activated Pediatric RRT

11

JHOC Concerns… JHOC After Hours

◦ Call 5-4444 just as you would any other time.

◦ If a team is not in JHOC, the operator will complete a 3-

way call with you and 911.

Peds Team Needed in JHOC

◦ As of April 28, 2012 the Pediatric Rapid Response team will

no longer be responding to emergencies in JHOC. When

you call 5-4444 the adult team will be called to respond.

◦ If you ask for the Peds RRT the person on the phone should

still call the adult team.

12

The OR’s, the ED and the ICU’s maintain their own

“Code Team”

The unit based physician and nursing staff will

“run” the code. (5-4444 does not need to be

called).

Unit Based Code Teams

13

What About Stroke?

Signs and SymptomsSudden slurred speech Sudden vision changes Sudden facial droop Sudden weakness of extremitiesSudden onset of severe headache

Who Do You Call? ◦The Brain Attack Team (BAT Team)

PING: Brain Attack

Pager: 3-6666 (enter your extension plus *911)

*Note: If the BAT Team is delayed in responding (longer than 6 mins) please proceed with contacting the HAL Line at 5-9444, and ask to speak with the Stroke Attending on call.

14

Phone Calls / Pages:◦ Code Team

(5-4444) ◦ RN – 911◦ MD◦ Area PSC’s◦ Main PSC desk

(5-6187, 5-2920, 5-6126)

◦ CSD – 58357 (JHH)5-5881 (JHOC)

Jobs/Roles:◦ CPR

Compression Ventilation

◦ Phone calls◦ Defibrillate◦ Document◦ IV access◦ IV fluids◦ Med prep/

administration

Code “To Do” List Supplies:

Ambu bag Crash cart Defibrillator Drug Box Arrest cards (for peds) IV Pump Suction BP Machine EKG Machine

15

Assess ABC’s Calling for help (Code team, RN, MD, PSC’s) CPR Bringing emergency equipment/supplies (includes

getting supplies out of cart when requested) Placing pads and using defibrillator Documenting event (Arrest record during/PSN after) Gaining large bore IV access (if signed off) Preparing IV fluids Cleaning/Replacing equipment after event

Technologist’s Duties in a Code

16

Excellent Basic Life Support (BLS)

◦CAB

Circulation

Airway

Breathing

◦Defibrillation

Most Important Technologist Role in A Code

17

Exactly the same as the technologists

Can also give medications

RN’s Duties in a Code

18

As Directed by RN, Technologist, MD

◦ Call the code team (5-4444)

◦ Page the RN (add 911 to page)

◦ Page/call the MD

Once Aware of Emergency

◦ Call main radiology PSC desk

◦ Direct/take the code team to area

◦ Maintain function of unit

PSC’s Duties In A Code

19

The Emergency Cart Adult Cart

◦ Labeled with word adult or letter “A”

◦ Has black drug box on top

Pediatric Cart◦ Labeled with word ped or

letter “P”◦ Has blue drug box on top◦ Has notebook with

pediatric drug sheets

To Use Cart◦ Grip handle on side of cart

swings up for easy steering◦ Lift up the red handle on the

front of cart to break the lock

◦ Push handle all the way back into the slot

◦ Remove cardiac board from front of cart

◦ Drawers are configured for A (airway), B and C (blood and circulation)

20

The Emergency Cart & Drug Box

On Top

◦ Emergency Drug Box

Blue = Peds

Black = Adults

Top Well

◦ Adult = Protective gear

◦ Peds = Extra Airway

Side Bins

◦ IV Fluids

21

The Emergency Cart & Drug Box

1st Drawer

◦ Airway/Breathing

2nd Drawer

◦ Circulation

3rd Drawer

◦ Miscellaneous

Ex: Stomach tubes, Res-Q

vac

Bottom Well

◦ Large Items

Ex: Ambu bag, Needle box

22

The Drug Box

BristojetsMedication

Vials

Syringes & Needles

23

Contrast Reaction Box

24

Contents:◦ Albuterol Inhalation◦ Ammonia Inhalant◦ Benadryl (po & IV/IM)◦ Epi (auto-inject peds/adult)◦ Epi (ampule)◦ Solumedrol◦ Nitroglycerin---------------------------◦ NSS IV◦ Prefilled saline syringe◦ Angiocath (20g & 22 g)◦ Nebulizer mask◦ Primary IV tubing◦ Syringe (3 cc w/ needle)

Contrast Reaction Box

25

Artificial Airway Devices

Oral Airways:

Placed mouth to pharynx. Not good for

patients with gag reflex.

