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Know the differences between Obstructive vs Restrictive lung disease. --------------------------------------------------------------------- Obstructive Vs Restrictive Lung Diseases - MEDizzy Mobility assessment (Weight bearing status and level of assistance). --------------------------------------...

Know the differences between Obstructive vs Restrictive lung disease. --------------------------------------------------------------------- Obstructive Vs Restrictive Lung Diseases - MEDizzy Mobility assessment (Weight bearing status and level of assistance). -------------------------------------------------------------------- We good right? YEAH SURELY Chest X-rays (no visual interpretation required in this exam) ------------------------------------------------------------- DRS ABCDE +-----------------------------------+-----------------------------------+ | **[DRS ABCDE | | | Approach]** | | +===================================+===================================+ | **D = Details** | - Patient details name, DOB, | | | MRN | | | | | | - Date and time film was taken | | | | | | - Previous imaging (useful for | | | comparison) | +-----------------------------------+-----------------------------------+ | **R = RIPE = Rotation, | **Rotation** | | Inspiration, Projection, | | | Exposure** | are they standing straight on? | | | | | | - Look for medial aspect of | | | each clavicle -- should be | | | equidistant | | | | | | - Look for spinous processes -- | | | should be vertically | | | orientated against vertebral | | | bodies | | | | | | **Inspiration** | | | | | | to determine if lung inflation is | | | sufficient, we count no. of ribs | | | that dissect midclavicular line | | | | | | - 5-6 anterior ribs, lung | | | apices, both costophrenic | | | angles and lateral rib edges | | | should be visible | | | | | | - Posterior ribs 9-10 normally | | | | | | - If number is less than above, | | | lungs = | | | hypoinflated/underinflated | | | | | | - If number is greater than | | | above, lungs = | | | hyperinflated/over inflated | | | | | | **Projection** | | | | | | - Portable film (ICU) = | | | generally AP | | | | | | - If no label, assume it's a PA | | | | | | - If the scapulae are not | | | projected, its PA | | | | | | **Exposure** | | | | | | Brightness or darkness of the | | | chest | | | | | | - L hemidiaphragm should be | | | visible to the spine and | | | vertebrae should be visible | | | behind the heart | +-----------------------------------+-----------------------------------+ | **S = Soft tissues and bones** | - Neck, thoracic wall, breasts, | | | clavicles, ribs, previous | | | injuries look for asymmetries | | | | | | - If a patient has very thick, | | | soft tissue due to obesity, | | | lung markings may be obscured | +-----------------------------------+-----------------------------------+ | **A = Airway** | - E.g. trachea, carina, | | | bronchi, hilar structures | | | | | | - Trachea looking for deviation | | | -- push or pulling of the | | | trachea | | | | | | - Carina and bronchi R main | | | bronchus is generally wider, | | | shorter and more vertical | | | than L main therefore, more | | | likely for inhaled objects to | | | become lodged in R main | | | bronchus | | | | | | - Hilar structures each hilar | | | has a collection of lymph | | | nodes which aren't usually | | | visible in healthy | | | individuals. L hilum often | | | slightly higher than R (cuz | | | of heart). Usually same size. | | | It is also where the | | | descending pulmonary artery | | | intersects the superior | | | pulmonary vein -- when lost, | | | possible lesion | +-----------------------------------+-----------------------------------+ | **B = Breathing** | - E.g. lungs and pleura | | | | | | - Lungs 3 zones Upper zone | | | (T1-T6), Middle zone | | | (T6-T10), Lower zone (T10 -- | | | end) | | | | | | - Compare, noting any | | | asymmetry/or symmetry | | | (pulmonary oedema), increased | | | airspace shadowing | | | (consolidation, malignant | | | lesion), lung borders | | | (absence = pneumothorax) | | | | | | - Pleura are not usually | | | visible in healthy | | | individuals -- if visible = | | | indicate pleural thickening = | | | mesothelioma | | | | | | - Fluid (hydrothorax) or blood | | | (haemothorax) can accumulate | | | in pleural space - ↑ opacity. | | | A combination of air and | | | fluid can accumulate in | | | pleural space | | | (hydropneumothorax) = mixed | | | pattern of both ↑ and ↓ | | | opacity within pleural cavity | | | | | | - Tension pneumothorax life | | | threatening condition ↑ing | | | amount of air being trapped | | | within pleural cavity | | | displacing mediastinal | | | structures (trachea) and | | | impairing cardiac function | | | | | | - If suspected clinically | | | (SOB and tracheal | | | deviation) - Immediate | | | intervention should be | | | performed without waiting | | | for imaging as this | | | condition will result in | | | death if left untreated | +-----------------------------------+-----------------------------------+ | **C = Cardiac** | - Assess heart size | | | | | | - In healthy pop, heart | | | should occupy no more | | | than 50% of thoracic | | | width -- generally 1/3 of | | | heart is on R and 2/3 on | | | L | | | | | | - \* this rule only applies | | | to PA chest xrays (as AP | | | films exaggerate heart | | | size) | | | | | | - Cardiomegaly (enlarged | | | heart) heart \> 50% of | | | thoracic width on PA | | | chest xray can develop | | | from valvular heart | | | disease, cardiomyopathy, | | | pulmonary hypertension | | | and pericardial effusion | +-----------------------------------+-----------------------------------+ | **D = Diaphragm** | - Including assessment of | | | costophrenic angles | | | | | | - **R hemidiaphragm** | | | | | | - Typically, higher than L | | | (d/t liver) -- stomach | | | under L side -- identify | | | by gastric bubble | | | | | | - **Costophrenic angles** | | | | | | - Formed from the dome of | | | each hemidiaphragm and | | | lateral chest wall | | | | | | - In healthy, costophrenic | | | angles should be clearly | | | visible -- ACUTE angle | | | | | | - Loss of acute angle = | | | costophrenic blunting may | | | indicate fluid or | | | consolidation in the | | | area, lung hyperinflation | | | (diaphragmatic | | | flattening) (COPD), | | | pleural effusion | +-----------------------------------+-----------------------------------+ | - **E = Everything else** | - E.g. Mediastinal contours, | | | bones, soft tissues, tubes, | | | valves, pacemakers, review | | | areas | | | | | | - ETT, CVP line, NG tube, PA | | | catheters, ECG electrodes, | | | PICC line, chest tube, | | | pacemakers, metal work | +-----------------------------------+-----------------------------------+