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Patient Vital Signs Medical Emergencies and Infection Control SP2010 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!
