3. Patient Assistance and Transfer
• Back Injuries are the leading cause
of missed work days among
health care workers
• Health care workers are 4.5 times
more likely to sustain back injuries
than any other profession
• 12% of healthcare workers
leave the profession due to back
injuries
4. • The problem of lifting patients
Is compounded by the increasing
Weight of patients due to the obesity
Epidemic in the United States and
• The rise in Geriatric patients who require
Assistance.
In the imaging department we are
Often faced with the challenge of
Difficult patient transfers.
Employing proper lifting techniques
prevents back injuries!
6. Patient Transfer
• Consult the chart or ask the nurse or about any
specific limitations of the patient.
• Anterior hip replacement – no abduction, adduction or
rotation but can sit up at a 90º angle
• Posterior – No adduction, rotation or crossing of legs.
Must NOT flex more than 90º
• Do not raise the left arm after pacemaker implantation –
follow department protocols.
• Verify patient identification.
• Gather the necessary equipment (for example, a
mechanical lift or wheelchair) and making sure that
the equipment is in good working condition.
• Enlist the patient’s help and cooperation when
possible. Ask for help if necessary
8. Often, patients will have some type of medical equipment, i.e.:
• Infusion catheters and pumps
• Oxygen: cannula, mask or tracheal intubation.
• Nasogastric or nasoenteric
• Urinary catheters
• Chest tubes
• ETC
Always check a patient’s O2 tank setting before switching to
room Oxygen.
11. Patient Monitoring
• Temperature
• Heart rate
• Blood pressure
• Respiration
Even patients
who seem healthy
and strong can
experience
sudden changes
in their condition
without warning.
12.
13. Blood Pressure
Systolic Pressure/Diastolic Pressure
• Place cuff over brachial artery
• Position bell of Stethoscope in
antecubital space
• Inflate to 160-180mm/hg
• Slowly release pressure
• Systolic pressure at first sounds of pulse
• Diastolic pressure when pulse no longer
audible
• Average adult BP 120/80
• Korotkoff Sounds
14. Pulse and Respiration
Measuring Pulse
• Radial Pulse
• Apical Pulse
• Carotid Pulse
• Femoral Pulse
• Popliteal Pulse
• Pedal Pulse
• Quantity
• Volume
• Regularity
• Normal-60 to 100 BPM
• Tachycardia- over 100 BPM
• Bradycardia-under 60 BPM
Measuring Respiration
• Respiratory Rate: the
number of breaths
(inhalation and exhalation)
per minute 12 to 20 pm
• Respiratory Rhythm
• Depth of Respiration
Quality of breathing
• Listen for abnormal sounds
• Dyspnea
15. Superior Venacava
Inferior Venacava
Ascending Aorta
Aortic Arch
Brachiocephalic Artery Left Common Carotid Artery
Left Subclavian Artery
Right Pulmonary
Veins
Right Atrium
Tricuspid Valve
Right Ventricle
Left Pulmonary Artery
Right Pulmonary
Artery
Left Pulmonary
Veins
Left Atrium
Chordae
Tendinaea
Mitral Valve
Left Ventricle
Pulmonary Valve
Descending Aorta
16. Signs of Patient Distress
• Eyeball your patient!
• Observe, compare, evaluate
• Is patient alert, focused?
• Does patient make eye contact,
are they responsive?
p211
• Watch for signs of distress
• Skin color, temperature
• Breathing
• Coherent speech
• Level of consciousness
17. Levels of Consciousness
• Alert and conscious
• Drowsy but responsive
• Unconscious but responsive to painful stimuli
• Comatose
!In trauma situations, be aware of injuries
both known and unknown!
P212,311
20. Imaging in the Emergency Department
• Obtain as much patient information as possible.
• Introduce yourself to patient and briefly explain what you
need to image.
• Access situation: What images are ordered and how will
you acquire them?
• Seek assistance moving and
positioning patient when necessary.
• Provide appropriate shielding.
21. Trauma Patients
• Radiographers should be cautious to avoid further
injury when handling patients with fractures,
wounds or burns
• Be alert for changes in the patient's condition that
may indicate shock or increased intracranial
pressure
• Cervical spine precautions must be observed until
the possibility of cervical spinal fracture has
been ruled out
22. Emergency Situations in the Imaging Suite
• Call For Help!
• Allergic Reactions:
• Benadryl
• Epinephrine
• Cardiac or Respiratory Arrest:
•Administer CPR
•Shock:
•Lie patient down, elevate feet
•Keep warm
•Turn patient on side if nauseous
23. Emergency Situations in the Imaging Suite cont.
Seizures:
• Do not leave patient
• Lie patient on back or side
• Place pillow or something soft under head
• Do not attempt to restrain patient
• Keep patient safe
Diabetic Reactions:
• Hydration is important
• Patient may respond to a piece of candy or fruit juice
• Some types of diabetic reactions require
immediate treatment with medication
Dizziness or Syncope:
•Sit patient down
•Give oxygen if needed
24. Documentation
• Documentation is your friend
• Sign of a professional
• Be objective
• Document Incidents
• Document any drugs, contrast administered
• Document Patient History include prior procedures and
current medications
• Document abnormal patient behavior
• Document patient condition, difficulties
25. It is vital to obtain a thorough patient history
during the radiographic examination!
