CP

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Author:
jessiekate22
ID:
171520
Filename:
CP
Updated:
2012-09-17 19:17:46
Tags:
CXR
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VIVA
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  1. Anatomy of the lungs
  2. CXR normal anatomy
    • PA view
    • 1. trachea
    • 2. R main bronchus
    • 3. L main bronchus
    • 4. Aortic arch
    • 5. Azygous vein
    • 6. R pulmonary artery
    • 7. L pulmonary artery
    • 10. R atrium
    • 11. L ventricle
  3. If it the projection is not written on the xray what way do you assume it is?
    • - PA- heart appears normal size
    • - if mobile xray take to them- done in AP
  4. When is a lateral CXR taken?
    • - not in ICU
    • - done when pt is mobile
  5. What are posible pt positions for CXR?
    • - erect
    • - supine
    • - lateral decubitis
    • - clavicles centred?
  6. Expousre of the CXR?
    • - white- high density- underexposed
    • - black low density- overexposed
  7. Where does the first rib sit?
    - T1
  8. Inspiratory effort
    • - CXR take on inspiratory effort
    • - normal 6th rib ant
    • - 9th rib post
    • - they discet the diaphragm in the mid clavicular line
    • - inspiratory film when trying to determine pneuothorax
  9. On CXR what do we look for when we look at soft tissue?
    • - breast tissue
    • - swelling
    • - subcutaneous emphseama(air under the skin)
    • - air under the diaphragm- be black but not in a circle
  10. What parts to we look for to ensure they are in the right place?
    • - mediastinum- heart should be less than 1/2 diameter of chect, SVC, R atrium, L ventricle, aorta
    • - hilum- bronchi, arteries, veins, lymph nodes
    • - trachea- midline, bifurcation should be visible
  11. What do we look at on the bones of a CXR?
    • - #
    • - Jts
    • - Thoracic shape
    • - vertebral column
    • - osteoporosis
  12. What do we look for with the CXR diaphragm?
    • - outline should be clear
    • - right higher than left= about 2.5cm = liver 
    • - costophrenic angle and cardiophrenic angle
    • - elevated (collapse pulls it up), flattened (something in chest pushing down- eg air when you are hyper inflated)
  13. What are we looking for with CXR lung fields?
    • - transluency symmetrical
    • - lung markings are evenly spaced and all the way out to the edge of the flim (eg pneumothorax)
    • - pleura should not be thickened eg pleural effusion
    • - horizontal fissue approx 4th IC space
  14. Where abouts do you want the ETT/ trache should sit?
    - Ta or 3-4cm about the carina
  15. What does the central venous catheter go into?
    - just above RA in SVC (superior vena cava)
  16. Swan Ganz Catheter goes into?
    • - in PA (pulmonary artery) outside RV
    • - also know as PAC
  17. Where does an ICC go?
    • - drain
    • - top lung for air
    • - bottom lung for fluid
  18. Where does a NGT go?
    - stomach
  19. What are opacity- interstitual space?
    • - finger like projections
    • - peribroncial suffing
    • - kerly B lines
    • - Upper lobe vascular distension
  20. What can cause opacity in the interstitual space?
    • - cardiogenic
    • - ARDS- leaky capillaries
    • - hypervolaemia
  21. What does peribroncial cuffing look like?
    - donut- white fluid around
  22. How can you tell the opacity is from the pleural space?
    • - veil like
    • - uniform in composition
    • - dependent if pt is mobile (at bottom of lung if upright)
    • - veil over entire lung if supone
  23. What can cause pleural effusion?
    • - exudate (irritaion- causing puss etc)
    • - transudate- fluid overload
    • - blood
    • - pus
    • - water
  24. On a chest XR how can u tell it is a pleural effusion?
    - has a menisucs
  25. How can you tell if the opacity is alveolar space?
    • - air bronchograms (go airway black- surrounded by consolidation) 
    • - patchy opacity
    • - limited by major fissures
  26. What are the 5 substances that cause opacity in the alveolar space?
    • - pus- infection
    • - blood- pulmonary contusion
    • - protein- alveolar proteinosos
    • - water- fluid overload
    • - cells- neoplastic
    • To tell look at distribution
  27. Alveolar opacity- consolidation v colapse
    • - often occurs simultaneously
    • - pure consolidation = signs of alveolar opacity, no loss of volume- eg rib and diaphragm are fine
    • - pure collapse = signs of alveolar opacity, loss of volume and movement of fissures or diaphragm
  28. Silhouette sign
    • - any borders hazzy = part of lung is collapsed and consolidated
  29. Right Ul atelectasis
    • - can see horizontal fissue moved up too high
  30. Left UL ateletasis
    • tell by the diaphragm being moved up
  31. Right middle lobe collapse
  32. Lower lobe collapse and consolidation
  33. Structured approach to looking at CXR what does this involve?
    •  LABELS name, date, MRN , time
    •  ORIENTATION is the film the right way round
    •  PROJECTION how is the film taken eg AP vs PA
    •  EXPOSURE underexposed, over exposed, normal
    •  PATIENT POSITION sitting, upright, supine, rotated
    •  SOFT TISSUE amount, air in soft tissues
    •  BONY STRUCTURES ribs, vertebral column
    •  MEDIASTINUM size, position
    •  DIAPHRAGM clarity, position
    •  SILHOUETTE SIGN borders of heart, diaphragm
    •  LUNG FIELDS translucency, lung markings
    •  LINES/ATTACHMENTS what and are they in the right place
  34. What are the signs of hyperinflation?
    • - flattened ribs
    • - elongated mediastinum
    • - blackened lung fields
    • - increased number of ribs visible above the diaphragm
    • - flattened diaphragm
  35. Think of common findings on CXR
    • - boobs
    • - bra underwires
    • - buttons
  36. What is sinus inversus?
    - where heart etc in flippe around the wrong way
  37. Right lung collapse
    • If you lok you can see trachea has been pulled across
  38. Aspiration pneumonia LL Right

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