lecture 4- pediatric, geriatric, and trauma considerations

pediatrics

infant to 17 years old

parents or guardians

• provide them with an explanation

• enlist their cooperation

• explain your expectations of the guardian 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

diagnosis made from radiographic procedures

• pyloric stenosis

• craniosynostosis

• hip dysplasia

• intussusception

• UTI/vesicoureteral reflux

• enlarged adenoids/tonsils

• child abuse

• physical trauma

• various communicable viruses

• nursemaids’ elbow/dislocation

• scoliosis

what to do if the child refuses to follow directions:

• may need to ask adult to leave the room

• explain the doctor/patients want the exam to be done

• repeat directions and proceed

• remain nonjudgmental

pigg o stat(pediatric immobilization)

• used during upright chest and abdominal radiography

• inform parent of use of immobilizer(reduces anxiety)

• ask parent if any questions

sheet immobilizer(pediatric immobilization)

• fold large sheet into any size or fashion

• also known as swaddling, bunny, or mummification method

• used for soft tissue neck imaging

octostop(pediatric immobilization)

• octagonal metal frame attached to end of board

• Velcro straps for head, torso, limbs

• used for fluro exams

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

image gently (2007)

• founded by alliance of radiation safety in pediatric imaging, ACR, american association of physicists in medicine(AAPM), american society of radiologic techs

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

• back to basics(x-ray)

• pause and pulse(fluro)

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 inly if pediatric patient’s anatomy of interest can completely cover the active AEC detector cells

• MEASURE

• COLLIMATE

child abuse

• physical abuse and neglect

• emotional abuse

• sexual

• 200,000 children a year are victims of it

3 R’s of reporting child abuse

RECOGNIZE

RESPOND

REPORT

• radiographers have ethical and legal obligation to recognize child abuse

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

• if child told different story than parent

what to do if child abuse is occurring?

• report to supervising tech or area supervisor

• remain professional

• if physician orders more images, you do not need to specifically tell the parents why

geriatrics

fear of hospitalization is greatest in the elderly

65 and older

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

• undergo almost 2.5 times more radiographic procedures than adults

• eligible for medicare benefits, social security benefits, and retirement

aging

multidimensional process of physical, psychological, and social change

common biological changes of aging

• arthritis

• atrophied muscle mass

• cataracts

• declined cardiac function

• decreased GI motility

• loss of skin elasticity

• osteoporosis

• smoking of psychomotor processing and responses

• decline in sensory function

physical health concerns of geriatrics

• arthritis

• COPD

• hypertension

• osteoporosis

• diabetes mellitus

• pulmonary artery disease

• cancer

• parkinson’s disease

mental health concerns for geriatrics

• dementia

• dependency

• depression

• fear of death

• frustration with physical changes

• alzheimer’s

procedures geriatrics may come in for

• chest

• abdomen

• knee

• hip

• spine

• fluro

• bone surveys

positioning considerations

1. maintain the body’s temp with blankets

2. transfer and position carefully to avoid causing skin tears

3. allow a supine position 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

geriatrics campaign

Image wisely campaign

elder abuse

• In US, 10% of those 65 and older experience this

• physical abuse

• emotional/psychological abuse

• financial exploitation

• neglect and abandonment

• sexual abuse

• our ethical and legal obligation to report

• most common at head, face, and neck

trauma

a deeply distressing or disturbing experience or physical injury

RT role in trauma

• make sure patient 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 patient about study

• communicate

• stop procedure if there is change in condition

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

• HIPAA

general guidelines for trauma patient care

• do not remove dressings/splints

• do not move patients on a stretcher/backboard until ordered to do so by physician in charge of patient

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

• do not remove pneumatic antishock garment or CPR compression vests

• do have an emesis basin ready for use

• do work quickly, efficiently, and accurately to minimize repeat images

trauma procedure guidelines

• asses situation and develop an action plan for imaging procedure

• take at least 2 radiographs at 90 degree angles to 1 another for each body part

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

• include 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 injure patient

cervical collar(trauma immobilizations)

*do not remove immobilizers from ED trauma alert patient without physician/RN ok

• prevents life-threatening movement

• MUST remain on while images are taken

• need doctor’s approval to remove

backboard(trauma immobilizations)

• support entire body

• usually radio-translucent

• cassette can be placed directly below backboard

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

fracture immobilizations(trauma immobilizations)

• traction

• traction split

• air splints/casts

• leg/arm immobilizers

• back brace

• fiberglass cast

standard precautions

1. hand hygiene

2. use personal protective equipment(PPE)

3. follow OSHA

• gloves

• gowns

• masks

• eye protection

• face shields

emergency x-ray equipment in RH trauma bay

• trauma beds with IR holders

• portable(mobile) x-ray'

• CT

• ultrasound

trauma levels

• trauma alert

• trauma response

• tier 3