week one

emergency team

made up of various people with a very specifc and important role to play in the well being and recovery of the patient

(ED physician, residents, medical specialists, trauma nursest, clerks, etc,)

imaging

(one of three responsibilites as an MRT)

Should be efficinent in the fast-paced environment

demonstrate a thorough knowledge of positioning and think quickly to adapt to alternat projections, positioning methods and exposure factors

2 views at 90

adapt CT and IR placement.
Be proficienti n standard precautions and immobilzation (shorter exposure, etc)

Radiation protection

(one of three responsibilites as an MRT)

protect the team, patients, and themselves

close collimation, fonadal protections, ALARA (Dose and time), aprins, non-essential staff may leave room, announce exposure, surrounding patients min 6 feet away

patient care

(one of three responsibilites as an MRT)

keep the patient within eye site. visual inspection and verbal dialogu to have ongoing assessment. never leave patienr unattended.
must be able to recognize any signs of altered patient condition

Assess vital signs, perfoms CPR, assist with oxygen delivery, get crash cart

adpat for the patient condition

communicator

announce arrival so the team knows youre there

ask for assistance if needed for lifting and placing- struggling alone will waste time

assit others if they need a hand

collaborator

interprofessional practice and courtesy.

some diagnostic tests take precedence over imaging, and event will be directed by the doctor in charge

clinical expert

clear and thorough documentation

history of MOI and can be critical for proper interpretation

include rational for sub-standard images when necessary

also have grides and markers properly placed, bag IP if needed, scan req, have extra equipment availabe, keep workspace clear

leader

crtically think and have awareness of you surrounding and antipcate with other services may need to proivide

care provider

PPE.

start with lead apron under PPE

AP CXR

will provide immediate information on the current patient condition and after placement of intrinsic tubes

many trauma patients will have to be supine

if air fluid levels are needed- do x-table in dorsal decub

spine

always do a lateral x-table first with the patient in the dorsal decub position

do not move forward with projectiosn until a doctor has reviewed the images

airway

(one of the criteria for analyzing a CXR)

air filled trachea, carinia and main bronchi.

trachea should be visible midline, veers slightly to the right of the aortic arch (lateral shift = pathology). assess the entire pathway for narrowing

breathing

(one of the criteria for analyzing a CXR)

assess each lung and compare sides for symmetry

look for signs of pathology

asses the retrocardiac lung opacity and markings

cardiac and circulation

(one of the criteria for analyzing a CXR)

assess the acrdiothoracic rations, heart is less than 50% of the thorax width. assess the heart position (1/3 to the right of midline and 2/3 to left). evaluates cardiac borders, major vessels and the size and position of the aortic arch

diaphragm

(one of the criteria for analyzing a CXR)

assess each __ has a clear and sharp border from the thorax latral edge to the spinal bodies. there is a hiatus hernia.

ensure there is no free intraperiotineal air between the right __ and the liver

CTAS

consists of five levels of response.

defines what patient situations require immediate attention as well as the expected response time of the emergency physician
(made by the Canadian Triage and Acuity Scale Naitonal Guidelines)

CTAS 1

physician attendance: immediatlly

resuscitation, immediate threat to life / limb.
(cardia / respirtaory events, major trauma, unconsciousness, shock)

CTAS 2

physician attendance: within 15 mins

emergency situations, potentila threat to life/ limb require medical intervention or delegation of acts

(altered mental state, substantial head injury, evere trauma, neonates)

CTAS 3

physician attendance: within 30 mins

urgent, potentially progress to a serious problem that would require medical intervention, assoicated with ability to live in a normal manner

(moderate trauma, asthma, GI bleed, acute pain)

CTAS 4

physician attendance: 60 mins

semi or less urgen, potential for deterioration or complications, would benefit from intervention or reassurance within 1-2 hours
(headache, corneal FB, chronic back pain, nausea / vomiting, UTI)

CTAS 5

physician attendance: within 120 min

non urgent, may be acute but not life threatening; may be chronic without deterioration

(minor trauma, sore throat, URI, mild abdomibal pain which is chronic or recurrent, vomiting, diarrhea)

reasons to not do C-spine

if the patient is:

• fully alert and oriented

• no head injury

• no drugs or alcohol

• no neck pain

• no abnormal neurology (ie: moves all four limbs)

• no clinical suspicion of cord injury

• no significant or other "distracting" injury

foot imaging

do you need or not need foot imaging if:

there is pain in the mid-foot zone, and any of the following are present:

• bone tenderness at the base of the 5th MT, OR

• bone tenderness at the navicular, OR

• inability to bear weight for 4 steps

ankle imaging

do you need or not need ankle imaging if:

• bone tenderness in the posterior 6cm of the distal tibia or medial malleolus, OR

• bone tenderness in the posterior 6cm of the fibular or lateral malleolus, OR

• inability to bear weight for 4 steps

knee imaging

• age 55 or older

• bone tenderness at the head of the fibula

• isolated tenderness in the patella

• inability to flex to 90° 

• inability to bear weight for 4 steps