3.3 Medical Emergencies & Patient Interventions

3.3 Medical Emergencies & Patient Interventions

Quick Answer: When a patient collapses, cannot breathe, or shows signs of a severe contrast reaction, stop the exam, call for help, and support ABCs (airway, breathing, circulation) within your training. Know how vasovagal/syncope differs from anaphylaxis, start CPR for pulseless arrest, and assist with oxygen, suction, vitals, and emergency setup without exceeding your scope.

Imaging environments concentrate risk: fasting patients, contrast injections, trauma, ICU portables, and claustrophobic stress. The CAMRT Care Provider competencies require RTRs to recognize and respond to medical emergencies and to perform or assist with defined patient interventions. You are not the code team leader, but you are often first at the bedside.

General Emergency Framework

Use the same disciplined sequence for almost every crisis:

1. Recognize — unresponsiveness, severe distress, seizure, massive hemorrhage, anaphylaxis signs, or vital-sign collapse.
2. Protect — prevent falls from the table; clear hazards; do not leave the patient alone.
3. Call for help — activate the facility emergency response / code team / “code blue” pathway and state location and problem clearly.
4. Support ABCs — open airway if trained and indicated; ensure breathing; check pulse; begin CPR if pulseless; apply AED when available.
5. Position — usually supine for shock/syncope (legs elevated if not contraindicated); sitting upright may help pure respiratory distress—use judgment and team direction.
6. Oxygen and monitoring — assist with oxygen delivery per protocol; attach pulse oximeter and automatic BP cuff when available.
7. Handover — concise report: what happened, contrast/meds given and timing, allergies, baseline status, interventions so far.
8. Document after the patient is safe.

Never complete “just one more exposure” on a pulseless or profoundly unstable patient. Survival interventions outrank the image.

Syncope and Near-Syncope

Syncope is a transient loss of consciousness from temporary cerebral hypoperfusion. In radiology it is often:

• Vasovagal (needle phobia, pain, fasting, prolonged standing)
• Orthostatic (standing quickly after lying flat)
• Cardiac (arrhythmia—more ominous)
• Hypoglycemic or hypovolemic contributors

Prodrome: light-headedness, nausea, warmth, tunnel vision, sweating, yawning. If you see this during upright imaging, sit or lie the patient down immediately before they fall.

Response for simple syncope / vasovagal event:

• Lower to supine; elevate legs if not contraindicated (e.g., avoid leg elevation with suspected respiratory distress of cardiac failure when team directs otherwise—default for classic vasovagal is supine + legs up).
• Protect the airway; loosen tight clothing.
• Monitor responsiveness, pulse, and respirations.
• Call for assistance; do not walk a recovering patient to the waiting room alone.
• Offer glucose only if hypoglycemia is suspected and the patient is conscious and able to swallow—follow protocol.
• Document the event; the patient may need physician assessment before discharge from the department.

Vasovagal vs Anaphylaxis (Critical Distinction)

Both can follow contrast injection or stressful procedures, but treatment pathways differ.

Mild contrast reactions (limited hives, warmth, brief nausea) need observation and notification per protocol. Moderate (generalized urticaria, mild bronchospasm, vomiting) need prompt treatment and provider involvement. Severe (marked hypotension, laryngeal edema, severe bronchospasm, cardiovascular collapse) is a life-threatening emergency: activate the code team, support airway, high-flow oxygen as directed, and prepare emergency drugs/equipment. Epinephrine is administered by authorized responders—know where the emergency box / cart is and how to bring it.

Link this section to later contrast chapters: prior contrast reaction is the key historical risk factor. Your job in the moment is recognition and escalation, not debating shellfish myths.

Cardiac and Respiratory Arrest

Cardiac arrest signs: unresponsiveness, absent or agonal breathing, no pulse. Respiratory arrest may still have a pulse initially—support ventilation and prevent progression to cardiac arrest.

Technologist actions:

• Confirm unresponsiveness and call for help / code blue immediately.
• Begin high-quality CPR as trained: hard and fast compressions on a firm surface (move the patient board/table considerations—get the patient onto a hard surface if feasible without delaying compressions excessively).
• Compression rate about 100–120/min, depth about 5–6 cm in adults, full recoil, minimize interruptions.
• Attach AED as soon as available; follow prompts.
• Provide breaths with barrier device/BVM if trained and equipped; coordinate with responders.
• Note time of collapse and any contrast or medications administered.

If the patient is on the x-ray table, lower the table, clear the tube assembly for access, and make space for the team. Assign someone to wait for the crash cart if others are available.

Other Emergencies You Must Recognize

Seizure

Protect from injury; do not restrain forcibly; never put objects in the mouth; time the seizure; place in recovery position after if breathing and no trauma contraindication; call for help—prolonged seizure (status epilepticus, often ~5 minutes or repeated without recovery) is an emergency.

