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 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 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
l Hypoglycemia
l 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
l Asthma
l 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
l Nausea and vomiting
l Epistaxis
l Vertigo and syncope
l Seizures
l Falls
l Wounds
l 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:
l Bacteria
l Viruses
l Fungi
l Protozoa
Microorganisms
l Can grow in or on an animal or plant and cause diseases.
l Host: animal or plant that provides life support to another organism.
l Disease: Any change from the normal structure or function in the human body.
l Infection: Growth of a microorganism on or in a host.
Varicella Zoster (Shingles)
Disease
n Disease occurs only when the microorganism causes injury to the host
Pathogen
l A disease producing microorganism.
– Multiply in large numbers and cause an obstruction
– Cause tissue damage
– Secrete substance that produce effects in the body
l Exotoxins ( high body temp, nausea, vomiting)
Bacteria
§ Strep Throat
§ Bacterial Pneumonia
§ Food Poisoning
Viruses
l Common cold
l Mononucleosis
l Warts
Oral Warts
Smallpox
Fungi
§ Athlete’s Foot
§ Tinea pedis
§ Ringworm
Protozoan
• Trichomonas Vaginalis
– STD
• Plasmodium Vivax
– Malaria
6 Steps of Infection
l Encounter
l Entry
l Spread
l Multiplication
l Damage
l Outcome
Chain of Infection
u Host
u Infectious Microorganism
u Mode of Transmission
– Vector/ Fomite
u Reservoir
Chain of Infection
Nosocomial Infections
u Iatrogenic Infection
u Compromised Patients
u Patient Flora
u Hospital Environment
u Blood borne Pathogens
Types of Nosocomial Infections
u Iatrogenic Infection – related to physician activities
u Compromised Patients - weakened resistance; immunosuppressed
u Patient Flora - microbes in healthy people
u Contaminated Hospital Environment
u Blood borne Pathogens – Hepatitis B and HIV
Blood borne Pathogens
u Disease-causing microorganisms that may be present in human blood. Ex: Hepatitis, Syphilis, Malaria, HIV.
u 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
l Single most important means of preventing the spread of infection.
l 7 to 8 minutes of washing to remove the microbes present, depending on the number present.
l Most effective portion of hand washing is the mechanical action of rubbing the hands together.
Personal Protective Equipment (PPE)
l Gloves
l Masks
l Gowns
l Protective Eyewear
l Caps
Universal Precautions
l Since there is no way you can know if a person is infected, you should ALWAYS use universal precautions:
l Wash your hands
l Wear gloves
l Handle sharp objects carefully
l Properly clean all spills
l 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, 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!