• Symptoms
• Duration of symptoms
• Possible causes of symptoms
• Recent procedures
• Related Illness or injuries
• Level and type of pain
208-211
27. • A patient must receive a full explanation of the
procedure and its risks and benefits before the
procedure begins.
• A patient must be competent to sign consent
form
• Only parent or legal guardians can sign for
minors
• Consent forms must be completed before
signing
• Only the physician named on the form can
perform the procedure
• Any condition stated on the form must be met
• The consent can be revoked by the patient at
any time
Informed consent must include
28.
29. Pharmacology
Six Rights of Medication Administration:
1. Right dose
2. Right medication
3. Right patient
4. Right time
5. Right route
6. With right documentation
31. Before the
Administration of
Any Medication
• Check Physician's orders
• Obtain a list of current patient medications
• Check for contraindications
• Be aware of exam sequencing and scheduling
and plan accordingly.
36. • Intrathecal route of drug administration is well
established in anesthesia and pain management.
• A variety of therapeutic substances can be delivered
by the intrathecal route.
Intrathecal Administration
37.
38.
39. • Do medical hand washing.
• Open a sterile set or tray by
unfolding the topmost part
of the covering wrapper
away from you.
• Open the second layer of the
wrapper to the sides of the
set or try.
• Open the final layer of the
wrapper toward you. The
wrapper can now become
the sterile field immediately
surrounding the sterile set
or tray.
41. • Ampules – single
doses
• Vials – small glass
bottle with sealed
rubber cap
• Pre-filled Syringes
42. • Check and recheck
label
• Check expiration date
• Never inject a solution
you haven’t drawn up!!
• Calculate correct dose
• Swab top of vial with
alcohol
• Assemble syringe and
needle
• Remove cap from
needle and draw back
air into syringe
• Inject air into vial
• Invert vial & withdraw
solution into syringe
• Remove air bubbles
43.
44.
45. Contraindications to Contrast Exams
Barium: be aware of issues concerning possibility
of perforated bowel.
Allergies to Iodine can lead to anaphylactic shock
Patient must have labs done prior to Iodine exam
BUN-6 to 20mg/dl
Creatinine-0.6 to 1.5mg/dl
GFR->60
Ask about medications and medical history
Diabetics should not take Metformin 24
hours prior to, and 48 hours following exam.
46. • Soft tissue has a low
absorption ratio
• Absorption is
dependent on:
- atomic number
- atomic density
- electron density
- part thickness
- K shell binding
energy
Absorption occurs
through photoelectric
effect
47. Contrast is a substance
that when introduced
into the body allows
for visualization of
structures that would
otherwise be difficult
to see
50. • Atomic number of 56
• Barium sulphate,
compound
• K shell binding energy
of about 37 kEv
• Inert colloidal
suspension
• Comes in powder form
or concentrated liquid
suspensions
• Administered orally,
rectally
or through a stoma or
NG tube
• Thin, thick or paste
51. • Contrast can be barium,
barium with air or
iodine
• Prep is NPO and a
cathartic
• Patient may be given
glucagon to reduce
spasms
• Sims position used to
insert enema tip
52. • Hygroscopic – can cause
constipation/impaction/bowel
obstruction
• Aspiration
• Hypervolemia from fluid overload
due to enlarged colon
• Perforation of colon/rectum
• Allergic reaction to latex tip
• Barium peritonitis
53. • Atomic number of 53
• Can be administered enteral – orally
or rectally, intravenously
(parenteral), orally, rectally, through
a catheter , directly into a structure
or intrathecally
• K shell binding energy
approximately 33 kEv
• Should not go over 70 kVp when
imaging
• Mainly aqueous
• Ionic and Nonionic (aqueous)
• Ethiodized Oils
54.
55. Possible Complications and Reactions to
Medications
• Infiltration/Extravasation
• Hematoma
• Phlebitis
• Thrombophlebitis
• Infection
• Septicemia
• Pulmonary Embolism
• Air Embolism
• Catheter Embolism
• Speed Shock
56.
57.
58.
59. • All iodine exams must
be completed first
• Ultrasound and CT
exams must be
performed prior to
barium studies
• Any thyroid studies
must be done prior to
iodine administration
• UGI performed prior to
BE!
60. Post Examination Instructions:
• Drink plenty of fluids
• Eat normally
• Rest
• Refrain from taking Metformin medication
for 48 hours following examination
• Now go home
