Medical Emergencies in
Diagnostic Imaging
Goal

The RT student will be able to recognize
life-threatening emergencies and initiate
appropriate medical action.
Objectives
After completing this lesson the student will be able to:
 List the visible symptoms of shock.
 List the visible symptoms of an anaphylactic reaction.
 List the observable symptoms of diabetic ketoacidosis,
hypoglycemia, hyperosmolar coma and describe the actions the RT
must take if he observes these symptoms in his patient.
 List the early symptoms of cerebral vascular accident and describe
the action the RT should take if these symptoms are observed.
 List the symptoms of respiratory failure and describe the action that
an RT must take if this emergency occurs in his department.
 List the symptoms of cardiac failure and describe the actions that
the RT must take if this emergency occurs
 List the symptoms of mechanical airway obstruction and describe
the action an RT should take if this emergency occurs.
 List the emergency action that the RT must take if a patient is
having a convulsion or is fainting.
Medical emergency?

The abnormal physiologic reactions,
especially of patients whose physical
condition is poor, that, occur quickly, with
little or no warning, and often life
threatening are called medical
emergencies.
Common medical emergencies
The most common medical emergencies in x-ray
departments are:
 Shock
 Anaphylaxis
 Diabetic reactions
 Cerebral vascular accidents
 Cardiac failure
 Respiratory failure
 Fainting
 Convulsions
What is the RT’s action?

The RT’s first action is:



Call the hospital/departmental emergency team, the
physician /radiologist conducting the procedure, and
colleagues for assistance.
Then obtain the emergency trolley/crash cart
immediately.
Emergency trolley/crash cart is a trolley that
contains medications and equipment
needed when a patient’s condition becomes
suddenly critical.
Shock?

Shock is a physiologic reaction to illness or
trauma, in which,
 there
is a disturbance of blood flow to the
vital organs, or
 a decreased ability of the body tissues to use
oxygen and other nutrients needed to
maintain them in a healthy state.

It can occur quickly and without warning.
who are affected? & causes?

Shock is most frequently seen in:
 Very
young children
 Elderly persons
 Generally debilitated (weak) people

Shock may be caused by :
 Injury
 Disease
 Intense
emotional reaction
Signs & symptoms of shock
Increased temperature
 Weak, thready pulse
 Rapid heartbeat
 Rapid shallow respiration
 Hypotension
 Skin pallor
 Cyanosis
 Increased thirst

Development of signs & symptoms

In the early stages, because of an inadequate
supply of oxygen to the brain, the patient will
display signs of:




Restlessness
Confusion
Anxiety
Later, (if allowed to progress), the patient will
become



Apathetic (droopy, unconcerned)
Confused (puzzled, bewildered)
Comatose (exhausted)
Categories of Shock





Hypovolemic shock
Septic shock
Cardiogenic shock
Neurogenic shock
Anapylactic shock
Hypovolemic shock
This is caused by an abnormally low
volume of circulating blood in the body.
 It May be due to:

 Internal
or external haemorrhage
 Loss of plasma because of burns
 Fluid loss from prolonged vomiting or diarrhea
 Heat prostration (weakness)
 Insufficient release of antidiuretic hormone
(ADH)
Signs & symptoms









Restlessness; thirst; cold, clammy skin
Pallor, sweating
Falling blood pressure; weak, thready pulse
Rapid respirations
Extreme weakness; lethargy
Cold extremities
Semiconsciousness, coma
Systolic blood pressure lower than 60 mm Hg
Oliguria to anuria
Action to take












Place the patient in a flat, supine position and allow him to rest.
Notify the physician & call for assistance
Make certain that the patient is able to breath without obstruction
(release any tight clothing and clear the airway)
Note any visible discharge of bodily fluids (blood, vomitus, faeces,
urine) and wipe them away.
Keep any blood out of patient’s view.
If there is loss of blood from open wound apply pressure to stop it.
Be prepared to assist with administration of oxygen, IV fluids or
medications.
Keep the patient warm and dry.
Check blood pressure, pulse, and respirations every 10 minutes.
Observe the pt’s skin colour and body temperature
Do not offer food or fluids
Do not leave the patient unattended.
Septic shock
A shock caused by severe systemic
infections and bacteremia (bacterial
endotoxins released in the bloodstream).
 Symptoms progress somewhat differently
from those of other types of shock.

