Bored

[ChrisPAinED]

The time you are so bored and the ED is not busy. Just watching for 1 patient so closely that you watch them get the portable X-ray.

 

By the way if you do see interest in the X ray you can have some clinical context. This is a male in his 50s with chest tightness. O2 was around low 90s high 80s. He was coughing and complained his chest has been tight for 2 days and he is tired of it. No wheezing No fever No known exposure. If you like you can share your interp and sorry about bad view.

 

PS this image was from a few shifts ago on a slow night.

[ohiovolffemtp]

Seeing the images on a portable is a very good practice.  It's a great way to improve your throughput by avoiding the wait for the radiologist's read or for the images to appear on PACS..  Don't just do it during slow times - do it as much as you can.

[LT_Oneal_PAC]

I almost always glance at the portable, but I have probably more time on my hands in critical access. 
 

*picks up dictaphone*
 

single view PA projection of chest uploaded to server from outside hospital for internal interpretation. Image is suboptimal with low resolution and reflection artifact obscuring the right lower lobe and right costophrenic angle limiting assessment. There is hilar opacities consistent with hilar lymphadenopathy versus central venous congestion versus significant bronchial mucous plugging. There is possibly streaking consolidation extending into the right lower lobe, though again, limited by artifact. Normal osseous structures without acute pathology. No pneumothorax. No cardiomegaly. No widened mediastinum. No appearance of free air under diaphragm. If further characterization desired please repeat CXR with 4 views of AP, Lateral, and both side lying decubitus. Given imaging quality cannot rule out pneumonia, neoplasm, pneumothorax, perforated viscus, fracture, pericardial effusion, pulmonary edema, pleural effusion, ARDS, COPD, or other acute pathology. Correlate clinically. Consider MRI or CT.

[Mayamom]

9 hours ago, LT_Oneal_PAC said:

picks up dictaphone*

This is great!!  Talk about CYA. 

[ChrisPAinED]

17 hours ago, LT_Oneal_PAC said:

I almost always glance at the portable, but I have probably more time on my hands in critical access. 
 

*picks up dictaphone*
 

single view PA projection of chest uploaded to server from outside hospital for internal interpretation. Image is suboptimal with low resolution and reflection artifact obscuring the right lower lobe and right costophrenic angle limiting assessment. There is hilar opacities consistent with hilar lymphadenopathy versus central venous congestion versus significant bronchial mucous plugging. There is possibly streaking consolidation extending into the right lower lobe, though again, limited by artifact. Normal osseous structures without acute pathology. No pneumothorax. No cardiomegaly. No widened mediastinum. No appearance of free air under diaphragm. If further characterization desired please repeat CXR with 4 views of AP, Lateral, and both side lying decubitus. Given imaging quality cannot rule out pneumonia, neoplasm, pneumothorax, perforated viscus, fracture, pericardial effusion, pulmonary edema, pleural effusion, ARDS, COPD, or other acute pathology. Correlate clinically. Consider MRI or CT.

Smoked 2 cigarettes a day, everyday, for 46 years. So correct this was a COPD exacerbation. 

[ChrisPAinED]

18 hours ago, ohiovolffemtp said:

Seeing the images on a portable is a very good practice.  It's a great way to improve your throughput by avoiding the wait for the radiologist's read or for the images to appear on PACS..  Don't just do it during slow times - do it as much as you can.

Yeah I usually open the report on one screen and open the image on another to look at but on slower nights I am usually walking around stocking my patients lol. But yeah I am going to be trying to see the portables as much as possible.

[ChrisPAinED]

17 hours ago, LT_Oneal_PAC said:

I almost always glance at the portable, but I have probably more time on my hands in critical access. 
 

*picks up dictaphone*
 

single view PA projection of chest uploaded to server from outside hospital for internal interpretation. Image is suboptimal with low resolution and reflection artifact obscuring the right lower lobe and right costophrenic angle limiting assessment. There is hilar opacities consistent with hilar lymphadenopathy versus central venous congestion versus significant bronchial mucous plugging. There is possibly streaking consolidation extending into the right lower lobe, though again, limited by artifact. Normal osseous structures without acute pathology. No pneumothorax. No cardiomegaly. No widened mediastinum. No appearance of free air under diaphragm. If further characterization desired please repeat CXR with 4 views of AP, Lateral, and both side lying decubitus. Given imaging quality cannot rule out pneumonia, neoplasm, pneumothorax, perforated viscus, fracture, pericardial effusion, pulmonary edema, pleural effusion, ARDS, COPD, or other acute pathology. Correlate clinically. Consider MRI or CT.

 

 

 

 

[EMEDPA]

17 hours ago, LT_Oneal_PAC said:

I almost always glance at the portable, but I have probably more time on my hands in critical access. 
 

*picks up dictaphone*
 

single view PA projection of chest uploaded to server from outside hospital for internal interpretation. Image is suboptimal with low resolution and reflection artifact obscuring the right lower lobe and right costophrenic angle limiting assessment. There is hilar opacities consistent with hilar lymphadenopathy versus central venous congestion versus significant bronchial mucous plugging. There is possibly streaking consolidation extending into the right lower lobe, though again, limited by artifact. Normal osseous structures without acute pathology. No pneumothorax. No cardiomegaly. No widened mediastinum. No appearance of free air under diaphragm. If further characterization desired please repeat CXR with 4 views of AP, Lateral, and both side lying decubitus. Given imaging quality cannot rule out pneumonia, neoplasm, pneumothorax, perforated viscus, fracture, pericardial effusion, pulmonary edema, pleural effusion, ARDS, COPD, or other acute pathology. Correlate clinically. Consider MRI or CT.

Sounds like a radiologist.

“The study is limited by patient body habitus, motion artifact, inability to tolerate positioning, artifact from external and internal hardware, low-dose technique, lack of intravenous, oral, rectal or intrathecal contrast, and equipment malfunction. Within these limitations, there are no gross findings to definitely suggest possible acute abnormality within the submitted images of the visualized portions of the area of clinical interest. However, the possibility of clinically significant pathology not identified on the current study cannot be excluded. As such, further evaluation with contrast enhanced MRI of the brain, sella, face, TMJs, internal auditory canals, temporal bones, neck, cervical, thoracic and lumbar spine, heart, chest, abdomen, pelvis, prostate, thighs, knees, lower legs, ankles, feet, toes, sternum, scapula, shoulders, upper arms, elbows, forearms, hands, and fingers is recommended. Additionally, CT urography, MR defecography, Sniff test, MUGA study, radiographs of the mastoid air cells, skeletal survey, bone age study, ultrasound guided paracentesis or biopsy, fiduciary marker placement, and shuntogram may also be helpful if clinically indicated or for confirmation. Comparison with prior studies may also be useful.”

Source: https://www.appliedradiology.com/articles/wet-read-the-ultimate-hedge