Hypoglycemia

Rapid onset: sweating, tremor, confusion, irritability, eventual decreased LOC. If conscious and able to swallow, fast-acting carbohydrate per protocol; if unconscious, emergency response—do not force oral fluids.

Suspected stroke / acute neurologic change

Face droop, arm weakness, speech difficulty, sudden severe headache—stop, note time last known well, activate emergency pathway; do not give food or drink.

Hemorrhage or wound issues

Apply direct pressure with standard precautions; do not remove impaled objects; call for help.

Respiratory distress / asthma / COPD exacerbation

Sit upright if possible; assist prescribed oxygen or inhaler pathways per order/protocol; do not leave the patient; prepare for deterioration.

Shock (overview)

Inadequate tissue perfusion: tachycardia, hypotension, cool clammy skin, altered mentation. Types include hypovolemic, cardiogenic, distributive (septic, anaphylactic, neurogenic), and obstructive. General imaging-room response: help, supine (with caveats), oxygen, monitoring, rapid team handover—specific drugs are team-administered.

Patient Interventions at Entry-Level Scope

The RTR Companion and competency profile describe interventions technologists may perform or assist with, always within training, employer policy, and provincial regulation. Teach these at recognition and assist depth for the exam:

Oxygen therapy assist

• Confirm the ordered or protocol rate/device when oxygen is already prescribed; in emergency, high-flow oxygen may be started under emergency protocols/team direction.
• Know common devices: nasal cannula (low flow), simple face mask, non-rebreather reservoir mask (higher FiO2 when used correctly), bag-valve-mask for ventilation assist.
• Ensure tubing is connected, cylinder has pressure or wall outlet is on, and the patient is monitored with SpO2 when available.
• Never remove oxygen for a “better film” if the patient depends on it—adapt technique (including portable timing) instead; if brief removal is ordered, minimize time and restore immediately.

Suctioning assist

• Know where suction equipment lives in the department and on the code cart.
• Yankauer (rigid) tips for oral secretions; assist the nurse/RT/physician who directs deep suctioning.
• Clear visible oral secretions that threaten the airway while awaiting skilled providers; use PPE.

Vital signs

• Measure and record pulse, respirations, blood pressure, SpO2, and temperature when indicated (pre-contrast baselines, post-reaction, post-syncope, department protocol).
• Report abnormal values promptly; repeat when the clinical picture changes.

Elimination assist (bedpans / urinals)

• Provide privacy and gloves; maintain body mechanics; observe output if measured voiding is ordered (e.g., post-procedure).
• Prevent falls when patients insist on walking to the washroom unassisted after contrast or sedation-related procedures—use a safe plan.

CPR and basic life support

• Maintain current BLS competence as required by employers and expected of entry-level practitioners.
• Participate in mock codes; know your role (compressions, AED, runner, scribe).

Contrast injection support: power injector, IV access

Scope varies by province, certification, and site authorization. At minimum, entry-level candidates should understand:

• Preparing a power injector: correct contrast agent and concentration, volume, rate, air purge, secure connections, patient communication about warm flush sensation.
• IV access: many Canadian sites authorize MRTs with documented venipuncture competency to obtain peripheral IV access for contrast; others rely on nursing. Know your scope—exam items test safety principles: aseptic technique, correct confirmation of patency, recognizing extravasation (pain, swelling—stop injection, manage per protocol).
• Inserting an IV line is a trained, competency-assessed skill—not something to attempt cold in an emergency without authorization. In emergencies, assist those who are competent and prepare equipment.

Extravasation and adverse reaction management connect to Clinical Expert substance administration content; here, emphasize stop injection, assess, escalate, document.

Communication During Emergencies

Use closed-loop communication with the team (“Epinephrine is ready,” “100 mcg given”). Speak calmly to the conscious patient. Notify the referring unit for inpatients after stabilization. Complete incident and chart documentation accurately—times, signs, drugs, who was called.

Exam Traps to Avoid

• Finishing the series on a pulseless patient.
• Treating anaphylaxis as “just a faint” (or vice versa).
• Elevating the head of a profoundly hypotensive vasovagal patient.
• Leaving a post-ictal or post-syncopal patient alone on the table.
• Removing dependent oxygen for image quality.
• Performing venipuncture or drug administration beyond authorization.

Closing Integration

Medical emergency competence completes the Care Provider safety arc begun with identity, transfer, history, and monitoring. You prevent many crises with screening and observation; when crises still occur, rapid recognition, activation, ABC support, and scoped interventions define the minimally competent RTR. On scenario items, pick the answer that mobilizes help and protects airway and circulation first—then imaging resumes only when the patient is safe.