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129 Cards in this Set

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Code blue

Cardiac arrest

Code red


Code pink

Infant abduction

Code purple

Child abduction

Code orange

Hazardous material spill

Code green

Incoming cardiac arrest

Code triage

Internal/external disaster. Expecting a lot of patients

Code yellow

Bomb threat

Code white

Pediatric medical emergency

Code silver

Person with weapon or hostage situation

Code grey


Purpose of crash cart

To keep circulation moving

Glasgow coma scale

Eyes, verbal, and motor

Total of 15pts. Score of 7 or less is dangerous

Crash cart

To keep circulation going. Located in room where they perform contract procedures (IV, iodine)


Levels of consciousness (can deteriorate quickly. Do Glasgow coma scale)

Loss of consciousness (put in shock position, keep warm, turn head sideways)


The body's physiological reaction to illness, trauma ,or stress in which there is disturbance of blood flow to vital organs

Interuption of circulation or blood flow or body inability to perfuse (gas exchange)

Shock stages

Compensatory (can intervene)

Progressive (can intervene)

Irreversible (prognosis is really bad)


Compensatory stage

(Symptoms may not appear)

Skin cold and clammy

Urine output decreases

Bowel sounds are hypoactive

BP is normal

Anxiety increases

Respiratory increases

If progresses, BP falls, going into renal and liver failure, and fluids leak out of capillaries. Now going into progressive stage

Blood Pressure


120/80 to 140/90

Systolic (heart squeezing) 120

Diastolic (heart relaxing) 80

Heart Rate


60 to 100 bpm

Respiration Rate


14 to 20 per minute


Fast heart rate. Over 100 bpm


Slow heart rate. Below 60 bpm


Progressive stage

-BP falls below 60 mm hg

-Respiration rapid and shallow

-Severe pulmonary edema from leakage from capillaries

-tachycardia, rapid as 150 bpm

-chest pain

-mental status (confusion, lethargy, LOC)

-renal, hepatic,GI, heme problems

If progresses, called irreversible stage.

Characteristics of Shock

* heart rate increases

* respiration increases

* Blood Pressure decreases

* urine output decreases


Irreversible stage

-Blood pressure remains low

-Renal and liver failure results

-Release of necrotic tissue toxins and an overwhelming of lactic acidosis (muscle pain or cramping, discomfort of abdominal and stomach, unusual sleepiness, weakness)

Causes of shock

(Disruption of blood flow or lack of perfusion)


-Emotional or under physical stress

-Serious injury or infection

-Vomiting or diarrhea


-Experiencing severe pain

-Bowel obstruction

-Undergoing procedure that causes rapid fluid loss


-young or very old

Types of shock

-Hypovolemic shock

-Cardiogenic shock

-Distributive shock (neurogenic shock and septic shock)

-Anaphylactic shock

-Obstructive shock

Hypovolemic shock

Low volume of blood circulating in the body. Occurs when 15 to 25% of blood loss.


-maybe internal or external


-Loss of plasma(water) from burns

-Fluid loss from vomiting

-Diarrhea, medications that dehydrate or heat stroke(prostration)


Difficulty breathing


Low blood pressure below


High blood pressure

Clinical manifestation of hypovolemic shock

Class I

Blood loss of 15%

BP within normal limits

HR is less than 100 bpm

Patient is slightly anxious

Respiration normal (14-20 per min)

Urine output is in normal range

Clinical manifestation of hypovolemic shock

Class II

Blood loss of 15% to 30%

BP is in normal limits

HR is greater than 100 bpm

Patient is increasingly anxious

Respiration ranges from 20 to 30

Urine output begins to decrease

Clinical manifestation of hypovolemic shock

Class III

Blood loss of 30% to 40%

BP decreases below limits

HR is greater than 120 bpm

Patient is anxious and confused

RR increases to 30 to 40 per min.