Signs & symptoms
In early stages, the skin is warm, dry, and flushed.
 Urine output may be normal or excessive.
 The patient may have chills.
 As the shock progresses, there may be an abrupt
personality change or a decrease in the level of
consciousness.
 There is an increase in pulse and respiration and a
decrease in urinary output.
 The skin becomes cold and clammy.
 Seizures, circulatory collapse, and cardiorespiratory
failure will follow if the course is not reversed.

Cardiogenic shock
A shock caused by a failure of the heart to pump
an adequate amount of blood to the vital
organs.
 This causes inadequate tissue perfusion.
 The onset of cardiogenic shock is sudden and
often occurs in patients hospitalized for acute
myocardial infarction, cardiac tamponade
(excessive pressure on the heart), or pulmonary
embolus.
 It may follow cardiac surgery.

Signs & symptoms
Restlessness, anxiety, falling blood
pressure, and falling pulse pressure.
 Weak, rapid pulse
 Shallow, labored respirations
 Decreased urinary output
 Cool, clammy skin
 Possible semiconsciousness or coma

Action to be taken









Summon emergency assistance and place the
emergency cart ready.
Notify the physician in charge of the patient.
Place the patient in a semi-Fowlers position or a position
of comfort.
Keep the patient warm and quiet.
Take the vital signs every 5 to 10 minutes.
Do not give the patient anything to eat or drink.
Do not leave the patient alone.
Be prepared to assist with oxygen and intravenous
fluids, and medication administration.
Be prepared to begin CPR.
Neurogenic shock
A shock occurs when concussion (limited
period of unconsciousness), spinal cord
injury, psychic trauma, or spinal
anesthesia causes abnormal dilatation of
the peripheral blood vessels.
 This dilatation in turn causes a fall in
blood pressure as blood pools in the veins.
This leads to reduced cardiac output and
shock.

Signs & symptoms





Hypertension and bradycardia
Warm, dry, skin and subnormal body
temperature.
Initial alertness unless the patient is unconscious
because of head injury.
Initially good, but deteriorating, tissue perfusion.
Visible signs of poor tissue perfusion – coolness
of extremities and diminishing peripheral pulse.
Action to take





Notify the physician in charge of the patient.
Summon assistance and stay with the patient.
Keep the patient flat, and monitor vital signs
every 10 minutes.
Do not move the patient if there is a possible
spinal injury.
Prepare to assist with oxygen, intravenous fluid,
and medication administration.
Anaphylactic shock





Anaphylactic shock is the result of an exaggerated
hypersensitivity reaction (allergic reaction) to an antigen
that was previously encountered by the body’s immune
system.
When this occurs, vasodilator substances (histamine and
histaminelike compounds) which may produce massive
vasodilatation and peripheral pooling of blood, are
released in the body.
This reaction is accompanied by contraction of
nonvascular smooth muscles, particularly the smooth
muscles of the respiratory system.
This reaction can produce shock, respiratory failure and
death within minutes following exposure to the agent
that produces the reaction.
This is the type of shock seen most often in radiology
departments.
Common causes of anaphylaxis
Drugs
 Iodinated contrast agents
 Chemotherapeutic agents
 Anesthetics
 Certain foods
 Insect venoms

Early signs & symptoms
Itching at the site of injection and/or
around the eyes and nose.
 Sneezing and coughing
 Apprehensiveness; a feeling of doom
 Nausea, vomiting, and diarrhea (usually
related to food)

