Monitoreo Respiratorio Radiol gico

1. Monitoreo Respiratorio Radiol�gico Dr. Jorge CABRERA VALENTIN Medicina Intensiva UCI Hospital Alberto Sabogal jocava26107@yahoo.com

2. MRI not widely used but can show malignancy especially We will look at actual films in the tutorials/practicalsMRI not widely used but can show malignancy especially We will look at actual films in the tutorials/practicals

3. Genralidades Rx de Torax Investigaci�n radiologica m�s com�n - 40% de todas las investigaciones -. Componente estandar de un examen pulmonar Revision sistematica es vital en la interpretacion de la Rx de Torax Up to 40% off all radiological investigations are chest x-rays 60% are carried out in the ICU, Sensitivity; 50% of critically ill patients in Icu will have abnormal chest x-ray A systematic review is vital when interpretating x-rays however what order is not critical and you will come across varying ordersUp to 40% off all radiological investigations are chest x-rays 60% are carried out in the ICU, Sensitivity; 50% of critically ill patients in Icu will have abnormal chest x-ray A systematic review is vital when interpretating x-rays however what order is not critical and you will come across varying orders

4. Limitaciones de una Rx de torax Imagen de 2 dimensiones de una estructura de 3 dimensiones Hallazgo en Rx pueden preceder a otras caracteristicas clinicas. Una Rx normal no descarta otra patolog�a Depende de una buena calidad de imagen A chest x-ray forms a piece in the pulmonary examination, should refer to previous x-rays if available and if possible put in context of the other pulmonary findingsA chest x-ray forms a piece in the pulmonary examination, should refer to previous x-rays if available and if possible put in context of the other pulmonary findings

5. Vistas/tipos de Rx de Torax Posteroanterior - PA Anteroposterior - AP Lateral Decubito

6. Vista PA Servicio de Radiolog�a, estandar Rayos X van de posterior a anterior Posicion parado PA Standard investigation carried out in the x-ray dept Cassette anterior to chest, x-rays shot post-ant from 2 metres away, shoulders abducted to remove scapula Carried out in standing therefore better inspiration PA Standard investigation carried out in the x-ray dept Cassette anterior to chest, x-rays shot post-ant from 2 metres away, shoulders abducted to remove scapula Carried out in standing therefore better inspiration

10. Anatomia Pulmonar Transverse fissure � 6th rib laterally Does not estend beyond pulm artery medially Visible in 50%Transverse fissure � 6th rib laterally Does not estend beyond pulm artery medially Visible in 50%

12. Vista AP Chasis colocado detras del paciente Rayos X van de anterior a posterior Sentado en una silla, semisentado o supino en cama, AP marcado en la Rx Corazon agrandado, pobre inspiraci�n AP Cassette placed behind the patient, portable machine Patient could be sitting in a chair, semi erect in bed, supine in bed. NOTE the patient position will affect the CXR Marked AP on film Heart enlarged often poorer expansion AP Cassette placed behind the patient, portable machine Patient could be sitting in a chair, semi erect in bed, supine in bed. NOTE the patient position will affect the CXR Marked AP on film Heart enlarged often poorer expansion

13. Paciente en UCI, Limitaciones: La calidad de la Rx puede variar ampliamente: de buena a no interpretable Incapacidad de cooperar La naturaleza de los ambientes de UCI Dificultad en controlar la radiaci�n en obesos Amplias diferencias en la exposici�n Se sugiere estandarizar la tecnica: posicion supina, placa vertical, distancia 120 cm, inspiracion pico, usando de 80 a 100 KVp y corto tiempo de exposicion para minimizar el artefacto respiratorio Cables de monitoreo y otros objetos externos deber�an ser removidos

14. Guia para ver una Rx Torax Rx Correcta Prepracion Cuarto oscuro Placas previas si estan disponibles Identificacion: Nombre, Fecha, Hora Tipo : PA, AP, supino, parado Calidad: Rotaci�n, lordosis, penetracion, inspiracion Distancia, potencia, tiempo de exposcion. Aparatos invasivos: Tubos, CVC, cables, How to view Check patient and x-ray details Left or right, markers placed on by radiographer, stomach on left. Heart not always on leftHow to view Check patient and x-ray details Left or right, markers placed on by radiographer, stomach on left. Heart not always on left

15. Guia para ver una Rx Torax Tejidos blandos y oseos Cuello, supraclavicular, axila, pared torax, mama, burbuja gastrica Humero, union escapular, escapula, clavicula, vertebra, costillas y esternon Mediastino Superior, medio Tama�o, forma, densidad Corazon Tama�o, forma, silueta How to view Check patient and x-ray details Left or right, markers placed on by radiographer, stomach on left. Heart not always on leftHow to view Check patient and x-ray details Left or right, markers placed on by radiographer, stomach on left. Heart not always on left

16. Guia para ver una Rx Torax Diafragma Forma, angulo costofrenico Pleura/Cisuras Pulmones Traquea y bronquios Hilio Vasculatura Parenquima Apex Detras del coraz�n How to view Check patient and x-ray details Left or right, markers placed on by radiographer, stomach on left. Heart not always on leftHow to view Check patient and x-ray details Left or right, markers placed on by radiographer, stomach on left. Heart not always on left

17. Basico Im�genes Radiolucidas Im�genes Radiopacas

18. Aparatos invasivos CVC Swan-Ganz, Sonda doppler esofagico MCP Tubos de torax Tubos endotraqueales, Traqueostomia Sondas enterales Balon de contrapulsaci�n Requieren confirmacion luego de su colocacion para confrimar posicion y descartar complicaci�n