Clin Sem- Lecture #4- Pediatric, geriatric, & trauma considerations

Pediatric age group

Infant- 17 years

Parents/guardians

• provide them w/ an explanation

• Enlist their cooperation

• Explain your expectations of them during the exam

Procedures pediatrics may come for:

• chest

• Nose to rectum

• Pelvis/hips

• Skull

• Extremities

• Bone age

• Scoliosis

• Bone survey

• Soft tissue neck

• Fluoro procedures

Examples of diagnosis made from radiographic producers:

• pyloric stenosis

• Craniosynostosis

• Hip dysplasia

• Intussusception

• UTI/ reflux

• Enlarged tonsils/adenoids

• Child abuse

• Physical trauma

• Various communicable viruses

• Dislocations

• Scoliosis

What to do if the child refuses to follow directions:

• ask adult to leave the room

• Explain the doctor or parents want the exam to be done

• Repeat the directions & proceed

• Remain nonjudgmental

Pediatric immobilization

• assists w/ holding still or positionGI

• May need to use creativity

• Provides patient safety

Pigg-o-stat

• used during upright chest & abdominal radiography

• Inform parent of the use of the immobilizer

  • Reduced anxiety w/ observing child in the device

• Ask parent if they have any questions

Sheet immobilizer

• fold a large sheet into any size or fashion

  • Swaddling, mummification, bunny methods

• Used for soft tissue neck imaging

Octostop

• octagonal metal frame attacked to end of board

• Velcro straps for head, torso, & limbs

• Pt can be rotated 360 degrees

• Useful for fluoro exams

• Used for children upon to 12 months

Image gently campaign

• 2007

  • Ensure that every tech selects & uses the appropriate exposures when performing imaging & interventional procedures in children as safely as possible to reduce radiation dose

BASICS mnemonic

• Beam

• Artifacts

• Structures

• Indicators

• Collimating

• Support

Pediatric technical factor considerations

• require lower kVp in comparison to adults

• Small focal point size is recommended= increase spatial resolution

• AEC should be used only if the pt’s anatomy of interest can completely cover the active AEC detector cells

• Measure!

• Collimate!

Child abuse

• nearly 200,000 children a year are victims of child abuse including:

  • Physical abuse & neglect

  • Emotional abuse

  • Sexual abuse

RTs role in reporting child abuse

• recognized, respond, report

• Radiographers have an ethical & legal obligation to become adept at the recognition of child abuse

  • Bruising, burns, or possible fractures that seem out of proportion to the report of how the injury occurred may be reasons to suspect abuse

    • Ex:

      • Child’s version of what happened vs the parents story

      • Child states they have not eaten for a long period of time

Geriatrics overview:

• fear of hospitalization is greatest here

  • On average 40% of elderly people admitted to the hospital every year for a fall WILL NOT return to independent living

Geriatric

• 65+

  • Eligible for medicare benefits, social security, retirement

Aging definition

• refers to multidimensional process of physical, psychological, & social change

  • Elderly undergo 2.5x more radiographic producers than adults under 65

Common biological changes of aging

• arthritis

• Muscle mass

• Cataracts

• Decline cardiac function

• Decreased GI motility

• Loss of skin elasticity

• Osteoporosis

• Decline in sensory function

Physical & mental health concerns

Physical:

• arthritis

• COPD

• Hypertension

• Diabetes mellitus

• Parkinson’s

Mental health

• dementia

• Dependency

• Depression

• Fear of death

• Frustration w/ physical changes

• Alzheimer’s

Positioning considerations:

1. Maintain pt’s body temp w/ blankets

2. Transfer & position carefully to avoid causing skin tears

3. Allow a supine pt to sit for a bit before standing up to avoid postural hypotension

4. Don’t make assumptions

5. Have sponges & pillows available

6. Never leave elderly pt alone in x-ray room

Image wisely campaign

Radiation safety in adult medical imaging

Elder abuse

• in the US, it is estimated over 10% of those age 65+ experience this

Elder abuse examples

• physical abuse

• Emotional/psychological abuse

• Financial exploitation

• Neglect & abandonment

• Sexual abuse

Trauma

• deeply distressing or disturbing experience or physical injury

RT role in trauma

• make sure pt is comfortable with your care

• Never ignore the pt’s complaint of pain

• Decide the most logical & least painful way to perform the study

• Educate the pt about the study

• Communicate

• Stop the procedure if there is change in condition

• Confer w/ nurse or physician about the pt receiving pain meds

• HIPAA

General guidelines for trauma patient care

• Do not remove dressings/splints

• Do not move pt’s unless instructed to do so by physician in charge

• Do not disturb impaled objects, support them so they do not move as you image

• Do not remove pneumatic anti shock garments or CPR compression vests

• Work quickly, efficiently, & accurately to minimize repeats

Trauma procedure

• assess situation & develop action plan

• Take at least 2 images at 90 degree angles to one another for each body part

• Make sure the central ray & image receptor alignment approaches routine positioning applications, adapting to the patient’s condition

• Include all anatomy of interest

• For long bone radiography, ensure entire bone is included, & support both joints

• Provide protective apparel for anyone who needs to be in the room caring for the injured pt

Trauma immobilizations: Cervical collar

• prevents life-threatening movement

• Must remain on while images are taken

  • Need doctors approval to remove

Trauma immobilizations: Backboard

• supports entire back

• Usually radio-translucent

• Cassette can be placed directly below backboard

• Can be used to move pt onto x-ray table

Trauma immobilizations: fracture immobilizations

• traction

• Traction splint

• Air splints/casts

• Leg & arm immobilizes

• Back brace

• Fiberglass cast

What level of trauma is reading & what trauma levels do they have?

• Level 1

  • Trauma alert

  • Trauma response

  • Tier 3

X-ray equipment in trauma bay:

• Trauma beds with IR holders

• Portable x-ray

• CT

• Ultrasound