Patient Vital Signs and Medical Emergencies

1. Patient Vital SignsandMedical Emergencies Orientation Fall 2011

2. 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

3. Vital Signs • Body Temperature • Respiratory Rate • Pulse / Heart Rate • Blood Pressure • Sensorium (mental alertness)

4. Importance of Vital Signs • Indicates the patient’s immediate condition • Can show improvement due to treatment • Can show a decline in condition

5. 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 survivebetween 93.2 ° F and 106 ° F

6. Thermoregulation Shivering when cold Sweating when hot

7. Measuring Body Temperature • Oral • Rectal • Axillary • Tympanic • Temporal

8. 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 Abnormalities in Body Temperature

9. 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

10. Abnormalities of Respiratory Rate • Tachypnea • Greater than 20 breaths per minute (adult) • Bradypnea – decrease is breathing • Dyspnea- difficulty breathing • Apnea- no breathing

11. Methods of Delivering Oxygen Nasal Cannula Masks Oxyhood Ventilators

12. Pulse • Adult • 60 to 100 beats per minute • Children under 10 • 70 to 120 beats per minute

13. Radial artery Brachial Carotid artery Apical pulses Measurement

14. 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

15. 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

16. 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

17. Abnormalities of Pulse Rate • Hypertension • Persistent elevation above 140/90 mmHg • Hypotension • Persistent less than 95/60 mmHg

18. Medical Emergencies

19. Medical Emergencies • What a Radioilogic technologist should know • Common Radiology Emergencies

20. 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

21. 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

22. Major Medical Emergencies ALOC Shock Anaphylactic shock Diabetic Crisis Respiratory Distress Cardiac Arrest Cerebrovascular accident

23. 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

24. 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

25. 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

26. Water Soluble Iodine • High atomic # 53 • Radiopaque • Used to radiograph • Vessels • Arteries • Veins • Function of internal organs

27. 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 Prevention and Signs - Symptoms

28. Diabetic Crisis Hypoglycemia Hyperglycemia

29. Hypoglycemia • Excessive insulin • Can result from normal dose of insulin & no food • Need carbohydrate

30. Hyperglycemia • Excessive sugar • Usually seen in diabetics • Pt. needs insulin

31. Respiratory Distress Asthma Choking

32. Asthma • Stressful situations • Inhaler or medical assistance • Remain calm and confident

33. Choking • Cannot speak • Universal distress signal • Encourage to cough • Heimlich Maneuver

34. Cardiac Arrest • Crushing pain in chest • Pain down arm 3. Begin CPR and use AED 4. 5.

35. Cerebrovascular Accident • Paralysis on one or both sides • Slurred or loss of speech • Dizziness • Loss of vision • Complete unconsciousness

36. Minor Medical Emergencies Nausea and vomiting Epistaxis Vertigo and syncope Seizures Falls Wounds Burns

37. Nausea and Vomiting • Tell pt to breath deeply and slowly • Turn on side if possible or turn head • Get emesis basin and moist cloths

38. Epistaxis - nosebleed

39. 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

40. 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

41. 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

42. 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!