Chest X-ray Interpretation for Critical Care Transports

1. Chest X-ray Interpretation for Critical Care Transports Focusing on what matters… Robert Donovan MD FACEPMedical Director PHI CaliforniaChief of Staff Doctors Medical Center

4. We went from surface anatomy to being able to look under the skin

6. How Are X-rays Made?

9. Bone: Somewhat densewhiter than tissue, darker than handcuffs Metal : DenseNothing goes through Air: Not dense at allall x-rays pass through Soft Tissues: Least DenseGrey color

10. X-Ray Findings you can’t afford to miss!!

11. 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

12. Checklist • A • B • C • D • S Check 4 R’s

13. For all X-Rays, check the 4 R’s…. • Right Person? • Right/Left? • Rotated? • Radiation?

14. 25 yo Male with complaint of pleuritic chest pain on the right side. If this is a 25 yo Male, then what are these?

15. Rightside

22. Checklist • Airway - Aorta • Breathing - Bones • Circulation - Cardiac • Diaphragm - Deformity • Soft tissues - Shoulder Check 4 R’s

23. Checklist • Airway - Aorta • A Check 4 R’s

24. A 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

25. 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

29. Checklist • Airway - Aorta • Breathing - Bones • B Check 4 R’s

30. 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

32. What we are looking for with.. • Bones (Focus on Ribs) • Fractures • Points towards degree of injury/mechanism • Gives us clues of possible underlying injuries

34. Checklist • Airway - Aorta • Breathing - Bones • Circulation - Cardiac • C Check 4 R’s

35. What we are looking for with.. • Cardiac • “Big” or “Not Big” • Well defined Margins • Subtle bumps (RV enlargement)

39. Checklist • Airway - Aorta • Breathing - Bones • Circulation - Cardiac • Diaphragm - Deformity • D Check 4 R’s

40. What we are looking for with.. • Diaphragm • Configuration • 2 rounded humps • Sharp Margins • Sharp Sulci • Look underneath • Gas where it should or shouldn’t be • NG tube

41. What we are looking for with.. • Deformity (All the other Bones) • Clavicle fractures/Dislocations • Humeral fractures/Dislocations • Scapula • Follow the curve of the tip • Look for Fracture Style Points often lost here

44. Checklist • Airway - Aorta • Breathing - Bones • Circulation - Cardiac • Diaphragm - Deformity • Soft tissues - Shoulder • S Check 4 R’s

45. What we are looking for with.. • Soft Tissues • Air • Foreign Bodies (Including chest tube placement)

49. What we are looking for with.. • Shoulder • Fracture • Dislocation