Urine output is greatly decreased

Clinical manifestation of hypovolemic shock

Class IV

-Blood loss of more than 40%

-Systolic BP decreases from 90 to 60mm Hg

-HR greater than 140 bpm w/weak and thready pulse.

-patient is confused and lethargic

-RR greater than 40 per min.

Urine output diminishes or ceases

Hypovolemic shock RT actions

Still what you doing, put in supine position w/ legs elevated 30 degrees unless spinal cord injury. Never put in tendelenburg position. Get doctor, make sure their breathing. If bleeding apply pressure. Get crash cart. Vitals every 5 min. Don't give fluids to patient

Cardiogenic shock

Caused by failure of the heart to pump adequate amounts of blood to vital organs.


-Patient hospitalized by myocardial infarction.

-cardiac dysrhythmias or other cardiac pathology.

Initial complaints:

-Chest pain that radiates to jaws and arms.

-Dizziness & respiratory distress

Clinical manifestation of cardiogenic shock


-Restlessness anxiety

-Rapid change in LOC

-Pulse irregular and slow; may have tachycardia and tachypnea

-corotid pulse hard to evaluate

-low BP

-decrease urine output

-cool clammy skin

Cardiogenic RT actions

Call code and get crash cart

Notify doctor

Prepare to assist w/oxygen, IV, meds.

Don't leave patient alone

Assess vitals every 5 min

Don't offer fluids

Be prepared to do CPR

Distributive shock

Inability for the blood to be distributed evenly and adequately, this occurs when the blood pools in the periphery (upper and lower extremities) this generally refers to the lower extremities because it is much further away from heart which takes longer to travel. AKA vasogenic shock.

Types of distributive shock:



Neurogenic shock

(Nerve shock)

Type of distributive shock

Results from loss of sympathetic tone causing vasodilation of peripheral vessels. resulting in low blood pressure, occasionally with a slowed heart rate, that is attributed to the disruption of the autonomic pathways within the spinal cord. It can occur after damage to the central nervous system, such as spinal cord injury.


Spinal cord injury

Severe pain

Neurologic damage

Depressant action of medication

Lack of glucose

Adverse effects of anesthesia

Clinical manifestation of neurogenic shock

-Hypotension (worst of because there

-Bradycardia. Is no balance. Only time. there is low BP and low HR )

-Warm dry skin

-Initial alertness if not unconscious (head injury)

-Cool extremities & diminishing peripheral pulses

Neurogenic shock RT actions

If suspected spinal injury do lateral c-spine to make sure cervical spine is aligned.

Call for help

Put in supine position

Crash cart

Monitor vitals

Get ready to assist

Septic shock

Type of distributive shock

Has a 40-50% mortality rate for its victims and fast within 12 hours. Single cause of death in ICUs.


Whole body infection by bacteria, endotoxins(bad for body) are released causing capillary permeability and vasodilation so blood cant circulate back to heart causing distributive shock.


Old and young age

Recent surgery

PICC lines, catheters

Diabetes, COPD, renal failure

Patients who are immunosuppressed


Massive burns or traumatic injury

Prosthesis, indwelling catheter

Invasive surgery(open surgery)

Obstructive shock

Results from pathologic conditions that interfere with the normal pumping action of the heart (unrelated to heart pathologies and conditions itself)

Most common is pulmonary embolism (PE)


-Pulmonary embolism **usually only one we see. (Chest pain)

-Pulmonary hypertension

-Arterial stenosis

-Constrictive pericarditis

-Tumors that interfere with circulation

Pulmonary embolism

Clinical manifestation

#1 cause of sudden death

Chest pain

Rapid, weak pulse


Dyspnea & tachypnea



Cough & hemoptysis (coughing up blood)

Diaphoresis (excessive sweating)

Syncope (feeling fajnt)



Rapidly changing LOC

Coma; sudden death may result

Anaphylactic shock

Exaggerated hypersensitivity to an antigen (foreign body) that was previously encountered by body's immune system. Histamine & bradykinin are released from body acting on smooth muscle to contract, causing vasodilation, which results in peripheral blood pooling. Or summarized: vessels are wide open, so it's trying to close to pump blood back to heart.



