Week 8 (exam 3) Flashcards
What do the different colors mean for X-rays
black = gas
gray-black = fat
gray = soft tissue
white = bone
Chest X-rays should almost always be
first-line diagnostic study ordered to evaluate conditions of the thorax
What are the indications for a chest x-ray
pulmonary/CV
- dyspnea, cough, chest pain, pleuritic pain, hypoxia
pre-operative medical clearance
confirmation of line placement (PICC and central line)
confirmation of tube placement (ET/NG)
Trauma
- penetrating, blunt, pneumothorax
What are the benefits, side effects, and contraindications of chest x-rays
low dose radiation and low cost
no short term effects
pregnancy and weight (weight limits and poor penetration of rays)
What views do we have for chest x-rays
typical view (2 options)
1. PA (posterior anterior)
2. lateral
Describe PA view - how are they taken
taken with patient’s breathheld at end of maximal inspiration
go back to slides (17) and identify the identifying markers
Why do we not want an anterior posterior view?
heart ends up magnified because is an anterior structure
- less able to see other structures
What 5 areas do we identify in lateral view chest x-ray
retrosternal clear space
hilar region
fissures
thoracic spine
diaphragm and posterior costophrenic sulci
REVIEW SLIDE (20)
How do we take a lateral view chest x-ray
left side against the cassette
Why do we do a lateral decubitus chest x-ray
done to evaluate for pleural effusion
- assess volume of effusion
- mobile or loculated
Describe the film quality of maximal x-ray transmission and maximal x-ray absorption
blackest —————- whitest
air, fat, soft tissue, calcium, x-ray contrast, bone, metal
X-ray should be taken with
maximum full inspiration by patient
How do you begin to read chest x-rays
- verify your info
- pt name and dob
- type of x-ray ordered and views
- pt hx and indication or x-ray - check film quality
- adequate inspiration
- adequate exposure/penetration
- no rotation - ABCDEFGHI’s of chest x-rays
Define the ABCDE for a frontal view interpretation
a: airway
b: bones
c: cardiac
d: diaphragm
e: everything else
What do you look for in airway
look at trachea and mainstem
- position: midline or deviation?
- carina (located between 5th and 7th vertebral bodies, 90 degree angle, point where lower edge of left and right mainstem bronchi meet, important landmark for ET tube placement)
Define Carina
located between 5th and 7th vertebral bodies
90 degree angle
point where lower edge of left and right mainstem bronchi meet
important landmark for ET tube placement
What do you look for in bones
look at ribs, clavicles, scapulae, and sternum
look for any lytic lesions, fractures, etc
What do you look for in cardiac
cardiac silhouette
What do you look for in diaphragm
look for flattening or elevation of hemidiaphragm
What does flattening of the diaphragm mean
indicates chronic lung disease (COPD)
What is effusions
fluid
- may not always be large and obvious
- check costophrenic angle (blunted = small effusion)
Define air-fluid level
presence of both fluid and air in the same physiological compartment of the body
Define fat-fluid level
likely indicating different types of pleural effusions
Define FFF
fields, fissures, and foreign bodies
Define consolidation
area of lung tissue filled with liquid
appears white on x ray
What is an air bronchogram
air-filled bronchus made visible by surrounding consolidation
What do we check the lungs for
infiltrates, masses, consolidation, air bronchogram, pneumothoraces, vascular markings
Air bronchograms that (BLANK) despite appropriate antimicrobial therapy should raise the suspicion of (BLANK)
persist for weeks
neoplastic process
Where do we must often see the foreign body/material in a lung
When something is aspirated, we most often see the foreign body/material in the right bronchus
- b/c it is wider and steeper than left bronchus
Where should the tip of an endotracheal tube be located
tip should be located approximately 5cm above carina
What are the indications of venous catheters
internal jugular vein
- unable to access peripheral veins
subclavian
- emergency venous access
- volume resuscitation
cavo-atrial junction (for PICC lines)
- peripherally inserted central catheter
- for pt requiring long-term IV therapy
Define gastric bubble
rounded under the left hemidiaphragm
- represents gas in the fundus of the stomach
We evaluate the hilum for
lymphadenopathy, masses, and calcifications
left side is usualy higher than right
What should you always do when ordeing films
ALWAYS REVIEW THE FILMS YOURSELF
