ICU Chest Films > Learning Objectives


Learning Objectives

    ICU Chest Films

    Introduction
    Rapid interpretation of chest x-rays by intensive care physicians and surgeons is essential when treating critically ill patients. Furthermore, the use of chest x-ray images in determining the placement of patient instrumentation is a skill which every intensivist should possess. This tutorial is designed to teach residents, interns and medical students in Radiology or ICU-based settings to recognize common pathology in the chest quickly and with certainty. Common chest x-ray findings are illustrated in a logical and interactive manner. Following the completion of this exercise the individual should be able to recognize the common normal and pathological appearances of portable chest x-rays in the postoperative or medically ill patient as well as common complications of mechanical lines and their correct positioning.

    Technique

    1. Understand the utility of normal PA chest films and films obtained in an ICU setting.
    2. Be able to recognize the differences between PA chest films and films obtained in an ICU setting (Erect AP, Supine AP, less than maximal inspiration).

    Interpretation and Pathology

    1. Recognize the location of the carina, the correct placement of endotracheal tubes and complications of malpositioned endotracheal tubes.
    2. Recognize the correct placement of thoracostomy and nasogastric tubes and the complications associated with malpositioned tubes.
    3. Recognize the correct and incorrect placement of central venous pressure monitors, pulmonary capillary Wedge pressure monitors, and intraaortic counterpulsation devices.
    4. Recognize subcutaneous emphysema.
    5. Be able to recognize pneumothorax in an erect and supine patient.
    6. Be able to recognize anteromedial pneumothorax, Pneumomediastinum and Pneumopericardium.
    7. Recognize the appearance and common locations of a pleural effusion on an erect, supine and lateral decubitus film.
    8. Be able to describe the radiographic appearance of subpulmonic effusions and interlobar pleural effusions.
    9. Be able to recognize a pericardial effusion and the best modality for monitoring this pathology.
    10. Recognize the radiographic appearance of pulmonary edema, Congestive Heart Failure, Adult Respiratory Distress Syndrome.
    11. Recognize the radiographic appearance and understand the etiology of atelectasis, pneumonia, aspiration syndrome, and pulmonary embolism

     



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