Iodinated contrast (found in sea food)

Insect venoms

Anaphylactic clinical manifestation

Mild systemic reaction:

-Begin within 2 hours of exposure

-Nasal congestion, sneezing,itching ect

-Peripheral tingling or itching at site of infection

-tightness of chest, mouth or throat

Moderate systemic reaction:

-All symptoms listed above w/rapid onset

-Flusging,feeling warmth,itching, uticaria(hives)


-Bronchospasm & edema of airway and larynx

-Dyspnea, cough and wheezing

Severe systemic reaction: worst case

-All above symptoms w/abrupt onset

-Decreasing BP, weak, thready pulse either rapid or shallow

-Rapid progression of bronchospasm, laryngeal edema, severe dyspnea & cyanosis

-dysphagia, stomach cramping, vomiting, diarrhea

-seizures, respiratory and cardiac arrest

-any mild reaction can become major within 2-3min.

Rarely at this stage

Benadryl and solu-cortef

Benadryl=anti histamine


They both relax smooth muscles(prevents restriction) and can be given prior to contrast study to minimize risk of anaphylactic reaction.


Have some thickness properties as your blood

Iodine reaction

Iodine Is foreign material

Contrast agents are categorized as drugs because they can be absorbed into the systemic(whole body) circulation and may affect physiologic response. Most drugs injected are isotonic.

Contrast agents are not isotonic, they are very viscous(thick and sticky). When contrast is injected causes sudden shift in body fluids, by diluting contrast to the same consistency of blood by stealing fluids from surrounding tissues and drawing them into the vessels. In doing so can cause dehydration.

This sudden shift of fluids can contribute to shock because of thickness of contrast agents.

Iodine reaction

Transient response


*Is not a reaction but a response to contrast agent. Its expected to happen!! Normal

-A warm flushed feeling from a rapid bolus injection

-Nausea or vomiting usually passes quickly


-Pain or burning at injection site

-Metallic taste

*Normal, it is expected and its temporary.

Do not confuse with an allergic reation.


Moderate (intermediate)


Infusion vs bolus injection

Infusion: slowly delivered in long period of time

Bolus: large amount in short period of time

Iodine reaction

Health assessment information

-Age of patient

-History of impaired hepatic function

-History of impaired renal function

-History of hypersensitivity reactions

-History of thyroid disease (wont work with other medications like cancer)


-Lactation (can go to baby and give allergic reaction)

-Aspirin sensitivity

-Sensitivity to tartrazine( coloring in food & beverages)

-beta blockers (heart medication)

-history of diabetes mellitus( may have impaired renal function)

-history of multiple myeloma (dont give contrast)

-simple cell disease (contrast attaches to RBC and no room for oxygen)

-hypertension (increases chance of reaction)

Basically anything that leads to heart can cause anaphylactic shock with contrast agent.


Extravasation vs infiltration

Iodine contrast can leak out.

Extrvasation= causes no damage to tissues if leaks out

Infiltration= causes damage and necrose to tissues if leaks out


A fluctuation of carbs or sugar going to brain, high bp going into vessels and then shuts off Like a switch off and on off and on off and on ect.. by doing this, the vessels keep stretching out eventually losing elasticity thus not being able to pump blood back to heart. So lower extremities for example are far from heart and wont get nutrients and oxygen due to not being able to pump blood and will die.

Diabetes type I

Type I Diabetes mellitus:

(insulin dependent)


Normal adult blood glucose level should range from 80 to 115 mg/dL

Body stops producing insulin. Abrupt onset, under 30. Genetic condition.

The body's immune system destroys the cells that release insulin, eventually eliminating insulin production from the body. Need insulin to produce energy.

