Book contents
- Intensive Care Medicine
- Intensive Care Medicine
- Copyright page
- Dedication
- Dedication
- Epigraph
- Contents
- Contributors
- Preface
- Foreword
- Abbreviations
- Section 1 Resuscitation and Management of the Acutely Ill Patient
- Section 2 Diagnosis, Assessment, Investigation, Monitoring and Data Interpretation
- Introduction
- The SBAR Tool
- Introduction
- Initial Primary Assessment
- Secondary Assessment
- Continuing Assessment
- Introduction
- Common Immediate Tests
- ECG Modes and Configurations
- Rate
- Cardiac Axis
- Bundle Branch Block
- QT Interval
- Other Abnormalities
- ST Abnormalities and Ischaemic Changes
- Inherited Disorders
- Introduction
- Types of Infection and Related Organisms
- Surveillance
- General Principles of Sampling
- Special Tests – Lumbar Puncture
- Introduction
- Indications for Arterial Blood Gas Samples
- Contraindications
- Sampling Sites
- Technique (Follow Local Hospital Procedure)
- Problems
- Complications
- Potential Sources of Error
- ABG Interpretation
- A Quick Approach to Deciphering the ABG
- Some Caveats
- Stewart’s Physicochemical Approach to Acid–Base
- Plain Film Radiographs (X-ray)
- Computed Tomography
- Magnetic Resonance Imaging
- Radiation
- Introduction
- Challenges of Portable Chest Radiography in ICU
- Systematic Assessment of ICU CXRs
- The ‘LLL’ Approach
- Pneumonia versus Pulmonary Oedema versus ARDS – Which Is It?
- Introduction
- CT Head Anatomy
- Meninges
- CT Checklist: ‘AB BCS’
- Grey–White Matter Differentiation
- CSF Spaces
- Skull/Scalp
- Introduction
- Systematic Assessment of the Abdominal X-ray: BBC
- B: Bones/Soft Tissue
- C: Calcifications/Artefacts
- Abdominal Pathology on CT
- Introduction
- Features of NEWS Scoring Systems
- Updated NEWS 2 Scoring System
- Advantages
- Disadvantages
- Introduction
- Clinical Reasoning and Critical Thinking
- The Clinical Reasoning Process
- Important Steps to Making a Differential Diagnosis
- Acknowledgements
- 2.1 Principles of Obtaining a History
- 2.2 Principles of Performing an Accurate Clinical Examination
- 2.3 How to Undertake Timely and Appropriate Investigations
- 2.4 General Principles of Performing and Interpretation of Electrocardiography Results
- 2.5 General Principles of Obtaining Appropriate Microbiological Samples and Interpretation of Results
- 2.6 Obtaining and Interpretation of Results from Blood Gas Samples (Acid–Base Balance and Disorders)
- 2.7 Principles of Interpreting Imaging Studies (X-ray/CT/MRI)
- 2.8 Imaging of the Chest
- 2.9 Imaging of the Head
- 2.10 Imaging of the Abdomen
- 2.11 Importance of Monitoring and Responding to Trends in Physiological Variables
- 2.12 How to Integrate Clinical Findings with Laboratory Investigations to Form a Differential Diagnosis
- Domain 3 Disease Management: Recognition, Causes and Management
- Section 4 Therapeutic Interventions and Organ Support
- Domain 5 Practical Procedures
- Section 6 Perioperative Care
- Section 7 Comfort and Recovery
- Section 8 End-of-Life Care
- Section 9 Paediatric Care
- Section 10 Transport
- Section 11 Professionalism, Patient Safety, Governance and Health Systems Management
- Index
- References
2.8 - Imaging of the Chest
from Section 2 - Diagnosis, Assessment, Investigation, Monitoring and Data Interpretation
Published online by Cambridge University Press: 27 July 2023
Book contents
- Intensive Care Medicine
- Intensive Care Medicine
- Copyright page
- Dedication
- Dedication
- Epigraph
- Contents
- Contributors
- Preface
- Foreword
- Abbreviations
- Section 1 Resuscitation and Management of the Acutely Ill Patient
- Section 2 Diagnosis, Assessment, Investigation, Monitoring and Data Interpretation
- Introduction
- The SBAR Tool
- Introduction
- Initial Primary Assessment
- Secondary Assessment
- Continuing Assessment
- Introduction
- Common Immediate Tests
- ECG Modes and Configurations
- Rate
- Cardiac Axis
- Bundle Branch Block
- QT Interval
- Other Abnormalities
- ST Abnormalities and Ischaemic Changes
- Inherited Disorders
- Introduction
- Types of Infection and Related Organisms
- Surveillance
- General Principles of Sampling
- Special Tests – Lumbar Puncture
- Introduction
- Indications for Arterial Blood Gas Samples
- Contraindications
- Sampling Sites
- Technique (Follow Local Hospital Procedure)
- Problems
- Complications
- Potential Sources of Error
- ABG Interpretation
- A Quick Approach to Deciphering the ABG
- Some Caveats
- Stewart’s Physicochemical Approach to Acid–Base
- Plain Film Radiographs (X-ray)
- Computed Tomography
- Magnetic Resonance Imaging
- Radiation
- Introduction
- Challenges of Portable Chest Radiography in ICU
- Systematic Assessment of ICU CXRs
- The ‘LLL’ Approach
- Pneumonia versus Pulmonary Oedema versus ARDS – Which Is It?
