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EVALUATION OF RADIOGRAPHERS KNOWLEDGE AND MANAGEMENT OF UNCONSCIOUS PATIENTS IN ENUGU METROPOLIS

Dept: MEDICAL RADIOGRAPHY AND RADIOLOGICAL SCIENCE File: Word(doc) Chapters: 1-5 Views: 2

Abstract

The study was undertaken to assess radiographers’ knowledge of management of unconscious patients and their response to unconscious patients in teaching hospitals as well as National Orthopeadic hospital Enugu. A population size of forty radiographers was studied. The sampling techniques used was convenience sampling. That was collected using self administered structured questionnaires. Data collected showed that 42.5% of the radiographers in the studied areas showed competence in their application of Basic life support (BLS). Only 30% has received any form of training on the subject. There is gross dissatisfaction among radiographers about facilities for acute management of unconscious patients in their department (97.5%). Most radiographers are not satisfied with their knowledge of management of unconscious patients (92.5%). However, almost all radiographers expressed concern on the need for improvement in the training of the radiographers and equipping of their departments with eme

1.0     Background of Study

The Medical field is a wide field comprising of all health care providers. All the various health care providers work together to restore the health of the patient. It is therefore pertinent for health care personnel to at least be well skilled in management of emergencies which they find in their hands in the course of their daily duty especially unconscious patients, who they may incidentally encounter.

Medical Radiography, which is known as the ‘eye of medicine’ is a part of this group which specializes in providing patient care through the use of radiographic and/or fluoroscopic equipments with other imaging modalities, like ultrasound, computed tomography, magnetic resonance imaging etc. As health care providers, it is imperative that the patients comfort, privacy as well as safety are guaranteed during the procedures.

In events of emergencies in the department, it is also the responsibility of the radiographer to institute acute management of such patients until more specialized care is available.

Emergency procedures are common recurrences in the x-ray department. Even apparently simple procedures may be fraught with dangerous risks. This is typified in the administration of sedatives during procedures whose careful monitoring and registered nursing support is essential

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 in this case, where nursing support is absent, the onus is on the radiographer to execute these tasks.

Therefore, as the role of the radiographer continues evolving from being primarily a diagnostician as more patients are being referred fro interventional procedures, it is expected that the radiographer, in addition to having professional autonomy and acceptability, also acquiresadequate resuscitation skills.

The emphasis is on knowledge and assessment of an unconscious patient as well as institution of basic life support also known as primary survey until the casualty team arrives.

It is also imperative to know common causes of loss of consciousness in the department and risk factors for these with the aim of preventing them.

In the past, very little effort has been made to train physiotherapists, radiographers and other paramedical officers in the art of basic life support. This has a negative impact on patients’ care as preventable deaths are allowed. Ideally, any hospital worker should be able to provide basic life support. However, where impossible, the officers that directly relate with the patients ought to be taught these skills and such department ought to be provided with cost – effective resuscitation equipment.

Although death is not common in the radiology department, alertness shows measurable correlation with the efficiency of a hospital.

 

1.2     Statement of Problem

          The radiographer encounter on a daily basis, patients prone to seizures, panic attacks, various maneuver, related syncopes, as wellas those with hypoglycemia and cardiac diseases which are important risk factors for loss of consciousness (LOC).

• There is tendency for critically ill patients to lapse into unconsciousness during long waiting time for radiological examination or during a radiological procedure.
• Radiographers may be required to assist a critically ill patients in such areas like the theatre, radiotherapy unit etc.
• Radiographer may be required to assist an unconsciouspatient in any hospital department.
• Most times Radiographers are on call and may encounter such situations where a critically ill patient lapses into unconsciousness.

Therefore, there is need to assess their knowledge of proper control in such situations.

 

1.3     Purpose of Study

To evaluate the knowledge and responses of radiographers tounconscious patients during radiological examination.

 

1.4     Specific Objectives

• Assess the level of training about unconscious persons which acquired in the course of their training.
• To determine the number of radiographers that have the knowledge of attending to unconscious patients.
• To determine their response to unconscious patients
• To assess the willingness of radiographers to update their knowledge and response to unconscious patients.
• To assess radiographers experiences and challenges on management of unconsciousness patients
• To assess updatedcourses/continuing educationcourses which they have attended on unconscious persons since graduation.

