X-Ray Blitz

Question 1

R.I.P

Answer 1

rotation, inspiration, penetration

Question 2

Abnormal chest X-ray findings

Answer 2

flattening of the diaphragm, increased AP diameter of the chest (lateral view)
long narrow heart
abnormal air collections in the lung

Question 3

Correct NGT positioning

Answer 3

NGT tip > 10 cm distal to the gastroesophageal junction

basically, below the left hemidiaphragm

Question 4

correct ETT positioning

Answer 4

ETT tip 5 cm (+/- 2cm) above the carina, at the level of the medial end of the clavicle

Question 5

Correct CVC positioning

Answer 5

Right: 1-1.5 cm above the level of the carina
Left: below the level of the carina

Question 6

Correct chest tube placement

Answer 6

5th intercostal space, mid-axillary

for pneumothorax: the tube tip is positioned upper pleural cavity

for pleural effusion: the tube tip is positioned in the lower pleural cavity

Question 7

when do you clamp a chest tube?

Answer 7

if on initial insertion you get an immediate return of 1500 cc or more.

reasoning: if the lung expands too quickly it can cause re-expansion pulmonary edema. that has a mortality rate above 20%. sudden fluid loss causes a low pleural pressure, below -20cmh2o