- Introduction
- CT Head Anatomy
- Meninges
- CT Checklist: ‘AB BCS’
- Grey–White Matter Differentiation
- CSF Spaces
- Skull/Scalp
- Introduction
- Systematic Assessment of the Abdominal X-ray: BBC
- B: Bones/Soft Tissue
- C: Calcifications/Artefacts
- Abdominal Pathology on CT
- Introduction
- Features of NEWS Scoring Systems
- Updated NEWS 2 Scoring System
- Advantages
- Disadvantages
- Introduction
- Clinical Reasoning and Critical Thinking
- The Clinical Reasoning Process
- Important Steps to Making a Differential Diagnosis
- Acknowledgements
- 2.1 Principles of Obtaining a History
- 2.2 Principles of Performing an Accurate Clinical Examination
- 2.3 How to Undertake Timely and Appropriate Investigations
- 2.4 General Principles of Performing and Interpretation of Electrocardiography Results
- 2.5 General Principles of Obtaining Appropriate Microbiological Samples and Interpretation of Results
- 2.6 Obtaining and Interpretation of Results from Blood Gas Samples (Acid–Base Balance and Disorders)
- 2.7 Principles of Interpreting Imaging Studies (X-ray/CT/MRI)
- 2.8 Imaging of the Chest
- 2.9 Imaging of the Head
- 2.10 Imaging of the Abdomen
- 2.11 Importance of Monitoring and Responding to Trends in Physiological Variables
- 2.12 How to Integrate Clinical Findings with Laboratory Investigations to Form a Differential Diagnosis
- Domain 3 Disease Management: Recognition, Causes and Management
- Section 4 Therapeutic Interventions and Organ Support
- Domain 5 Practical Procedures
- Section 6 Perioperative Care
- Section 7 Comfort and Recovery
- Section 8 End-of-Life Care
- Section 9 Paediatric Care
- Section 10 Transport
- Section 11 Professionalism, Patient Safety, Governance and Health Systems Management
- Index
- References
Summary
Key Learning Points
1. Chest X-ray anteroposterior (AP) films magnify the heart and mediastinum, and obscure the left lower zone.
2. When assessing the correct positioning of internal jugular central venous catheter placement, as a rule of thumb, the tip should lie at the level of the carina and to the right of the mediastinum.
3. When assessing the correct positioning of an endotracheal tube, the tip should lie 5–7 cm above the carina.
4. When assessing the lung fields, divide the lungs into three zones: upper, middle and lower thirds. Compare each side and check for asymmetry.
5. Consolidation refers to small airways and alveoli that are filled with material – pus, fluid, blood or cells. Consolidation is not synonymous with infection.
- Type
- Chapter
- Information
- Intensive Care MedicineThe Essential Guide, pp. 47 - 60Publisher: Cambridge University PressPrint publication year: 2021
References
References and Further Reading
de Lacey, G, Morley, S, Berman, L. The Chest X-Ray: A Survival Guide. Edinburgh: Elsevier; 2008.Google Scholar
Godoy, M, Leitman, B, de Groot, P, Vlahos, I, Naidich, D. Chest radiography in the ICU: Part I, evaluation of airway, enteric and pleural tubes. AJR Am J Roentgenol 2012;198:563–71.CrossRefGoogle ScholarPubMed
Goodman, L. Felson’s Principles of Chest Roentgenology: A Programmed Text, 3rd edn. Philadelphia, PA: Elsevier; 2007.Google Scholar
Life in the Fast Lane. DRSABCDE of CXR interpretation. litfl.com/drsabcde-of-cxr-interpretation/Google Scholar
Radiology Masterclass. 2019. Chest X-ray – tubes. www.radiologymasterclass.co.uk/tutorials/chest/chest_tubes/chest_xray_tubes_startGoogle Scholar