Late symptoms
Angioneurotic edema of the face, hands,
and other body parts
 Urticaria (an itchy rash resulting from the
release of histamine)
 Chocking, wheezing, or dyspnea and
cyanosis
 Hypotension, weak rapid pulse and dilated
pupils

Precautions & Actions to take





Keep the emergency trolley ready and correctly prepared
whenever an iodinated contrast medium is being
administered.
Before starting any procedure that involves the use of
iodinated contrast medium, ask the patient the following
questions.
“Are you allergic to any food or medicine?” “Which
ones?”
“Do you have asthma or hay fever?”
“have you ever had an x-ray examination that involved
the use of contrast medium?”. “If so, did you have a
reaction during or following that examination?”
If the answer for any question is positive, the radiologist
should be informed for necessary precautions
 Never leave a patient who is receiving an iodinated
contrast agent unattended.
 If he complains itching, if swelling or redness of the skin
is noted, or if the patient seems unduly anxious notify
the radiologist.
 Monitor the vital signs and observe for respiratory
distress.
 If the patient is in anaphylactic shock, call the
emergency team
 Keep the patient in semi Fowler’s position or sitting
position if possible.
 Prepare to assist with the administration of oxygen,
intravenous fluids, and medications.

Medications given for anaphylaxis
 Epinephrine
(Adrenaline)
 Diphenhydramine
 Hydrocortisone
 Aminophylline
If the patient stops breathing start
pulmonary resuscitation.
 If the patient becomes breathless and
pulseless, administer Cardiopulmonary
resuscitation (CPR)

Diabetic emergencies
Diabetic mellitus(DM) is a chronic disease
involving a disorder of carbohydrate, protein,
and fat metabolism, which also affects the
structure and function of the blood vessels.
 The underlying cause is a disturbance in the
production, action, or utilization of insulin, a
hormone normally secreted by the islands of
langerhans located in the pancreas.
 Medical treatment consists of diet therapy,
insulin injections, or use of oral hypoglycemic
drugs.

Types of diabetes and diagnosis




Type 1 ;- Insulin-dependent form:- There is no
production of insulin and therefore depend on outside
sources of insulin for the entire life.
Type 2 :- Noninsulin-dependent form:- The production of
insulin is less than necessary or the insulin does not
have the desired effect on the body. They are treated
with diet control and drugs that increase the
carbohydrate metabolism.
DM is diagnosed by laboratory measurement of blood
glucose levels.
A normal adult blood glucose level should range from 80
to 115 mg/dl.
Complications of DM



Hypoglycemia
Diabetic ketoacidosis
Nonketotic hyperosmolar coma
Hypoglycemia


Hypoglycemia or insulin reaction occurs when patients
who have diabetes mellitus have an excess amount of
insulin in their blood stream, an increased rate of
glucose utilization, or an inadequate diet to utilize the
insulin.
A patient who has DM may come to the imaging
department after he has taken insulin or some other
hypoglycemic agent, but before his body has had
sufficient nourishment to utilize the medication. The
result may be a hypoglycemic reaction. The onset of
symptoms is rapid, and immediate action is necessary in
order to prevent coma.
Signs & symptoms







Shaking, nervousness, and irritability
Dizziness and hunger; may complain of
headache
Profuse perspiration; cold, clammy skin
Blurred vision
Tremor, numbness of lips or tongue, slurred
speech
Impaired motor function; convulsions
Diminishing level of consciousness; quick lapse
into coma
Actions to take







Notify the Radiologist
Administer some type of sugar immediately
Call for help
Do not leave the patient unattended
Monitor vital signs
if the patient is unconscious prepare to assist
with administration of oxygen, intravenous
fluids, and medication
usually in this type of coma, 20 to 50 % glucose
in solution is administered intravenously.
Diabetic ketoacidosis
When a patient has insufficient insulin available
to metabolize the glucose that is present, his
body begins to mobilize fatty acids, and the
result is an acidotic state called diabetic
ketoacidosis.
 In this condition, acid and ketone bodies
accumulate in the blood. If this accumulation is
not corrected quickly, the patient will become
comatose and may die.

