3.3 Medical Emergencies & Support Equipment

Recognizing and Responding to Emergencies

Radiographers must recognize a medical emergency, initiate the correct first response, and activate the facility emergency (code) team. The radiographer does not diagnose or prescribe; the priority is airway, breathing, circulation (ABC), calling for help, and staying with the patient. Emergency questions on the ARRT exam test recognition of signs and the appropriate first action.

Shock

Shock is inadequate tissue perfusion. The general presentation includes falling blood pressure, rising pulse, cool clammy skin, pallor, and altered mental status. There are four broad categories:

The radiographer's response is to stop the exam, call the code team, place the patient supine with legs elevated (unless contraindicated), keep the airway open, provide oxygen per protocol, and monitor vital signs until help arrives. Anaphylactic shock from contrast is a distributive shock and a true emergency treated first with epinephrine by the responding provider.

Contrast Reactions

Reactions to iodinated contrast are graded:

• Mild: limited hives, nausea, warmth, mild itching. Usually self-limiting; observe and reassure.
• Moderate: widespread urticaria, bronchospasm, facial or laryngeal edema, vomiting. Requires treatment and provider notification.
• Severe (anaphylactoid): profound hypotension, laryngeal edema, cardiovascular collapse. Life-threatening; epinephrine is first-line, plus airway support and code activation.

A frequent exam trap is the shellfish/iodine allergy myth; there is no true cross-reactivity between shellfish and iodinated contrast. What matters is a prior contrast reaction. Distinguish a benign vasovagal reaction (bradycardia, hypotension, pallor, diaphoresis) from anaphylaxis; the vasovagal patient is treated with supine positioning and legs elevated, and typically recovers. Extravasation of contrast into soft tissue is managed by stopping the injection, elevating the limb, and applying a compress per protocol.

Cardiac and Respiratory Arrest

Suspected cardiac arrest (unresponsive, no normal breathing, no pulse) requires immediate activation of the emergency response, high-quality CPR with chest compressions at 100-120 per minute and a depth of about 2 inches (5 cm) in adults at a 30:2 compression-to-ventilation ratio, and early use of an AED. In respiratory arrest, the patient has a pulse but is not breathing adequately; support ventilation with a bag-valve mask and oxygen. Know the location of the crash cart, oxygen, and suction in every room.

Diabetic Emergencies

Two opposite states appear on exams:

• Hypoglycemia (low blood sugar): rapid onset with sweating, tremor, tachycardia, confusion, and possible loss of consciousness. If the patient is conscious, give fast-acting oral glucose (juice, glucose tablets). If unconscious, activate the emergency team and do not give oral fluids.
• Hyperglycemia / diabetic ketoacidosis: slower onset with excessive thirst, frequent urination, fruity (acetone) breath, and deep rapid Kussmaul respirations. This requires medical evaluation. When in doubt about which state, treating for hypoglycemia in a conscious patient is the safer initial step because low sugar deteriorates fastest.

Seizure and Syncope

During a seizure, protect the patient from injury, lower them to a safe surface, cushion the head, do not restrain and do not place anything in the mouth, time the event, and note its character. A seizure lasting more than about 5 minutes (status epilepticus) is a medical emergency. Syncope (fainting) is a brief loss of consciousness, often vasovagal; ease the patient to the floor to prevent a fall, position supine with legs elevated, and monitor until recovery. Anticipate syncope in patients who report lightheadedness, especially after standing quickly (orthostatic changes).

Oxygen Delivery and Support Equipment

Radiographers must move patients without disturbing lifelines. Common oxygen delivery devices and flows:

Key line and tube rules:

• Foley (urinary) catheter: keep the drainage bag below the level of the bladder to prevent backflow, and never pull or kink the tube during positioning.
• Chest tube (pleural drainage): keep the drainage unit upright and below the level of the chest; never clamp or raise it above the chest, which can cause a tension pneumothorax.
• Nasogastric (NG) tube: avoid dislodging; it drains or feeds the stomach and its tip should stay in place.
• Central venous line / PICC: tip lies near the SVC/right atrium; handle sterilely and never tug.
• IV and oxygen tubing: keep patent and untangled; move the pole and lines with the patient so nothing is pulled out.

Before and after every transfer, confirm all lines are intact, the oxygen is still connected and flowing, and the patient's airway is unobstructed.

The Primary Survey and Crash Cart

Every emergency begins with the primary survey: check responsiveness, then airway, breathing, circulation. If the patient is unresponsive with no normal breathing and no pulse, activate the code and begin CPR. Know where the crash cart, oxygen, suction, and AED are located in each imaging room before an emergency happens, because seconds matter. The radiographer's defined role in a code is to summon the team, start the response, clear equipment for access, and assist the code team, not to diagnose or medicate.

Positioning During Emergencies

Body position is itself a first-aid measure. Place a shock or syncope patient supine with legs elevated to improve cerebral perfusion, unless a head, spine, or breathing problem contraindicates it. A patient in respiratory distress often breathes best sitting upright. An unresponsive breathing patient without spinal precautions can be placed in the recovery (lateral) position to protect the airway from aspiration. A common exam trap is elevating the head of a hypotensive patient; that worsens cerebral perfusion. Reassess vitals and level of consciousness continuously until the responding team assumes care, and document the times, findings, and interventions afterward.