Person must receive insulin 8njections to control blood glucose levels and prevent ketoacidosis

Diabetes type II

Type II Diabetes Mellitus:

Producing insulin but body is not utilizing insulin properly. (Insulin resistant) Gradual onset, over 40 who are obese. Caused by obesity, hereditary factors, or environmental conditions. Diet and exercise can control it. Take hypoglycemic agents to prevent hyperglycemia if diet and exercise dont work. Ketoacidosis does not occur in type II because there is enough of insulin present in body to prevent the breakdown of fat. Stress or infection may result in ketoacidosis.

In type II diabetes, The body isn't able to use insulin the right way. This is called insulin resistance. As type 2 diabetes gets worse the pancreas may make less and less insulin and this is called insulin deficiency.

Normal adult blood glucose level

should range from 80 to 115 mg/dL

Gestational Diabetes

Occurs in later months Of pregnancy. Caused by hormones secreted by the Placenta that prevent the action of Insulin. Usually treated with diet but insulin may be needed to control blood glucose levels.

Hormones from the placenta help the baby develop. But these hormones also block the action of the mothers insulin in her body. This problem is called insulin resistance. The mother is not able to use insulin properly. Do not know the cause of it.


Coma maybe a complication of type 2 diabetes. It may occur in the elderly with no known history of diabetes. Mistakenly perceived as being inebriated Or having had a stroke. There is a loss of effective insulin leading to diuresis (excessive sweating) And loss of fluid and electrolytes. Blood glucose is often greater than 600 mg/dL

Clinical manifestation of hyperglycemia

-Extreme dehydration, dry skin, sunken eyes.

-Hypotension, tachycardia, increased body temp.

-Extreme thirst, muscle twitching, difficult, slurred speech.

-Metal confusion, seizures, half paralyzed, and coma.


Diabetic ketoacidosis is a Serious condition that can lead to diabetic Coma (passing out for a long time) or even death.

When your cells don't get the glucose they need for energy your body begins to burn fat for energy, which produces ketones. Ketones Are chemicals that the body creates when it breaks down fat to use for energy. The body does this when it doesn't have enough insulin to use glucose the body's normal source of energy. When ketones build up in the blood, they make it more acidic.

Orthostatic hypotension

When you lay for a long period of time and get up quickly you will get dizzy and that is because blood is pooled to lower extremities and if you get up too quickly there's no blood going to brain and you get Dizzy. So we need to do is sit up patient to get circulation going to brain.


Clinical manifestation

Weakness, drowsiness, headache, blurred vision, abdominal pain, nausea and vomiting

Sweet odor to the breath, and ortho static hypotension.

Warm, dry skin Parched tongue breed dry mucus Membranes, extreme thirst( polydipsia) and polyuria


Not enough sugar in system

Vasovagal reaction

Its emotional. Anything that makes you faint, like being star struck, scared, pain, sight of blood, emotional distress ect. Occurs when the patient experiences high anxiety about the procedure and its results.

Vasovagal syncope

BP and HR drop suddenly. (One of the rare cases it doesn't balance out, that's why you pass out) temporary not shock.

Try to calm them and explain the procedure so they know what to expect. Tell them that they will feel a contrast It may be warm and may have a metallic taste.


Cerebrovascular Accident (Stroke)

Disruption of blood flow circulating through the brain, a clot or ruptured vessel or occlusion. Rupture of cerebral artery, resulting in hemorrhage directly into the brain tissue or into space surrounding brain.

They occur with little to no warning aka brain attacks. Need clotting agents to stop or controlling bleeding.


Clinical Manifestations

-possible severe headache


- Muscle weakness or flaccidity of face or extremities, usually one sided.

- eye deviation usually one sided, possible loss of vision


-dizziness, or stupor

-ataxia (not able to move)

-may complain of stiff neck

- Nausea and Vomiting and loss of consciousness

Everything spins.


A syndrome! Not disease!

A seizure is an unsystematic discharge of neurons of the cerebrum that results in an abrupt alteration in brain function. Lasts for only seconds or several minutes. Accompanied by a change of LOC.

