dr_hani
11-14-2002, 04:22 PM
-To assure that all areas of the chest are examined, assess chest x-rays by following these five steps:
1-Inspect the bony framework
2-Inspect the soft tissues that overlies the thoracic cage
3-Examine the lung fields
4-Examine the diaphragm and pleural surfaces
5-Examine the heart and mediastinum
-When looking at chest x-rays remember these tips:
1-Read the label on the chest film. This is similar to administering medications. Is this the right patient, time, date, position and identification?
2-Assess the quality of the film. Is there good penetration - not over or underexposed. Did the patient take a deep breath? On a film with good inspiration you should be able to count 8-9 ribs bilaterally, remembering that as the lungs inflate the chest cavity enlarges and the diaphragm flattens.
3-Look at the diaphragmatic curves, are they rounded or flat?
4-Assess the boundaries top to bottom, side to side, assessing the lung tissue for blackness and contrast. Lungs that are too black may indicate a pneumothorax or overexposure/poor technique. Look at the bones from front to back, the spine, clavicle, scapula and ribs (count them). An inexperienced reviewer may confuse the scapula with a pneumothorax. The lungs have 3/5 of the volume on the right and 2/5 of the volume on the left. Look at the boundaries, are vascular markings lost on the lung? A pneumothorax can usually be seen at the apices due to rising air.
5-Look at the heart and major vessels. Is the heart enlarged, the mediastinum widened?
6-When assessing the Airway, visualize the carina of the trachea and the bronchus. Is the patient intubated?
7-Is the patient properly positioned, not rotated, spine straight not rotated and all structures visualized?
-Normal Chest x-ray PA veiw :
http://www.nursingceu.com/NCEU/courses/chest/image008.jpg
1-Trachea
2-Right Mainstem
3-Left Mainstem
4-Left Pulmonary Artery
5-Right upper lobe pulmonary vein
6-Right Interlobar artery
7-Not labeled
8-Aortic knob
9-Superior vena cava
10-Ascending aorta
11-Carina
12-Right atrium
13-Right ventricle
14-Left ventricle
15-Left Hemidiaphragm
16-Right Hemidiaphragm
17-Costophrenic angles
1-Inspect the bony framework
2-Inspect the soft tissues that overlies the thoracic cage
3-Examine the lung fields
4-Examine the diaphragm and pleural surfaces
5-Examine the heart and mediastinum
-When looking at chest x-rays remember these tips:
1-Read the label on the chest film. This is similar to administering medications. Is this the right patient, time, date, position and identification?
2-Assess the quality of the film. Is there good penetration - not over or underexposed. Did the patient take a deep breath? On a film with good inspiration you should be able to count 8-9 ribs bilaterally, remembering that as the lungs inflate the chest cavity enlarges and the diaphragm flattens.
3-Look at the diaphragmatic curves, are they rounded or flat?
4-Assess the boundaries top to bottom, side to side, assessing the lung tissue for blackness and contrast. Lungs that are too black may indicate a pneumothorax or overexposure/poor technique. Look at the bones from front to back, the spine, clavicle, scapula and ribs (count them). An inexperienced reviewer may confuse the scapula with a pneumothorax. The lungs have 3/5 of the volume on the right and 2/5 of the volume on the left. Look at the boundaries, are vascular markings lost on the lung? A pneumothorax can usually be seen at the apices due to rising air.
5-Look at the heart and major vessels. Is the heart enlarged, the mediastinum widened?
6-When assessing the Airway, visualize the carina of the trachea and the bronchus. Is the patient intubated?
7-Is the patient properly positioned, not rotated, spine straight not rotated and all structures visualized?
-Normal Chest x-ray PA veiw :
http://www.nursingceu.com/NCEU/courses/chest/image008.jpg
1-Trachea
2-Right Mainstem
3-Left Mainstem
4-Left Pulmonary Artery
5-Right upper lobe pulmonary vein
6-Right Interlobar artery
7-Not labeled
8-Aortic knob
9-Superior vena cava
10-Ascending aorta
11-Carina
12-Right atrium
13-Right ventricle
14-Left ventricle
15-Left Hemidiaphragm
16-Right Hemidiaphragm
17-Costophrenic angles