rev. 4/9/13 kristina hoerl, msn, rn, crn, nurse educator chris rowe, bsn, rn, nciim 1
TRANSCRIPT
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Emergency Skills for Radiology Technologists
Rev. 4/9/13Kristina Hoerl, MSN, RN, CRN, Nurse EducatorChris Rowe, BSN, RN, NCIIM
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The Learner Will Be Able To: Identify types of emergency situations in radiology.
Identify the appropriate contact for various
emergency situations.
Verbalize the information to provide when calling a
code.
State & demonstrate the roles of technologists,
RN’s and PSC’s in an emergency.
Demonstrate familiarity with the emergency carts
and defibrillator.
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General concerns that patient “doesn’t look or feel
right” (Concern can come from patient, family or staff)
Change in mental status or loss of consciousness
Heart Rate < 45 or >130
Respiratory Rate < 8 or >30
Oxygen saturations <90% despite 60% O2
New or prolonged (over 5 minutes) seizure
Severe chest pain
Emergencies in Adults
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Who is a peds patient?◦ Under 21 y/o being treated by pediatric service
Examples of “Triggers” for Calling Team:
◦ General concern that patient “doesn’t look or feel right” (Concern can come from patient, family, or staff)
◦ Worsening respiratory status (change in pattern/rate)
◦ oxygen saturations <90% despite 60% O2
◦ Decrease in blood pressure
◦ Pulse <60 or >220
◦ Seizures with apnea
◦ Acute change in mental status or level of consciousness
◦ Respiratory &/or Cardiac Arrest
Emergencies in Pediatrics
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Time is critical in an emergency.
Technologists can activate an emergency
team without approval of an RN or MD
based on guidelines learned in CPR
If any question if event could be life
threatening: Call the code team FIRST
Possible Emergency Identified: Now What?
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Patient Populatio
n
Type of Emergenc
y
Team to Call
PedsAny medical condition needing additional support & cardiac/respiratory arrests.
Peds Rapid Response Team
(RRT)
AdultsAny medical condition needing additional support & cardiac/respiratory arrests.
Adult Code
(Adult RRT does NOT respond to radiology)
AdultsPresent or imminent respiratory failure in patient with known or suspected difficult airway.
Difficult Airway Team
Who Ya’ Gonna Call?
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How Do I Get the Right Team?
Call 5-4444
Answer the 4 W’s
◦ What kind of emergency?
Medical, Fire, Security
◦ Who needs help?
Adult, Child
◦ Where is help needed?
Department, Building, Floor, Room Number
◦ Which emergency team is needed?
Adult Code Team, Peds Rapid Response, Difficult Airway Team
Provide Additional Info
◦ Your name, contact number
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MEDICAL EMERGENCY – DIAL 5-4444
State: I need the:
PEDS ADULTRapid Response Team Code Team
OR Emergency Airway Team
To ___________________ in ______________________ (department) (building & floor)
in room number _____________. My extension is __________.
Make sure you hang up LAST!
** When activating the ADULT Emergency Airway Team assign someone to get
the Adult Emergency Airway Cart from _____________________________**
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A system whereby families of pediatric patients
can access the Pediatric Rapid Response Team
If a family requests the Peds RRT be activated:
◦ Contact the radiology nursing staff.
◦ If the family feels they cannot wait for nursing
assistance or they still have concerns after
speaking to the nurse, the radiology staff are to call
5-4444 for the family.
Family Activated Pediatric RRT
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JHOC Concerns… JHOC After Hours
◦ Call 5-4444 just as you would any other time.
◦ If a team is not in JHOC, the operator will complete a 3-
way call with you and 911.
Peds Team Needed in JHOC
◦ As of April 28, 2012 the Pediatric Rapid Response team will
no longer be responding to emergencies in JHOC. When
you call 5-4444 the adult team will be called to respond.
◦ If you ask for the Peds RRT the person on the phone should
still call the adult team.
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The OR’s, the ED and the ICU’s maintain their own
“Code Team”
The unit based physician and nursing staff will
“run” the code. (5-4444 does not need to be
called).
