clinical 2 notes.docx

Clicnical 2 notes 1^st^ ppt - Intraprofessinoal : A = SAME // - Interprofessinoal ; different - **Interdependence: no indivual works alone** - **Trust and Respect: No individual is responsible for all aspects of the patient's care,** - **Individuality: Each member has a specific...

Clicnical 2 notes 1^st^ ppt - Intraprofessinoal : A = SAME // - Interprofessinoal ; different - **Interdependence: no indivual works alone** - **Trust and Respect: No individual is responsible for all aspects of the patient's care,** - **Individuality: Each member has a specific skill set that contributes to the care of the patient** - Nurses types 1. Linced : do basics and under supervision of registerd nurse 2. REGISTERED nurse : give medication , report any changes to doctor, can rate all nurses also in hospital 3. Nurse practitioner : work closely with doctors , they have advanced training in diagnosis, // supervised by doctors Doctors: - **Intern** -- Recent medical school graduate gaining practical experience - **Fellow** -- Licensed physician receiving advanced training - **Resident** -- Licensed physician in an educational program to become certified in a specialty area (Radiology, Orthopedics, Cardiology, etc) **Speech Pathologists** - Work closely with people who have had a stroke or who have another disorder that interferes with swallowing or communication. - They determine which foods a patient can safely eat without aspirating. - Can suggest ways to swallow to minimize risk. - They evaluate the thought processes involved in communication. **Remediation: solving : by documenting / following rules** **2^nd^ ppt** Cardinal rules of radiation protection - Time - Distance - Shield - A table with numbers and symbols Description automatically generated - For technologists-in-training and students, the annual recommended dose limit is 6mSv per year as per Qatar Law 31 Tld placement : between the neck and the waist facing forward. We don't expose people even for evaluation of equipement or for training purposes and studying focal spot-to-skin distance = large By collimating, the area of useful beam is reduced thus reducing gonadal exposure. - When xrays goes through the patient attenution happens - 1- Absorption (total loss in radiation energy) - 2- ***[Scatter (Change in energy and direction of the photon)]*** - 3- Transmitted (photons that reach the detector) Scatter photon can harm imaging personnel by increaing their occupiationl exposure.... What to do ? 1. Tube filtration removing low energy xray 2. Collimation - Gonad shield 0.25 mm Pb lead FOR patient 100 kv or less - But when 150 kvp we need 0.5 mm For IR , front 0.5 mm and back 0.25 +-----------------------------------+-----------------------------------+ | **Primary barriers** | **Secondary barriers** | +===================================+===================================+ | 1- Walls and floor where the | 1- Walls and floor where the | | X-ray tube can be directed are | X-ray tube | | considered primary barriers | **[CANNOT]** be | | | directed are considered secondary | | 2- Wall behind the vertical image | barriers | | receptor or "wall/chest bucky" | | | | 2- Walls of the control booth | | 3-Floor under the radiographic | | | table | | +-----------------------------------+-----------------------------------+ - When necssery , use short time + high mA - High grid ratio needs high mAs.... او بكذا راح تكون الصوره خايسه ف بعدين يزيد الدوز - NO AEC when there radiopaque /// for example metal - No dose creep increasing factors bc they are scared of getting bad image /// what to do ? -- proper AEC // record factors for future - focal spot to skin distance for mobile // 30 cm thyroid = 0.5 mm fluoro mangement : - Increase the distance between the patient and the tube and decrease the distance between the patient and the image receptor - Pule exposure // low frame rate - LIH - Be aware that magnification mode increases the dose to the patient Radiation intensity in air = expoure = rontegen Old one was the rem \^\^ radition equlvient dose - - Effective dose takes into account the type of radiation and the body part irradiated - (WR) radiation weighting factor - (WT) tissue weighting factor - There is No unit to measure amount of Radiation - EfD = D ( Absorbed Dose ) x WR x WT - Quantities and units for Quantifying Ionizing Radiation\ Equivalent Dose (EqD)\ Determined by Absorbed Dose ( D ) x Weighting Factor ( Wr)\ EqD = D x WR In terms of units = Sv = Gy x WR\ - - Radiation biodosimetry = Measurement of the amount of ionizing radiation that a person has been exposed\ to during an imaging procedure - Radiation bioassay: nvolves the analysis of biological samples to determine the amount of radioactive\ material present in the body -  - - Law of bergonie andtriboundeo 1. Age *.* Younger cells are more sensitive than older ones. 2. Example : embryos, fetuses, infants, children, and adolescents are more sensitive than adul 3. *Differentiation.* Nonspecialized cells are more sensitive than highly complex ones 4. *Metabolic rate.* Cells that use energy rapidly are more sensitive than those with a slower metabolism. 5. *Mitotic rate.* Cells that divide and multiply rapidly are more sensitive than those that replicate slowly. 6. Example (blood producing cells are highly sensitive compared to nerve cells that have a long life) Trauma Sub trauma.: Sport injury.// No need for immediate attention. Acute trauma.: Don\'t leave unattended. + Vital signs.+ Pain relief required. Levels of concsiousness 1... Alert and conscience. 2. Drowsy. 3. Unconscious but reactive to stimuli. 4. Comatose. \-- In case of gunshot.\--\> Chest X-ray first.// Then neck and spine. In case of. Motor vehicle accident+ Diving injuries. Spine first. - Common injuries include Jefferson's \#, Hangman's \#, teardrop \#, dens \# and facet dislocation - Some. Spinal cord injuries patient. They come without neurologic signs. - And lateral C spine. Include simulator secure. - Swimmers. The View.: C7-T1. /// Shoulder. Is. Rotated slightly posterior to separate the humeral heads.// Good. Two inches above jugular notch. - If we can\'t. Depressed the shoulder, we will angle 3 to 5° cauded. - **Jefferson Fracture: Compression fracture of the bony ring of vertebra C1** - **Hangman's Fracture: which involves the pedicles of C2 on both sides** **Best demonstrated in lateral image** - dens fx - facet dislocation - Teardrop fx - Thoracic spine: - Place edge of IR 3.8-5cm above relaxed shoulders - Include T3/T4 to L1 - Lumbar spine: - CR centered to level of iliac crest - Include T12 to sacrum chest - If air-fluid levels are suspected, use dorsal decubitus position ( if patient cannot turn on side) - If patient's condition permits, lateral decubitus position with patient lying on affected side will also show air-fluid levels - Exposure made on second full inhalation, if possible Abdomen - If air-fluid levels are suspected, use dorsal decubitus position ( if patient cannot turn on side). Center CR 5 cm above iliac crests to include diaphragm. - If patient's condition permits, lateral decubitus position with patient lying on affected side will also show air-fluid levels. Center CR 5 cm above iliac crests to include diaphragm. - Use of a grid provides optimal image quality. Ensure it's perpendicular to CR - Exposure made on exhalation A screenshot of a medical information Description automatically generated  GCF= [mAs with grid] mAs without grid [mAs1] = [GCF1] mAs2 GCF2