1) Emergency departments are designed to treat acute medical issues without appointments and are staffed by trauma physicians. They classify patients into non-urgent, urgent, and acute categories to prioritize care. 2) For trauma patients, MDCT is often the preferred imaging method and should be located near the emergency room along with radiography. Interventional radiology may perform procedures like embolization to stop hemorrhaging. 3) In reaction emergencies, treatments vary based on symptoms but may include oxygen, antihistamines, epinephrine, saline, and moving the patient to stabilize their condition. Staff are trained to recognize and respond to different types and severities of reactions.

1. HANDLING THE EMERGENCIES IN
RADIOLOGY AND FIRST AID IN THE
X-RAY DEPARTMENT

2. Introduction
• Emergency means serious, unexpected event that demands
immediate attention.
• Serious problem need active response to the doctors
• We must be prepared to minimize the possibility of further
injury or complication.

3. Emergency department
• Also known as an Accident and
emergency department or causality
department.
• The emergency departments (EDs) of
most hospitals serve a variety of clients.
• It is medical treatment facility
specialized in emergency medicine.
• Acute care of patient without prior
appointment.

4. Trauma units
• Trauma units are designed to cope with life- threatening
injuries.
• Trauma units are usually staffed with one or more trauma
physicians who receive highly specialized training in the
diagnosis and treatment of traumatic injuries.
• There are three designated levels of trauma facilities:
 Level 1
 Level 2
 Level 3

5. Emergency code response
• When working alone, or when qualified assistance is not
immediately available.
• You can obtain help by using the emergency call system.
• Blue code – medical emergency (24444)
• Red code – fire (22589)

6. Emergency response Team
• Hospitals have a designated group of health care workers who
respond to this type of code.
• Usually consists of one or more physicians, several nurses, a
respiratory therapist, and an electro-cardiographer.

7. Patient assessment
• Assess patients and observe changes in their clinical signs and
conditions is very important
• Patients with a history of chronic cardiac or pulmonary disease
are at greater risk.
• Before any patient is injected with a contrast medium or
subjected to an invasive procedure, a thorough history of
previous cardiac events, allergies, chronic diseases, and
medications should be taken.
• Baseline vital signs must also be taken and recorded.

8. Cont...
• Patients in the ED are classified as non-urgent, urgent or acute
(life-threatening).
• The most acute cases are seen first.

9. Management of Severely Injured Patients
• The acute trauma setting is not the place for disagreement
about the patient. Immediate management decisions must be
made by the head physician.
• The trauma team leader/head physician is an overall charge in
acute care.
• Trauma team leader must be an experienced consultant, there
must be a consultant in Radiology in charge of trauma.

10. Location and Facilities
• Triaging (decide the order of treatment)of patients is very important.
• Imaging technique of choice is the one which is definitive in trauma
setting, most often head to thigh CE-MDCT.
• The MDCT should be adjacent to emergency room.
• Radiography must also be present near the emergency room.
• The imaging environment requires all the life support facilities
available in the emergency room. This will include monitoring and
gases.

11. Radiography
• CXR-Chest radiograph must be obtained to document the
position of tubes and to evaluate for pneumothorax or
hemothorax and mediastinal abnormalities
• AXR or pelvic X Ray are usually irrelevant if patient is going
for CT.
• Cervical spinal injury precautions and pelvic binders should
remain in place until the MDCT has been fully assessed

12. C6 #

13. Focused Abdominal Sonography in Trauma (FAST)
• FAST is used to demonstrate
- intra-abdominal hemorrhage
- Solid organ injuries- spleen, liver, kidney
- Pericardial effusion

14. Focused Abdominal Sonography in Trauma (FAST)

15. Focused Abdominal Sonography in Trauma (FAST)

16. MDCT
• Clear of the need for protocols must exist for notifying the CT
department urgent imaging and how the department will
respond to ensure that the scanner is clear to receive the
incoming injured patient.
• IV assess right ante-cubital assess is preferred for contrast
administration.
• Radiation dose should be considered.

17. Poly-trauma protocol MDCT is indicated when:
• There is hemodynamic instability
• The mechanism of injury suggests that there may be severe
injuries that cannot be excluded by clinical examination or
plain films.

18. Interventional Radiology(IR)
• The role of IR in the emergency dept. is to stop hemorrhage as
quickly as possible
• The decision on whether a patient with traumatic hemorrhage
undergoes endovascular treatment, open surgery, a combination
of the two is typically a decision made by both the trauma team
leader and interventional radiologist after consultation.
• Interventional treatment modalities include Balloon occlusion,
or transarterial embolization to stop hemorrhage.