Signs & symptoms
Weakness, drowsiness, and dull headache
 Sweet odor to the breadth, hypotension
 Warm, dry skin; parched tongue; dry
mucous membranes; extreme thirst
 General weakness, lethargy, and fatigue
 Flushed face, deep and rapid respirations
 Tachycardia, weak, thread pulse and,
ultimately, coma

Actions to take








Check patient chart to identify him as a diabetic.
Stop treatment/examination
Notify the physician
Call for assistance
Do not leave the patient unattended
Monitor vital signs
Give fluids by mouth if possible
Prepare to assist with administration of
intravenous fluids, and oxygen
Hyperosmolar coma
Hyperosmolar coma(hyperglycemic, nonketoic coma) is a
complication of diabetes mellitus that usually occurs in
the elderly diabetic patient.
 It is frequently mistaken for a stroke or drunkeness and
is extremely serious, life-threatening problem
 Factors that cause this condition are




diagnostic procedures that require changes in diet, especially
fasting for long hours,
hyperglycemic-inducing agents and resistance to insulin.
The blood glucose level in patients with this problem is
grater than 600 mg/dl; there is little or no ketosis and
the plasma is hyperosmolar.
Signs & symptoms
Extreme patient dehydration; dry skin;
sunken eyes
 Increased body temperature; polyuria;
extreme thirst
 Muscle twitching; difficult, slurred speech
 Mental confusion; convulsion
 Coma

Actions to take
Stop treatment
 Notify the physician
 Call for assistance
 Do not leave the patient unattended
 Monitor vital signs
 Give fluids by mouth if possible
 Prepare to assist with administration of
intravenous fluids, and oxygen

Respiratory failure, cardiac arrest,
airway obstruction

Respiratory failure or severe respiratory
dysfunction may result from airway obstruction
caused by






the patient’s position,
the tongue, a foreign object, vomitus lodged in the
throat,
disease,
drug overdose,
injury, or coma.
Whatever the cause, gas exchange is no longer
adequate to maintain normal arterial blood
gases.
Symptoms of a partially obstructed
airway







Labored, noisy breathing
Wheezing
Use of accessory muscles of the neck, abdomen
and chest for breathing
Neck-vein distention
Anxiety
Cyanosis of the lips and nail beds
Productive cough with pink-tinged, frothy
sputum
………………….continued

If the patient lapses into complete
respiratory failure, his pulse will continue
to beat for a brief period of time.
However, the pulse becomes weak and
then ceases. Chest movement stops and
eventually cardiac arrest will result.
Action to take
1. Clear and open the airway

Check the larynx and trachea to make certain that the
patient’s tongue, epiglottis, or a foreign body is not
blocking the airway.

Tilt the head by placing one hand on the patient’s
forehead and applying firm backward pressure with
the palm to tilt the head back.

Keep the fingers of the other hand under the lower
jaw near the chin and lift so that the chin is brought
forward.

The lips should remain apart
If the patient does not resume breathing, rescue breathing
must be begun.
2. Rescue Breathing









Move the patient to a supine position
Check the carotid pulse
Squeeze the nostrils together
Cover his mouth tightly with yours
Inflate the patient’s lungs by giving two full breaths in succession
into his mouth.
Allow the patient time to exhale these breaths as you inhale
between each.
Recheck the carotid pulse
If present continue pulmonary resuscitation by breathing into
patient’s mouth at the rate of 12 breaths per minute.
Check the carotid pulse each minute.
If the pulse is absent cardiac compression must be started
immediately.
3. Application of External cardiac
compression






External cardiac compression is effective only if the
patient is lying on a firm surface.
Take an adequate amount of time to determine
pulselessness (5 to 10 seconds).
Performing cardiac compression on a person whose
heart is functioning is extremely dangerous.
Once compressions have started, do not interrupt
them for more than 7 seconds at a time.
Place the heel of one hand in the midline of the
sternum above the xiphoid process.
Put the other hand on the first.