Nasal Trumpet:

Placed nasal passage to the pharynx.

26

Artificial Airway Devices

Shiley Trach Tube:

Placed in opening in trachea

Endotracheal (ET) Tube:

From mouth to trachea

27

Difficult Airway Kit

Used by Anesthesia for patients who are hard to intubate

Locations:

* Nuclear Medicine

* MRI

* IR

28

For patient’s who arrest with a known or suspected difficult airway◦ Known

Blue difficult airway bracelet◦ Suspected

Short, thick neck Severe obesity Prior neck surgery or tumor Receding jaw Facial trauma

MD’s from head/neck & trauma surgery come to assist anesthesia

Airway Emergency

29

If you have an airway emergency for an adult patient, 2 things must happen:

◦ 1) Call the paging operator, x5-4444, and tell them you have an "airway emergency" and specify the patient location.

◦ 2) Send staff to get the airway emergency cart from the location closest to you.

AIRWAY EMERGENCY CART

30

DIFFICULT AIRWAY CART LOCATIONS NEAREST TO RADIOLOGY AREAS

ED Rad:

◦ Adult ED NCB 1 Rm #ZB01W

Zayed 3:

◦ General OR NCB 3 Rm #

ZOR03

Zayed 4:

◦ CVSICU NCB 5 Rm #ZB05E

**Unless otherwise

noted, we must retrieve

cart**

31

DIFFICULT AIRWAY CART LOCATIONS NEAREST TO RADIOLOGY AREAS (CONT’D)

WBG Rad:

◦ WBG 5

Nsg shift coordinator will

deliver

Historic Building:

◦ Halsted 2 - Alcove H268

JHOPC:

◦ JHOPC PACU Rm #LL055

**Unless otherwise noted,

we must retrieve cart**

32

Purpose◦ Provides for documentation of event◦ Becomes the MD order sheet

Information Needed◦ Airway – ventilation ?, ETT tube ?◦ Compressions – yes/no, time◦ Defibrillation – yes/no, time◦ Vital signs & heart rhythm◦ Drugs – dose & time◦ IV fluid type & location

The Arrest Record

33

The Zoll AED

34

►Victims in water

► Victims with transdermal medication patches

►Victims with implanted devices

AED: Special Situations and Contraindications

35

Make sure the Zoll is connected to the pads.

Place pads directly on pt’s bare skin by rolling pad in place. (remove bras)

Using the Zoll AED

36

Power On AED Defib• Turn the power switch to defib.

37

Clear rescuers and bystanders from the patient ensuring that no one is touching the patient. Avoid all movement affecting the patient during rhythm analysis.

Press the ANALYZE button. Rhythm analysis takes 5 – 15

seconds If a shockable rhythm is present,

the AED will display a visual

message and announce

“Press Shock.”

Analyzing the Rhythm

38

Before pressing the shock button always…◦ Loudly state, “I’M CLEAR,

YOU’RE CLEAR, WE’RE ALL CLEAR!”

◦ Perform a visual check to be

sure no one is touching the

patient

Only press SHOCK button

if all clear

SHOCK the Patient

39

Pediatric AED Use ◦ For children OVER 1 year old

◦ Use Pedi-pads for patients under 15 kg (4 y/o)

◦ AED will shock at 200 J even for kids Betsy Hunt, MD (Head of JHH Pediatric CPR Committee)

states:

”the AHA feel(s) that shocking very early in a

witnessed arrest is far more important than the issue

of using too many joules...”

AED and Peds

40

If You Are Unsure How To…

Prime IV tubing with fluids

Set up suction equipment

Use wall or bottled oxygen

Locate emergency equipment

Use any other emergency equipment

ASK THE NURSE IN YOUR AREA

41

You have now

completed the lecture

part of the emergency

skills class.

Bring your certificate

of completion and a

pen to your hand’s

on class

Thank You For Your Attention

42

DART may be used as resource for peds

patients

◦ Will be activated by Peds RRT

◦ Supplies/equipment obtained from PICU or Adult ED

When calling 5-4444 include as much info as

possible including your modality

BAT Team – Call HAL Line @ 5-9444

◦ This replaces PING

Emergency Skills Class Updates1-21-14