Patient Care and Management
This domain covers safe patient handling, identification and consent, infection control, contrast administration, and emergency response. Items are scenario-based and reward the first correct action and the correct drug or dose.
Identification and consent
- Verify two identifiers (name plus date of birth or medical record number) before every examination.
- Informed consent requires capacity, disclosure of risks, benefits, and alternatives, and voluntary agreement; document it.
- Ask about pregnancy; when the answer is uncertain, consult the radiologist before proceeding and shield when possible.
Infection control
- Hand hygiene is the single most effective intervention.
- Standard precautions apply to all patients; transmission-based precautions (contact, droplet, airborne) are added for specific organisms.
- Follow donning and doffing order, never recap needles, and dispose of sharps immediately.
Contrast and emergencies
- Screen for prior reaction, asthma, renal function (eGFR), metformin use, pregnancy, and thyroid disease.
- Typical premedication for prior reaction: prednisone 50 mg by mouth at 13, 7, and 1 hour before, plus diphenhydramine 50 mg, per institutional protocol.
- Extravasation: stop the injection, follow policy for cannula removal, elevate the limb, apply cold compress, document, and monitor.
- Anaphylaxis: epinephrine 0.3-0.5 mg intramuscularly (1:1000) into the anterolateral thigh, call for help, give oxygen, place supine with legs elevated, and give IV fluids.
- BLS: 30 compressions to 2 breaths, 100-120 per minute, depth 5-6 cm, full recoil.
Worked example
Minutes into an iodinated contrast injection a patient becomes dyspneic and hypotensive. Recognition is anaphylaxis. First actions: stop the injection, call the emergency team, give intramuscular epinephrine into the vastus lateralis, administer oxygen, and lay the patient supine with legs raised. Reasoning: epinephrine is first-line because it reverses bronchospasm and vasodilation; antihistamines are adjuncts and do not correct airway compromise or hypotension.
Traps
- Giving diphenhydramine before epinephrine in anaphylaxis.
- Proceeding with contrast without checking renal function or prior reactions.
- Moving a hypotensive patient to a sitting position.
- Documenting an event later instead of at the time.