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
Measuring Body Temperature
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
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
–Greater than 100 bpm
20 bpm in resting adult
•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
SPINAL INJURY PT
X-TABLE LATERALS
CERVICAL SPINE
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
•Ensure an open airway (ABC’s)
•Control Bleeding
•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
•Ensure an open airway (ABC’s)
•Control Bleeding
•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
•ALOC
•Shock
•Anaphylactic shock
•Diabetic Crisis
•Respiratory Distress
•Cardiac Arrest
•Cerebrovascular accident
Head Injuries
Levels of consciousness
•Least severe
–Responsive
•More serious
–Can be roused, but drowsy
•Even more serious
–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
•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
•Ensure an open airway (ABC’s)
•Control Bleeding
•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
•Ensure an open airway (ABC’s)
•Control Bleeding
•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
•ALOC
•Shock
•Anaphylactic shock
•Diabetic Crisis
•Respiratory Distress
•Cardiac Arrest
•Cerebrovascular accident
Head Injuries
Levels of consciousness
•Least severe
–Responsive
•More serious
–Can be roused, but drowsy
•Even more serious
–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
•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
Hypoglycemia
Hyperglycemia
Hypoglycemia
•Excessive insulin
•
Can result from normal dose of insulin & no food
•Need
carbohydrate
Hyperglycemia
•Excessive
•Usually
•
sugar
seen in diabetics
Pt. needs insulin
Respiratory Distress
Asthma
Choking
Asthma
•Stressful situations
•Inhaler or medical assistance
•Remain calm and confident
Choking
Cardiac Arrest
•Crushing pain in chest
•Pain down arm
3. Begin CPR and use AED
4.
5.
Cerebrovascular
Accident
Minor Medical Emergencies
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
•Lack of blood flow to brain
•Feel
dizzy after laying down or standing for awhile
•Lay patient
down
•Orthostatic hypotension
•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
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
Entry
Spread
Multiplication
Damage
Outcome
Chain of Infection
Host
Infectious
Mode of
Microorganism
Transmission
–Vector/ Fomite
Reservoir
Chain of Infection
Nosocomial Infections
Iatrogenic Infection
Compromised
Patient
Patients
Flora
Hospital
Environment
Blood
borne Pathogens
Types of Nosocomial Infections
Iatrogenic Infection – related to physician activities
Compromised
Patient
Flora - microbes in healthy people
Contaminated
Blood
Patients - weakened resistance; immunosuppressed
Hospital Environment
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, Flesheating 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!