20. MRI
• MRI is not indicated in the setting of acute trauma care.
However availability of clear protocols for the transfer of
emergency to MRI facilities after stabilizing the patient is
recommended.

21. Upcoming Slide contains sensitive image

22. No Imaging !
• There may be circumstances where imaging is inappropriate;
for example, where a emergency patient is admitted with
profound shock, is not responding to intravenous fluids and the
site of bleeding is clear from the mechanism of injury.
• Such patients may be best taken straight to theatre.

23. Contrast Media Reactions : Management and
Preventions
• The cause of reactions to iodinated contrast agents has been
studied at length but is still unknown.
• An appropriate history is helpful.
• Who had no adverse reaction to an iodine contrast agent at one
time might experience a reaction on a subsequent occasion.
• Contrast medium sensitivity test is appropriate to minimize this
reaction

24. Categories of reactions
Mild: nausea, vomiting, cough, sneezing, warmth, headache,
itching, chills, sweats, rash, anxiety.
Moderate: tachycardia / bradycardia, hypertension / hypotension,
swelling – eyes, face.
Severe: convulsions, hypotension, arrhythmias,
unresponsiveness, cardiopulmonary arrest.

25. Nausea and vomiting
• Breathing suggestions.
• "Breathe through your mouth, taking short, rapid, panting
breaths," or "Take some long, slow, deep breaths through your
nose," are both effective instructions.
• On the other hand: if a patient expresses a need for a basin.
 Offer it immediately.
 Provide tissues and water to rinse the mouth.
 support the patient in a sitting or lateral recumbent position to
avoid aspiration of vomitus.
 The lateral recumbent position is safest for the patient with
nausea who is unable to sit up.

26. Urticaria
• TRANSIENT(lasting for short time)
• Supportive Treatment Including Observation
• PROTRACTED(lasting for longer time)
• Diphenhydramine (AVIL-50 mg) Intramuscular Or
Intravenous
• PROFOUND(intense emergency)
• H1 and H2 Anti-histamine (CIMETIDINE-300 mg IN 200ml)
• Adrenaline 1:1000- 0.1-0.3 ml In Adults (Max- 3mg)
• 0.1 mg/Kg Up to 0.3 Max Children

27. Respiratory reaction
• LARYNGEAL EDEMA(excess ofwatery fluid
collection in the cavitiesor tissues in the body)
– Oxygen- 6- 10 l/min
– EPINEPHRINE-Intramuscular/nebulization
(1:1000) 0.5ml(0.5mg)-adult dose
– Intubation
• BRONCHOSPASM(Narrowing of bronchi)
• PULMONARY EDEMA:
– Elevate Head End Of Bed
– O2- 10 L/Min
– Furosemide/Laxis- 40 Mg Iv Slowly
– Morphine – 1-3mg
– Shift To Icu

28. Hypotension
WITH BRADYCARDIA
• Elevate The Feet
• O2-- 6-10 l/min
• Normal Saline Rapidly To Be Given
• Atropine 0.6-1.0 mg Iv Repeat After
3-5min Max 3mg Total
• Pediatric 0.02mg ( Max 0.6mg)
WITH TACHYCARDIA
• Elevate The Feet
• O2-- 6-10 l/min
• Normal Saline Rapidly To Be
Given
• Adrenaline 0.5 ml

29. Convulsion
• Mild:
– Turn patient around to avoid aspiration
– Airway Should Be Clean And Open
– O2- 10l/Min
• Severe:
– Diazepam- 5mg Iv Slowly (anti- convulsion)
• Hypertensive Crisis:
– O2 10 l/Min
– Nitroglycerine- 0.4 mg Tab Sublingually
– If No Response:
– Nifedipine- 10mg Capsule Sublingually
– Monitor Bp Closely

30. Extravasation policy
Initial
• Elevate extremity
• Icepack - 15 -60 min
t.d.s x 3 days
 Observe for 2-4 hrs if volume >
5ml
 Call referring physician
Surgical consultation if :
• Increasing pain after 2-4 Hrs
• Change in sensation distal to site of
Extravasation
• Volume –
Ionic : >30ml
Nonionic : > 100ml

31. Note
• Severe reactions may begin as mild / moderate reactions
• Ensure resolution prior to discharge
(E.g.) in vagal reactions, bradycardia, and hypotension
should resolve.
• Otherwise, call code or transfer to emergency department

33. Reference
• Ehrlich - Patient Care in Radiography - With an Introduction to
Medical Imaging, 7th ed.
• https://radiology.ucsf.edu/patient-care/patient-
safety/contrast/iodinated/contrast-extravasation.