Alexander A Schult, M.D., FCCP. October 21, 2017 Revised 1/10/18

Transcription

1 Alexander A Schult, M.D., FCCP October 21, 2017 Revised 1/10/18

2 Identifying normal anatomy Identifying various pathologic states Identifying placement of hardware Identifying limitations of portable CXR

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8 In the supine, intubated patient the first sign of barotrauma is often subcutaneous emphysema.

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17 Tension Mediastinal shift is usually seen in a tension pneumothorax, but the use of PEEP may prevent this from occurring. The most reliable sign of tension pneumothorax is depression of a hemidiaphragm. Other signs of tension pneumothorax include shifting of the heart border, the superior vena cava, and the inferior vena cava. The shifting of these structures can lead to decreased venous return.

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20 How much fluid must accumulate before you expect to see changes in the supine patient's chest x-ray? 5 ml 50 ml > 500 ml

21 How much fluid must accumulate before you expect to see changes in the supine patient's chest x-ray? 5 ml 50 ml > 500 ml

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24 How much fluid must collect before costophrenic blunting is visible in the erect patient? ml ml ml > 500 ml

25 How much fluid must collect before costophrenic blunting is visible in the erect patient? ml ml ml > 500 ml

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28 The rate of serious malposition of endotracheal tubes has been reported to be between 12-15%. Given that frequency, daily chest x-rays in intubated patients are recommended (maybe). The ideal position for endotracheal tubes is in the midtrachea, 5 cm from the carina, when the head is neither flexed nor extended. This allows for movement of the tip with head movements. The minimal safe distance from the carina is 2 cm.

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30 95% of patients' carinas project over the T5, T6, or T7 vertebral bodies.

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42 No cardiomegaly No pleural effusions No Kerley B-lines

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45 A retrosternal crunch is sometimes auscultated. (Hamman s)

46 Post pericardiocentesis Continuous diaphragm sign

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49 The catheter should be in the region of the aortic isthmus or left main bronchus and above the origins of the celiac trunk and superior mesenteric artery

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51 1. Which of the following statements is true? -Most ICU chest films demonstrate significant findings. -ICU chest films are usually taken in the Posteroanterior (PA) view. -ICU chest films are both sensitive and specific. -The target to film distance is unimportant. 2. On which one or more of the following patients do daily portable x-rays need to be taken? -75 year old woman with a left subclavian central line. -Intubated 51 year old male suffering from COPD. -24 year old man status post appendectomy with two peripheral IV lines. -89 year old woman in the ICU for severe congestive heart failure.

52 1. Which of the following statements is true? -Most ICU chest films demonstrate significant findings. -ICU chest films are usually taken in the Posteroanterior (PA) view. -ICU chest films are both sensitive and specific. -The target to film distance is unimportant. 2. On which one or more of the following patients do daily portable x-rays need to be taken? -75 year old woman with a left subclavian central line. -Intubated 51 year old male suffering from COPD. -24 year old man status post appendectomy with two peripheral IV lines. -89 year old woman in the ICU for severe congestive heart failure.

53 Quiz What are the other major abnormalities? Is the TLC position correct?

54 4. Ambient light can reduce the detectability of lesions on chest film. -True -False 5. Supine positioning of the patient affects which one(s) of the following? -Cephalization of the pulmonary vasculature -The appearance of a pneumothorax -Widens mediastinum -The appearance of pneumonia

55 4. Ambient light can reduce the detectability of lesions on chest film. -True -False 5. Supine positioning of the patient affects which one(s) of the following? -Cephalization of the pulmonary vasculature -The appearance of a pneumothorax -Widens mediastinum -The appearance of pneumonia

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