Unit Based Code Teams
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What About Stroke?
Signs and SymptomsSudden slurred speech Sudden vision changes Sudden facial droop Sudden weakness of extremitiesSudden onset of severe headache
Who Do You Call? ◦The Brain Attack Team (BAT Team)
PING: Brain Attack
Pager: 3-6666 (enter your extension plus *911)
*Note: If the BAT Team is delayed in responding (longer than 6 mins) please proceed with contacting the HAL Line at 5-9444, and ask to speak with the Stroke Attending on call.
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Phone Calls / Pages:◦ Code Team
(5-4444) ◦ RN – 911◦ MD◦ Area PSC’s◦ Main PSC desk
(5-6187, 5-2920, 5-6126)
◦ CSD – 58357 (JHH)5-5881 (JHOC)
Jobs/Roles:◦ CPR
Compression Ventilation
◦ Phone calls◦ Defibrillate◦ Document◦ IV access◦ IV fluids◦ Med prep/
administration
Code “To Do” List Supplies:
Ambu bag Crash cart Defibrillator Drug Box Arrest cards (for peds) IV Pump Suction BP Machine EKG Machine
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Assess ABC’s Calling for help (Code team, RN, MD, PSC’s) CPR Bringing emergency equipment/supplies (includes
getting supplies out of cart when requested) Placing pads and using defibrillator Documenting event (Arrest record during/PSN after) Gaining large bore IV access (if signed off) Preparing IV fluids Cleaning/Replacing equipment after event
Technologist’s Duties in a Code
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Excellent Basic Life Support (BLS)
◦CAB
Circulation
Airway
Breathing
◦Defibrillation
Most Important Technologist Role in A Code
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Exactly the same as the technologists
Can also give medications
RN’s Duties in a Code
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As Directed by RN, Technologist, MD
◦ Call the code team (5-4444)
◦ Page the RN (add 911 to page)
◦ Page/call the MD
Once Aware of Emergency
◦ Call main radiology PSC desk
◦ Direct/take the code team to area
◦ Maintain function of unit
PSC’s Duties In A Code
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The Emergency Cart Adult Cart
◦ Labeled with word adult or letter “A”
◦ Has black drug box on top
Pediatric Cart◦ Labeled with word ped or
letter “P”◦ Has blue drug box on top◦ Has notebook with
pediatric drug sheets
To Use Cart◦ Grip handle on side of cart
swings up for easy steering◦ Lift up the red handle on the
front of cart to break the lock
◦ Push handle all the way back into the slot
◦ Remove cardiac board from front of cart
◦ Drawers are configured for A (airway), B and C (blood and circulation)
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The Emergency Cart & Drug Box
On Top
◦ Emergency Drug Box
Blue = Peds
Black = Adults
Top Well
◦ Adult = Protective gear
◦ Peds = Extra Airway
Side Bins
◦ IV Fluids
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The Emergency Cart & Drug Box
1st Drawer
◦ Airway/Breathing
2nd Drawer
◦ Circulation
3rd Drawer
◦ Miscellaneous
Ex: Stomach tubes, Res-Q
vac
Bottom Well
◦ Large Items
Ex: Ambu bag, Needle box
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The Drug Box
BristojetsMedication
Vials
Syringes & Needles
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Contrast Reaction Box
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Contents:◦ Albuterol Inhalation◦ Ammonia Inhalant◦ Benadryl (po & IV/IM)◦ Epi (auto-inject peds/adult)◦ Epi (ampule)◦ Solumedrol◦ Nitroglycerin---------------------------◦ NSS IV◦ Prefilled saline syringe◦ Angiocath (20g & 22 g)◦ Nebulizer mask◦ Primary IV tubing◦ Syringe (3 cc w/ needle)
Contrast Reaction Box
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Artificial Airway Devices
Oral Airways:
Placed mouth to pharynx. Not good for
patients with gag reflex.
Nasal Trumpet:
Placed nasal passage to the pharynx.