SIEZURES ARE A SYNDROME OR SYMPTOM OF A DISEASE, NOT A DISEASE THEMSELVES. They may be caused by infectious disease, especially those accompanied by a high fever.

Causes of seizures

Are caused by extreme stress, head trauma, brain tumors, structural abnormalities of the cerebral cortex, genetics defects(epilepsy), birth trauma, vascular disease, malformations, postnatal trauma. Odors and flashing lights can cause a seizure in a person who is seizure prone.

Seizure types

Simple partial: affects one side of brain

Simple/complex partial: starts in one place primary & triggers a secondary pathway.

Generalized /complex: the whole brain is misfiring at same time

Generalized seizure

(Grand-mal)- tonic/clinic seizures

Clinical manifestation:

-May utter sharp cry as air is rapidly exhaled

-muscles become rigid & eyes open wide (TONIC PHASE)

-may exhibit jerky body movements & rapid irregular respirations (CLONIC PHASE)

-may vomit

-may froth and have blood streaked saliva by biting lips and tongue.(cant controll it)

-may exhibit urinary & fecal incontinence.

-usually fall into deep sleep after seizure due to being exhausting.

Sims position

For seizure patients. Turn them to side or between with face downward so secretions can drain from mouth.

Simple partial seizure

The seizure activity depends on the area of the brain involved.

Clinical manifestation

Only finger or hand may shake

May speak unintelligible

May be dizzy

May experience strange odors,smells and taste

Simple complex seizure

Clinical manifestation

The patient is not responsive to the environment, although he appears to be awake. A complex partial seizure or last from 1 to 4 minutes. They look stoke

-patting and rubbing oneself

-may remain motionless or experience emotional outburst of fear, crying or anger.

- lip smacking, grimacing,swallowing movements or panting.

-will be confused for several minutes after episode with no memory of incident.

Head injury LOC

1: alert and conscious

2: drowsy but responsive

3: unconscious but reactive to pain

4: comatose


How you walk

Head injury RT actions

Lateral recumbent

Lying on their side

Like for head injury, seizure ect... patients


Temporary lack of blood flow to brain from tear of small vessels that attach to skull and that is due to vigorously shaking of head or getting hit on head.1 or 2 concussions ok, but a lot is bad.

Spinal injury

Should be evaluated by doctors before being moved. Even a slight movement can cause pressure on cord, resulting in paralysis or death. If possible make film exposures without moving patient. If a change of position is required use logrolling method. When doing logrolling method always 2 or more people. Move whole body in one motion avoiding twisting or bending of spine.

Compound fracture

Open. Bone protrudes through skin

Comminuted fracture

Broken into many pieces

Avulsion fracture

Is where tendon pulls bone and detaches it

Incomplete (greenstick) fracture

Where bone doesn't break but bends significantly


Grading sound or feel.

Ex. Fracture


When there's a newly fresh wet cast, do not squeeze cast because it will cause indication inside cast pressing down on skin and can stop circulation.

1st degree burn

Redness or hyperemia involving superficial layers of skin. Maybe a little blister. Skin tissue

2nd degree burn

Blisters (vessication) involving deeper layers of skin. Skin tissue

3rd degree burn

Destruction involving any tissue below the skin. Skin tissue and bone


Nausea and vomiting are frequently encountered. Vomiting can often be prevented by a reassuring touch and presence of a radiographer and by instruction to breathe through your mouth taking short rapid panting breaths support patient in sitting position or lateral recumbent position to avoid aspiration of vomits. If the patient needs to vomit, give basin tray, and tissue and water to rinse mouth. If patient goes unconscious, turn to side and clear airway.



Squeeze firmly against nasal septum for 10 min. If bleeding last more than 5 min get doctor. Dont let them swallow blood, spit out. Dont lie down, blow nose, or talk.


Due to a different cause. Will not feel lightheaded but will describe the Room is moving or whirling. Will cling to table and will fall if not assisted. Alcohol or drugs affect people the same way.

