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Computed Tomography ARRT (patient
interaction/management).
Save what should you document before scanning the patient? - ANSWERobtain accurate pertinent info
- recent procedures, surgeries, symptoms, possible trauma, pain in specific areas
- ask open ended questions what exams should be schedules before contrast exams? - ANSWERtrunk exams ( chest, abdomen, pelvis) or only after sufficient time has passed for the bowel to clear to reduce the possibility of interruptions during the exam, what can you tell the patient to do before the exam? - ANSWERempty their bladder what is implied consent? - ANSWERwhen a patient is in need of immediate medical services but is unconscious or is physically unable to consent to the treatment... in this case treatment is rendered under the assumption that the patient would consent it they could what are types of immobilization devices? - ANSWERstraps, cushions, breath holds
why is holding your breath considered immobilization? - ANSWERwhen you hold your breath, and reduces motion; moving during the CT exam would be detrimental to the image quality normal level of consciousness - ANSWERperson is awake, alert, and responsive to their environment lethargic state - ANSWERperson is drowsy but can be roused obtunded state - ANSWERpatient is in a more depressed level of consciousness and may not be easily aroused from a state of confusion stupor - ANSWERstate of near unresponsiveness (semicomatose) coma - ANSWERpatient is completely unresponsive to stimuli examples of vital signs - ANSWERtemperature, pulse, blood pressure, and respirations normal body temperature - ANSWER97.7 to 99.5 F ( 36.5-37.5 C) normal pulse rate for adults - ANSWER 60 - 100 beats per/min normal pulse rate for children - ANSWER 70 - 120 bpm
- corresponds to the onset of the P wave of the ECG ventricular systole - ANSWER- contraction of the right and left ventricles
- beginning of the QRS complex in ECG complete cardiac cycle - ANSWERperiod of relaxation after hear contractions, consists of ventricular diastole and atrial diastole and corresponds to the T wave of the ECG what heart phase are Cardiac CT images reconstructed from? - ANSWERdiastolic phase why are patients with slow heart rates ideal for cardiac CT exams? - ANSWERthey exhibit longer diastolic phases which yield higher quality cardiac images what can be used to slow down the heart rate? - ANSWERbeta adrenergic receptor blocking receptors what is the optimal heart rate for a multidetector CT? - ANSWER65 bpm if not contraindicated, what medicine can be given to the patient to cause dilation of coronary vessel and improve their visualization in a MSCT study? - ANSWERsublingual nitroglycerine hypoxemia - ANSWERlow concentration of oxygen in the blood
hypoxia - ANSWERinsufficient oxygenation of tissue at the cellular level signs the patient has hypoxia - ANSWERheadache, dizziness, nausea more severe symptoms are: ataxia, tachycardia, pulmonary hypertension if hypoxia is left untreated it can lead to..... - ANSWERcyanosis ataxia - ANSWERloss of muscle coordination pulmonary hypertension - ANSWERincreased pressure in the pulmonary vasculature localized hypoxia can lead to________ - ANSWERpain, cyanosis, eventual gangrene true /false Oxygen is considered a drug and must be administered by a doctor
. - ANSWERTrue what color is the oxygen flow meter? - ANSWERgreen nasal cannula - ANSWERtwo pronged plastic device for delivering oxygen directly into nose ( delivers 1-5 LPM) oxygen mask - ANSWERcovers patients mouth and nose to deliver oxygen a 6 LPM or higher
normal creatinine values - ANSWER0.5-1.5 mg/dl BUN/ creatine ratio - ANSWER6:1-22: normal eGFR - ANSWER 90 - 120 mL/min
- anything lower means decreased renal function Prothrombin time - ANSWERmeasure of coagulation (12-15 secs) normal range for INR (international normalized ratio) - ANSWER0.8-1. Partial thromboplastin time (PTT) - ANSWER 25 - 35 secs normal platelet count - ANSWER140,000-440,000 per mm^ D-Dimer test - ANSWERused to diagnose for deep vein thrombosis and pulmonary embolism, if elevated amounts are found in blood stream, it may indicate recently degraded clots... may lead to CT angio of pulmonary arteries coumadin (warfarin) - ANSWERis an anticoagulant used to prevent clots and heart attacks; patient is prone to excessive bleeding by trauma or even a intravenous contrast agent administration, make sure adequate pressure is applied after IV removal
Metformin - ANSWERaka Glucophage; used to treat type 2 diabetes, if the patent has acute injury to kidneys or severe chronic kidney, they may be instructed to withhold from taking it before receiving iodinated contrast and 2 days after Anxiolytic - ANSWERmedication used to reduce anxiety
- benzodiazipines are a class of anxiolytics (Valium, Xanax, Klonopin, Ativan) serotonin reuptake inhibitors - ANSWERcan also be given to anxious patient ( Paxil, Zoloft, Prozac) what types of contrast are used in CT? - ANSWERbarium and iodinated where is iodinated contrast usually delivered? - ANSWERblood stream intravenously, directly into a vein or artery for localized enhancement, intrathecal space, joint space, orally osmolalaity - ANSWERthe agents propensity to cause fluid from the outside of the blood vessel to move into the bloodstream ionic contrast medium - ANSWERcontains salts ( sodium or meglumine), each molecule has 3 iodine atoms and when injected into blood stream, it disassociates into two ions , the more ions = high osmolality (COnray) nonionic contrast - ANSWERnon salt chemical compounds that also contain 3 iodine atoms per molecule, they do NOT disassociate in solution and are low osmolar (omnipaque)