 

1.5     Significance of Study

The research will

• Increase the knowledge and response of radiographers to unconscious patients
• Increase the awareness of radiographers on the level of training in emergency situations.
• Provide a safer environment within the radiology department
• Ensure the safety and improvement on the overall well being of the patient.

 

1.6     Definition of Terms

1. Unconsciousness: Can be defined as altered level of consciousness. Consciousness is a state of normal cerebral activity in which the patient is aware of both self and environment and is able to respond to internal changes, for example, hunger and to changes in the external enviroment

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   . Gradation of consciousness vary from normal alertness to drowsiness, stupor and coma. In the drowsy patient, there is slight blurring of consciousness from which the patient is easily rousable. Stupor is a state of unconsciousness from which a patient can be roused on vigorous external stimulation. In coma, the patient is completelyunrousable and unresponsive to all external stimuli.

          Glasgow Coma Scale (GCS) is a reproducible score that describes state of consciousness in terms of three categories of performance: eye openings to command, verbal responses and motor responses.

This is as follows:

Eye – opening

Best verbal response

Best motor response

Spontaneous – 4

Fully alert & oriented – 5

Obeys command 6

To speech 3

Confused – 4

Localizes pain – 5

To pain – 2

Inappropriate – 3

Normal withdrawal –

No response – 1

Incomprehensible – 2

Abnormal flexion (decorticate) – 3

No response – 1

No response 1

A normal extension (decerebrate) -2 No response – 1

Maximum score is 15, minimum score is 3

GCS ? 8 indicates with low level of consciousness

GCS – 9 12 indicatesmoderate consciousness

GCS – 13 – 15 indicates optimal consciousness

An abbreviated coma scale, AVPU, is sometimes used in initial assessment of the critically ill:

A       –        Alert

V       –        Response to vocal stimuli

P       –        Response to pain

U       –        Unresponsive

Causes of loss of consciousness in the Radiology Department it is important to note that there are multiple risk factors for loss of consciousness in the radiology department, these may be indirectcauses which include.

1. Age (extremes)
2. Existing cardiac diseaseseg.
3. Arrhythmias
4. Left ventricular dysfunction

• Aortic stenosisetc

1. Postural hypotension
2. Micturition /cough/ vasovagal syncope
3. Epileptic seizures and other neurological dysfunction. Direct causes may include:
4. Falls very uncommon in radiology department, however can result in significant morbidity and mortality

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5. Hypoglycemia

• Anxiety especially in elderly patients etc.

1. Basic Life Support: This is the primary survey carried out at the site of event. It uses the ABCDE mantra to inculcate care mythology not just for the unconscious patient but also for other emergency situation like trauma

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   . This includes:
2. Airway: Lie patient in recovery position iesemiprone.

Plus Cervical       Assess the airway. Do a jaw thrust or heat titl to

Spine                    maintain patency. Neck should be immobilized to

Protection            prevent spinal cord injury by longitudinal manual support

before turning patient to side.

B: Breathing:      If patient is cyanosed or apenic after airway has been cleared, mouth to mouth resuscitation should be started. If oxygen is available, ventiulate with 100%

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C: Circulation:    Assess circulation. Check pulse. If pulseless, start external cardiac massage. Also known as cardiopulmonary resuscitation, this is part of the technique to manually stimulate the heart and assist its pumping action. It involves compressive force over the lower sternum with the heels of the hands placed one on top of the others, directing the weight of the body through the verticalstraight arm. Depth of compression is usually 5-6cm and rate is 100 – 120/min at the ratio of 30 chest compression to 2 ventilations orbreath for 5 cycles. After which BLS protocol is repeated from the beginning if CPR failed.

D –Disability:      Assess responsiveness rapidly with AVPU.

E – Exposure:     Do a head – to toe examination.

Obtaining the history of the condition is helpful but must not interfererwith the initial rapid clinical assessment and resuscitation.

1. Radiological Technologist / Radiographer:A certified person in the health care team under direction, to take routine radiographers for use in medical and surgicaldiagnosis andtreatment, and to sorelated work as required. This would include providing cardiopulmonaryresuscitation andadministering offirst– aid to patient while in the department.