Presentation on theme: "Chest X-ray Interpretation for Critical Care Transports Focusing on what matters… Robert Donovan MD FACEP Medical Director PHI California Chief of Staff."— Presentation transcript:
Chest X-ray Interpretation for Critical Care Transports Focusing on what matters… Robert Donovan MD FACEP Medical Director PHI California Chief of Staff Doctors Medical Center
We went from surface anatomy to being able to look under the skin
How Are X-rays Made?
Metal : Dense Nothing goes through Soft Tissues: Least Dense Grey color Air: Not dense at all all x-rays pass through Bone: Somewhat dense whiter than tissue, darker than handcuffs
X-Ray Findings you can’t afford to miss!!
Systematic Approach to Chest X-rays Lots of methods Learn any one, then stick to it Most errors are made because of poor viewing conditions, no method, and going too fast
A B C D S
For all X-Rays, check the 4 R’s…. R ight Person? R ight/Left? R otated? R adiation?
25 yo Male with complaint of pleuritic chest pain on the right side. If this is a 25 yo Male, then what are these?
What we are looking for with.. Airway – Position Is it mid-line? If not: ?Rotation ? Pathology ? Tension? – Corina Helps with placement of ET tube depth – Caliber Steepling – hints towards croup as Dx
What we are looking for with.. Aorta – Location Helps Identify Left vs Right on x-ray Helps you find left mainstem bronchus – Calcifications Nice but not particularly significant – Size (Mediastinum) Despite current media: size matters Big -> possible aortic pathology
Airway - Aorta Breathing - Bones B
What we are looking for with.. Breathing – Look at the lung fields – Hazy/White = pneumonia/infiltrate or mass – Too Dark (or absence of markings) Possible Pneumothorax Possible Bulla
What we are looking for with.. Bones (Focus on Ribs) – Fractures Points towards degree of injury/mechanism Gives us clues of possible underlying injuries