For children, land marks are the same , but only one hand is
used to prevent excessive pressure.
For adult cardiac compression, the lower half of the sternum is
compressed.
Compress the sternum 1 ½ to 2 inches directly downward and
then release the compression completely.
Do not apply pressure on the rib cage itself.
Keep your elbows straight and give 15 compressions in a
smooth, even rhythm.
Then inflate the patient’s lungs two more times.
Next give 15 more compressions, then two more inflations.
This rhythm must be maintained until help arrives.
Following the initial cycles of compressions and ventilations, pause
to reassess the pulse and breathlessness.
 If the patient remains breathless and pulseless, continue the cycle
of two ventilations and 15 compressions, maintaining 80 to 100
external chest compressions per minute.

Cerebral Vascular Accident
(Stroke)

Cerebral vascular accidents (CVA) are
caused by occlusion or rupture of the
cerebral arteries directly into the brain
tissue or into the subarachnoid space. This
is commonly called a stroke. Strokes vary
in severity from a mild transischemic
attack (TIA) to severe life threatening
situations.
Signs& symptoms








Possible severe headache
Muscle weakness or flaccidity of face or
extremities.
Eye deviation, usually one sided, may loose
vision
Dizziness or stupor
Difficult speech (dysphasia) or no speech
(aphasia0.
Ataxia
May complain of stiff neck.
Nausea or vomiting may occur.
Actions






Call for emergency aid, do not leave patient
alone.
Put patient in resting position with head slightly
elevated.
Monitor vital signs every 10 minutes.
Report to the physician
Prepare to administer intravenous medications,
fluids, and oxygen
Prepare to administer CPR if the patient
becomes breathless or plseless.
Fainting
Fainting is caused by an insufficiency in
the supply of blood to the brain. The
possible causes are:
 Heart disease
 Hunger
 Poor ventilation
 Fatigue
 Emotional shock


Signs and symptoms
 Pallor,
dizziness, and possibly nausea
 Cold, clammy skin

Actions
 Have
the patient lie down, if possible
 Position his head so it is level with or some
what lower than his body.
 Summ)on medical assistance.
Convulsive seizures

Convulsive seizures are associated with many physical
disorders, including;






uremia,
eclampsia,
tetanus,
infections characterized by high body temperature,
poisoning,
and increased intracranial pressure caused by a brain tumour
Epilepsy is the most common cause of convulsive
seizures.
 Children are more susceptible than adults to seizures of
all types.

Classifications of seizures

Grand mal or generalized seizures:-
The patients whole body convulses, and he
loses consciousness for a period of
minutes.
 Partial seizures :- one focal point is
affected
 Petit mal or absence seizures.
Signs and symptoms (of Grand
mal or generalized seizures)







May utter a sharp cry as air is rapidly exhaled.
Muscles become rigid, and eyes open wide
(tonic phase)
May exhibit jerky body movements and rapid,
irregular respirations (clonic phase)
May vomit
May froth, and may have blood streaked saliva
caused by biting his lips or tongue
May exhibit urinary incontinence.
Usually falls into a deep sleep.
Action
Prevent the patient from injuring himself during a
seizure.
 Do not attempt to insert hard objects into the mouth.
 Do not place your fingers into the patient’s mouth
 Stay with the patient
 Protect him from hitting his head or limbs against hard
objects.
 Restrain him gently.
 Call for help
 After the seizure, position the patient to prevent
chocking or aspiration of secretion and vomitus
 Turn the patient to his side or to a prone position.
 Prepare to assist in oxygen administration
 If possible remove dentures or foreign objects from the
mouth.
 Note and report to the physician.

summary