advantages of using water as contrast? - ANSWERincreased palatability, improved patient comfort , better demonstration of bowel wall, does not interfere with 3 dimensional applications VOlumen - ANSWERa very low density (0.1%) barium sulfate solution that can be administered for detailed CT examination for a small bowel what are the four H's for administrating iodinated contrast? - ANSWERhistory(check it), hydration(important for renally compromised), have equipment ready if reaction occurs, heads up( assess patient throughout the exam ) breakthrough reaction - ANSWERrepeat adverse reaction to iodinated contrast material in a patient that has undergone pretreatment regimen ( they are at greater risk for moderate/severe reactions) what is the pretreatment regimen for patient at risk for an adverse contrast reaction? - ANSWERcombination of an antihistamine and corticosteroid are taken at timed intervals beginning as early as 12-24 hours before the contrast injection physiologic and pathologic conditions that increase risk of adverse effect - ANSWERasthma, environment/food allergy, renal disease, multiple myeloma, diabetes mellitus, pheochromocytoma, sickle cell disease, hyperthyroidism, significant cardiac disease, anxiety contraindications for iodinated contrast - ANSWERallergy to iodine, prior severe allergy to contrast, renal insufficiency/failure,
is contrast contraindicated for a pregnant woman? - ANSWERthere is no direct contraindication because it is unknown if the contrast can cross the placental barrier but caution should be exercise what are the post steps given to nursing women after a contrast study? - ANSWERpump and discard breast milk for 24 hours after the contrast administration can dialysis patients have a contrast study? - ANSWERthey can be a candidate for a contrast study but it is at the discretion of the referring physician and the radiologist angio catheter - ANSWERan IV catheter placed within a vein and used to administer fluids, medication, and or contrast media butterfly needle - ANSWERa hollow needle surrounded by plastic flaps (wings), these wings facilitate insertion of the needle into the vein, t it is then secured by the flaps with tape and tubing attached is connected to the IV or syringe dose range for intravascular RCM - ANSWER 50 - 150ml range for serum iodine to be seen adequately on CT - ANSWER 2 - 8 mg/ml types of central venous catheters - ANSWERsubclavian lines, implanted access ports, peripherally inserted central catheters
what flow rate is usually used for peripheral venipuncture location? (hand/wrist) - ANSWERflow rate less than 1.5 mL sec what size catheter can sustain 3 mL/sec rate? - ANSWER22 G or larger single phase acquisition - ANSWERCT image acquisition occurs at a single specific time during or after the injection of the contrast agent multiphase acquisition - ANSWERthe acquisition of multiple series of CT images over timed intervals. CT images may be acquired before, during, or after the contrast injection what are some advantages of power injectors? - ANSWERconsistent reproducible flow rates, precise volume/dosage control, higher injection rates for optimal contrast enhancement , automatic delays for proper enhancement patterns aside from clearing the IV line, why else do we flush it with saline after contrast injection? - ANSWERit allows for reduction of contrast agent dose and helps eliminate the streaking artifact that often results from a high concentration of iodine in the mediastinal vasculature dual head power injectors have______ - ANSWERdeliver saline and contrast what is a major disadvantage of using a CT power injector - ANSWERincreased risk of extravasation
if an extravasation occurs what should you do? - ANSWERthe needle/catheter should be removed and pressure should be applied with a warm moist compress if an adverse reaction occurs, how long will it take to become noticeable? - ANSWERwithin the first 20 minutes of having administered contrast what two types of adverse reactions are there? - ANSWERallergic and physiologic what are mild allergic reactions to contrast? - ANSWERmild urticaria, milt cutaneuous edema, nasal stuffiness/sneezing, scratchy/itchy throat what are mild physiologic reactions to contrast? - ANSWERnausea/vomiting, pronounced sensation of warmth and or flushing, and sweats/chills, anxiety, altered taste, mild hypertension, transient vasovagal reaction what treatments are given for mild reactions? - ANSWERusually it requires not treatment, but the patient should be closely observed until symptoms are gone true /false moderate reactions are life threatening. - ANSWERfalse, but they can progress rapidly if ignored what are moderate allergic reactions to contrast? - ANSWERmoderate-severe urticaria, diffuse erythema, facial edema, tightening of the throat,hoarse voice, wheezing
treatment for severe hypertension - ANSWERgive O2, monitor ECG, administer labetalol in IV slowly, may give nitroglycerine, call for assistance treatment for convulsions and seizures - ANSWERturn patient onto side to avoid aspiration, give O2, administer Iorazepam slowly, call for help it intubation needed treatment for pulmonary edema - ANSWERgive O2(6-10 L), elevate torso, administer diuretics, call for assistance common delayed reactions - ANSWERurticaria, pruritus (itchiness), nausea/vomiting , drowsiness, headache, fever/chills how long does it take for cutaneous reactions to occur? - ANSWER3 hours- 7 days contrast induced nephrotoxicity (CIN) - ANSWERa substantial decline in renal function that can occur after a patient receives IV contrast material. it is usually signified by a marked increase in serum creatinine over a baseline measurement obtained prior to contrast agent administration. risk factors for CIN - ANSWERdiabetes, myeloma, advanced age, cardiovascular disease
