Pediatric, Geriatric, and Trauma Considerations

pediatrics

infant to 17 years old

RT must:

• be sensitive and effective

• use age-appropriate methods of communication

• establish a rapport and acquaint child to new environment

• respect modesty

parents of guardians

• provide them with an explanation

• enlist their cooperation

• explain your expectations of the guardian during the exam

procedures pediatrics may come in for:

• chest

• nose to rectum

• pelvis/hips

• skull

• extremities

• bone age

• scoliosis

• bone survey

• soft tissue neck

• fluoro procedures

diagnosis made from Radiogrpahic Procedures:

• pyloric stenosis

• craniosynostosis

• hip dysplasia

• intussception

• Urinary tract infections/ vesicoureteral reflux

• enlarged adenoids/ tonsils

• child abuse

• physical trauma

• various communicable viruses

• nursemaid’s elbow/ dislocation

• scoliosis

what to do if the child refuses to follow directions:

• you may need to ask the adult to leave the room

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

• repeat the directions and proceed

• remain nonjudgmental

pediatric immobilizaiton

• assists with holding still or positioning

• is NOT a method of punishment

• made need to use creativity

• provides pateint safety

Pigg O Stat

• used during upright chest and abdominal radiography

• inform parent of the use of the immobilizer

  • reduces anxiety with observing child in the device

• ask the parent if they have any questions

sheet immobilizer

• fold a large sheet into any size or fashion

• known as swaddling, mummification, or bunny method

• used for Soft Tissue Neck Imaging

octostop

• octagonal metal grame attached to end of board

• velcro straps for head, torso and limbs

• patient can be rotated 360 degrees

• useful for fluoroscopy exams

• can be used on children up to 12 months of age

Pediatric: Image Gently Campaign

• founded in 2007 by Alliance of Radiation Safety in Pediatric Imaging, the American Collge of Radiology (ACR), the American Association of Physicists in Medicine (AAPM), and the American Society of Radiologic Technologists

  • goal- ensure that every tech selevts and uses the appropriate exposures when performing imaging and interventional procedures in children as safely as possible to reduce radiation dose

Pediatric Technical Factor Considerations

• require lower kVp for appropriate attenuation compared with adults

• small focal spot size is recommended= increase spatial resolution

• AEC should be used only if the pediatric patient’sanatomy 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 and neglect

  • emotional abuse

  • sexual abuse

radiographer’s role in Reporting child

• radiographers have an ethical and 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

• if your patient is here for imaging and you suspect child abuse, inform your supervising technologist or area supervisor

  • referring physician may be contacted and additional images might be ordered

• remain professional with the parent of caregiver at all times

  • if the physician orders additional images, you do not need to specifically tell the parents why. Simply state “the dr. would like more images”

fear of hospitalization is greatest in the elderly

on average, 40% of the elderly perople admitted to the hospital every year for a fall will not return to independent living

geriatrics

• persons 65 and older represent the fastest growing age group in america

  • 65 is arbitrary age that designated for convienence as the age at which a person is eligible for Medicare benefits, Social Security benefits, and retirement

• aging in humans refers to a multidimensional process of physical, psychological, and social change

• the elderly undergo almost 2.5 times more radiographic procedures than adults under 65 years of age

common biological changes of aging

• arthritis

• atrophied muscle mass

• cataracts

• declined GI motility

• lost of skin elasticity

• osteoporosis

• smoking of psychomotor processing and responses'

• decline in sensory function

physical health concerns:

• Arthritis

• COPD

• hypertension

• osteoporosis

• diabetes mellitus

• pulmonary artery disease

• cancer

• parkinson’s disease

mental health concerns

• dementia

• dependency

• depression

• fear of death

• frustration with physical changes

• alzheimer’s

procedures geriatrics may come in for:

• chest

• abdomen

• knee

• hip

• spine'

• fluoro procedures

• boen surveys

positioning considerations

1. maintain the patient’s body temp with blankets’

2. transfer and position carefully to avoid causing skin tears

3. allow a supine patient to sit for a bit before standing up to avoid postural hypotension

4. don’t make assumptions about what your patient, ask them instead

5. have sponges and pillows available for the patient’s head up or to elevate their knees

6. never leave an elderly patient alone in the x-ray room

when imaging the elderly

you must develip cultural knowledge, awareness and sensitivity

geriatric: image wisely campaign

radiation safety in adult medical imaging

elder abuse

• in the US, it is estimated that over 10% of those age 65 and older experience some form of elder abuse

  • physical abuse

  • emotional/ psychological abuse

  • financial exploitation

  • neglect & abandonment

  • sexual abuse

• is it your ethical and legal obligation to report elder abuse to the person at your institution who makes inquires

trauma definition

a deeply distressing or disturbing experience or physical injury

RT role in trauma

• make sure the pateint is comfortable while in your care

• never ignore a patient’s complaint of pain

• decide the most logical and least painful ways to perform the study

• educate the patient about the study

• communicate

• stop the procedure if there is change in condition

• confer with nurse or physician about the patient recieving pain meds

• HIPAA

general guidelines for trauma patient care:

• DO NOT remove dressing or splints

• DO NOT move patients who are on a stretcher or backboard until ordered to do so by the physician in charge of the patient

• DO NOT remoce pneumoatic antishock garments or CPR compression vests

• DO have an emesis basin ready for use

• DO work quickly, efficiently, and accurately to minimise repeat images

trauma procedure guidelines

• assess the situation and devloped an action plan for imaging procedure

• take at least two radiographs at 90 degrees angles to one another for each body part

• make sure that the central ray and image receptor alignment approaches routine positioning applications, adapting to the patient’s condition

• incluse all anatomy of interest

• for long bone radiography, ensure entire bone is included, and support both joints

• provide protective apparel for anyone who needs to be in the room caring for the injured patient

trauma immobilizations

do not remove any immobilizers from ED trauma alert pateint without Physician/ RN ok

• cervical collar

• backboard

• fracture immobilizations

cervial collar

• prevents life threatening movement

• must remain on while images are taken

• need doctor’s approval to remove

backboard

• supports entire body

• usually radio-translucent

• cassette can be placed directly below backboard

• can be used to move patient onto x-ray table

fracture immobilizations

• traction

• traction splint

• air splints/ casts

• leg & arm immobilizers

• back brace

• fiberglass cast

standard precations

1. hand hygeine

2. use personal protective equipment (PPE)

• always follow OSHA- maintain standard precautions

reading hospital is a level 1 trauma center

• cares for complex injuries with specialty and subspecialty care abailable 24/7

• all staff (including imaging professionals and specialty doctors) are immediately available to the trauma patient 24/7

emergency x-ray euipment in RH truama bay

• trauma beds with IR holders'

• portable (modible x-ray)

• CT

• Unltrasound

trauma levels

• trauma alert

• trauma response

• Tier 3

what are the 3 R’s of reporting child abuse

• Recognize

• Respond

• Report