Vital signs

Several situations that may alter a person's normal vital sign, such as sleep, exercise, medications and emotions . Aka cardinal signs

Brain cant function for more than 4 or 5 min without an adequate supply of oxygen.


A measurement of the state of metabolism of the body. It is a physiologic balance between the heat produced in body tissues and he lost to the environment. Changes in the body's Physiology occur when the body temperature fluctuates even 2 or 3゚ 3 body temperature is controlled by the hypothalamus. If a fever persist over long period of time CNS damage can occur.

Body utilizes a lot of oxygen

Temperature oral

Put under tongue. Do not use if patient has been drinking hot or cold beverages. Wait 15 min When the patient is breathing oxygen with a face mask, patience is unconscious, delirious, unresponsive, infant, in surgery, injury to nose or mouth, history of convulsions, or unable to breathe. Chewing gum and smoking also affect temperature. Leave the mometer in the mouth for 3 to 5 minutes.

Normal temp with discription: 98.6 O

Temperature axillary

Armpit. Place under the arm and cross arm over the chest. Be sure to wipe off sweat and deodorant. Leave under arm for 5 min.

Normal temp with discription: 97.6 A

Temperature rectal

Core temp!

Usually done on infants. Should not be done if patient is restless or has a rectal pathology such as tumors or hemorrhoids. Wear gloves and provide lubricant. Insert 1 to 11/2 inches and hold in place for 2-3 min.

Normal temp with discription: 99.6 R

Temperature tympanic


It's a small handheld device that measures the temperature of the blood vessels in the tympanic membrane of the ear.

Normal temp with discription: 98.6 T


Elevated body temperature (frequent complications of fever is convulsions

Underlying or intermittent temp

Alternating between fever and normal temperatures


Temperature rises, then drops, but never returns to normal


Sudden turning point of a disease- usually with a sudden drop in fever


Fever gradually returns to normal


Without a fever


Lowered body temperature. Can cause death if below 93.2 F (34C) aka hypopyrexia


Elevated body temperature

105.8 F or 41 C to 111.2 F or 44 C.

High temperatures can affect CNS


Tells how often the heart beats grid areas of the body in which arteries are superficial, the pulse can be felt by holding the artery beneath the skin against a solid surface of bone

Normal HR

60 to 90 beats per minute

Where to take pulse

-Apical - heart heard with stethoscope






-Dorsalis pedis

The first seven are most common and Last are:

-Posterial tibial


Usually the pulse is rapid if BP is low and slow when BP is high


One respiration = 1 inspiration + 1 expiration.


Adult 15 to 20 breaths/minute

Child 25 to 30

Infant 30 to 60

Discriptors for respiration







Lungs expand and stay in expanded state, does not retract. Air is trapped in lungs so cant get air out.


Lungs are constricted and xant get air inside


Lack of oxygen- look for cyanosis around lips, ear lobes,gums and nail beds


Rapid breathing of 40 or more respiration/minute


Person can only breath in a upright position. If lay down will have difficult breathing

Stertorous breathing



Death rattle (near death or dying)= rapid breathing for 30 seconds slows down then stops for about 10-30 seconds and the sequence starts all over again.


Obstructive by secretions. Sounds wet and mucousy


Abnormal high pitch. Heard in inspiration. Indicates glottic edema or asthma

Blood pressure

Is the force exerted by the blood on the walls of the vessels as it is pumped by the heart.

Shock is the best indicator

Increases after a big meal, stress, emotions, strenuous activities.

Systolic / diastolic

Systolic :Contractions of the ventricles

Diastolic: relaxation of the ventricles

Normal Blood Pressure

Adult: 120-140/80-90 mm Hg

Children: 90-120/50-70 mm Hg

Most important lab data for technicians

BUN and creatinine

BUN= blood urea nitrogen


High BUN - renal disease or compromised function

Low BUN - severe liver disease or malnutrition