My EM Notes

Interpreting Images

Systematic review
A	Assess Quality Airway	• PA v AP • Count post ribs - 11 for good insp. • Rotation - vertebral spines equally b/w medial clavicle ends
B	Bones soft tissues	• symmetry, fractures, osteoporosis, and lesions. • soft tissues for foreign bodies, swelling, and subcutaneous air.
C	Cardiac	• should be <50% of the chest diameter on PA films and <60% on AP films. • Check for the heart shape, calcifications, and prosthetic valves.
D	Diaphragm	• shape may be flat with COPD,tension pneumothorax •R higher than L • look for free gas below
E	Effusions Extra-thoracic	• costo-phrenic angles for sharpness
F	Fields Fissures FB	• masses, consolidation, vessels, bronchograms • ?fluid in fissures, change of position • FB's- ETT, CVC, NG tubes, other
G	Great vessels Gastric bubble	• aortic knuckle size and shape • gastric bubble not displaced?
H	Hilar mediastinum	• LNs, Ca++, masses • widening - suggestion of dissection • displacement - suggestion of mass • angle of main bronchi - suggestive of collapse, masses • L hilum should NEVER be lower than R

Cardiac outline	LA dilation	Pleural thickening	Azygos lobe	Atelectasis
	double cardiac border			L lower lobe
Chilaiditi syndrome	LA dilation	Pulm HT	Pulm infarct
colon loops not free gas	3rd hump on L 1.aorta 2.hilum 3.LA	engorged pulm trunks	Pulm Infarct: R base

Systematic review
B	• Bowel gas	• 3,6,9 rule - small bowel <3cm, large bowel <6cm, caecum and sigmoid <9cm
B	• Bones	• ribs, lumbar vertebrae, sacrum, coccyx, pelvis and proximal femurs
C	• Calcification • artifacts	• arterial Ca++, phelobliths, calculi • clips, tubes, implants