Medical Emergencies
Allergic Reactions
•	Allergy is an abnormal acquired immune response to a substance that would not normally trigger a reaction
•	Can be introduced via contact, ingestion, inhalation or contact
•	Two common reactions in Radiology 
–	Latex
–	Contrast Media
Cardiac or Respiratory Arrest
•	Cardiopulmonary arrest-absence of pulse and respiration with loss of consciousness 
•	Respiratory Arrest- absence of chest movement and breathing sounds
CPR steps
•	1. CALL Check the victim for unresponsiveness. If there is no response, Call 911 and return to the victim. 

•	2. BLOW  Tilt the head back and listen for breathing.  If not breathing normally, pinch nose and cover the mouth with yours and blow until you see the chest rise. Give 2 breaths.  Each breath should take 1 second.

•	3. PUMP  If the victim is still not breathing normally, coughing or moving, begin chest compressions.  Push down on the chest 11/2 to 2 inches 30 times right between the nipples.  Pump at the rate of 100/minute, faster than once per second.
    
•	CONTINUE WITH 2 BREATHS AND 30 PUMPS UNTIL HELP ARRIVES 
NOTE: This ratio is the same for one-person & two-person CPR.  In two-person CPR the person pumping the chest stops while the other gives mouth-to-mouth breathing
Physical Injury or Trauma

•	Vomiting- make sure patient is upright or recumbent patient is turned on side

•	Fractures- support site when moving. Splints should not be removed for x-rays. 

•	Spinal Injuries- Do not move. Obtain a cross table image and have a RAD “clear” the spine before moving. If there is a fracture the patient should be log rolled.
Other Medical Disorders
•	Nose bleed- have patient seated or in Fowler’s position, place cold cloth (ice pack) over nose and pinch
•	Orthostatic hypotension- (▼BP when standing) assist patient
•	Vertigo-(dizzy; room moving)- protect from falls
•	Syncope (faint)-have patient bend forward & place head between the knees
•	Convulsion- do not attempt to restrain; keep patient safe; use tongue blade to prevent biting tongue
•	Shock- diminished peripheral blood flow and insufficient oxygen supply to body tissues; keep patient  warm and flat
•	Seizure- keep patient from harm, loosen clothing, turn head to the side, use tongue blade to prevent biting tongue
•	Stroke- interference with blood supply to the brain.  The patient should have head and shoulders elevated, maintain open airway

Contrast Media
Types and Properties
•	Positive- radiopaque (appears white on film)
–	High atomic number
–	Barium
–	Iodinated
•	Water or oil base
•	Negative- radiolucent (appears black on film)
–	Lower atomic number
–	Air or gas
–	Usually used with Positive contrast
•	Viscosity- more viscid (thick, sticky) agents are more difficult to inject and produce more heat and vessel 
•	Osmolality- low osmolality agents have fewer particles in a given amount of solution and are less likely to provoke an allergic reaction.
•	Ionic	
–	High osmolality 
–	Water or oil base
–	More viscous at room temperature
–	Less cost 
•	Non-Ionic
–	Low osmolality
–	Water base
–	Less injection discomfort
–	higher cost

Type of contrast: Barium-contraindication: perforations
 
Type of contrast: water soluble iodinated contrast medium -contraindication: allergy to iodine 

Contrast media: IV non ionic (usually)
Contraindicated when allergy to iodine and abnormal labs (BUN creatinine)

Contrast: air
.
Patient History
1. pre medications- if patient has had an allergic reaction to contrast they can be pre medicated before having x-ray procedure.
•	2. contraindications- allergy to iodine, abnormal labs

scheduling and sequencing examinations
–	first exams without contrast (US, abdomen)
–	Next, Urinary contrast studies (IVP)
–	Next, Biliary studies (OCG)
–	Barium studies (BE, UGI)
–	Oily contrast studies (bronchogram, lymphangiogram) 

Patient Education
1. verify informed consent
–	Information that should be on a consent form
•	Risks
•	Benefits
•	Other options
•	Risks of not electing procedure
Preps
GB- iodinated contrast evening before examination; water only in AM
UGI- NPO after midnight
BE-laxatives and cleansing enemas; diet restrictions 
IVU- NPO after midnight, cleansing enemas, empty bladder before exam

post-examination instructions
Barium- drink plenty of fluids to remove Barium from colon, return to normal diet, stools will be white
IV contrast- watch for delayed allergic reaction
Gastrograffin- may cause diarrhea 
Glucophage- may resume 48 hours after procedure with normal lab results
Invasive procedures- fever call your doctor

Administration of Contrast
•	1. routes 
–	oral 
–	Rectal
–	IV
–	Cavity
–	joint space
–	subarachnoid space
Complications/Reactions
•	1. local effects 
–	extravasations/ infiltration, phlebitis
•	2. systemic effects
–	Mild (flushing, hives, nausea, vomiting, dizziness, itching, ect)
–	Moderate (hypertension, tachycardia, bradycardia, hypotension)
–	Severe (shock, profound hypotension, unresponsiveness)
Radiographer’s response and documentation