Question

You are working the evening shift at the community hospital. It has been a rather quiet evening until you get a call for a STAT mobile unit and head off to the ICU. You gather the IR cover, the IR, two aprons, and the mobile unit and head off to the ICU. When you enter the unit, you see that the room you are about to enter is quite busy with nursing personnel. You review the radiology request and realize that the patient is a friend who has been having heart problems off and on ever the past several years. You see that she has been intubated and a tracheostomy has been attached. As you enter the room and your friend sees you, she becomes agitated and waves you over to the bed.

1, what type of image should you do? Should you take a “normal” chest radiograph or assure that the tube placement is easily identified? 2, what will your plan be to help calm your friend’s agitation? 3, Because she is intubated and attached to the ventilator, how will you proceed to take the image?

Answer 1

1.The bedside chest x-ray (CXR) is an indispensible diagnostic tool for monitoring seriously ill patients in the intensive care unit. Bedside CXRs are an irreplaceable tool with which to detect the malposition of tubes and lines and to identify associated complications. Although the image quality is often limited, bedside CXRs still provide valuable diagnostic information.

So I will do Chest x-ray.

##As my pstient is incubated and trachyostomy is also done, so knowing the position of the tubes are very important.A chest X-ray is often acquired following placement of an endotracheal tube (ET tube) to determine the position of its tip. The trachea, carina and main bronchi are almost always identifiable on a chest X-ray image, as long as the image is viewed on a high quality screen in a darkened room.

2. After admitting in hospital and going through intubation and tracheotomy it is very normal that the patient will be agitated.

1. Stay calm : After noticing the patient I will not be panicked. I will stay calm. These is very helpful to give psychological suppot to patient.

2.Conversation : I will start conversation with the patient so that she can express her feeling to me. These will reduce her anxiety.

3.Maintaining IPR: I will answer her questions and provide Knowledge to her regarding her disease conditions.

4.Empathy :One of the quickest ways to calm an angry or difficult patient is by being empathetic. So I will be empathetic to my patient.

5. I will avoid arguing with my patient .

So, to make my patient comfortable and to reduce her agitation I will do these things.

3. As she is attached with ventilator so I will connect the x-ray tube to a flexible arm that is extended over the patient while an x-ray film holder or image recording plate is placed beneath the patient.