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Artificial Airway Devices
Shiley Trach Tube:
Placed in opening in trachea
Endotracheal (ET) Tube:
From mouth to trachea
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Difficult Airway Kit
Used by Anesthesia for patients who are hard to intubate
Locations:
* Nuclear Medicine
* MRI
* IR
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For patient’s who arrest with a known or suspected difficult airway◦ Known
Blue difficult airway bracelet◦ Suspected
Short, thick neck Severe obesity Prior neck surgery or tumor Receding jaw Facial trauma
MD’s from head/neck & trauma surgery come to assist anesthesia
Airway Emergency
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If you have an airway emergency for an adult patient, 2 things must happen:
◦ 1) Call the paging operator, x5-4444, and tell them you have an "airway emergency" and specify the patient location.
◦ 2) Send staff to get the airway emergency cart from the location closest to you.
AIRWAY EMERGENCY CART
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DIFFICULT AIRWAY CART LOCATIONS NEAREST TO RADIOLOGY AREAS
ED Rad:
◦ Adult ED NCB 1 Rm #ZB01W
Zayed 3:
◦ General OR NCB 3 Rm #
ZOR03
Zayed 4:
◦ CVSICU NCB 5 Rm #ZB05E
**Unless otherwise
noted, we must retrieve
cart**
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DIFFICULT AIRWAY CART LOCATIONS NEAREST TO RADIOLOGY AREAS (CONT’D)
WBG Rad:
◦ WBG 5
Nsg shift coordinator will
deliver
Historic Building:
◦ Halsted 2 - Alcove H268
JHOPC:
◦ JHOPC PACU Rm #LL055
**Unless otherwise noted,
we must retrieve cart**
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Purpose◦ Provides for documentation of event◦ Becomes the MD order sheet
Information Needed◦ Airway – ventilation ?, ETT tube ?◦ Compressions – yes/no, time◦ Defibrillation – yes/no, time◦ Vital signs & heart rhythm◦ Drugs – dose & time◦ IV fluid type & location
The Arrest Record
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The Zoll AED
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►Victims in water
► Victims with transdermal medication patches
►Victims with implanted devices
AED: Special Situations and Contraindications
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Make sure the Zoll is connected to the pads.
Place pads directly on pt’s bare skin by rolling pad in place. (remove bras)
Using the Zoll AED
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Power On AED Defib• Turn the power switch to defib.
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Clear rescuers and bystanders from the patient ensuring that no one is touching the patient. Avoid all movement affecting the patient during rhythm analysis.
Press the ANALYZE button. Rhythm analysis takes 5 – 15
seconds If a shockable rhythm is present,
the AED will display a visual
message and announce
“Press Shock.”
Analyzing the Rhythm
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Before pressing the shock button always…◦ Loudly state, “I’M CLEAR,
YOU’RE CLEAR, WE’RE ALL CLEAR!”
◦ Perform a visual check to be
sure no one is touching the
patient
Only press SHOCK button
if all clear
SHOCK the Patient
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Pediatric AED Use ◦ For children OVER 1 year old
◦ Use Pedi-pads for patients under 15 kg (4 y/o)
◦ AED will shock at 200 J even for kids Betsy Hunt, MD (Head of JHH Pediatric CPR Committee)
states:
”the AHA feel(s) that shocking very early in a
witnessed arrest is far more important than the issue
of using too many joules...”
AED and Peds
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If You Are Unsure How To…
Prime IV tubing with fluids
Set up suction equipment
Use wall or bottled oxygen
Locate emergency equipment
Use any other emergency equipment
ASK THE NURSE IN YOUR AREA
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You have now
completed the lecture
part of the emergency
skills class.
Bring your certificate
of completion and a
pen to your hand’s
on class
Thank You For Your Attention
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DART may be used as resource for peds
patients
◦ Will be activated by Peds RRT
◦ Supplies/equipment obtained from PICU or Adult ED
When calling 5-4444 include as much info as
possible including your modality
BAT Team – Call HAL Line @ 5-9444
◦ This replaces PING
Emergency Skills Class Updates1-21-14