Tuesday, January 23, 2007

Educational Tips

I'd like to review the need for rib series x-rays. Rib series include 6 views. This is a pretty significant dose of radiation. Ergo, there are very specific criteria for when to order this test.
  • Suspected fx's to ribs 1 - 2
  • Suspected fx's to ribs 9-12
  • Multiple rib fx's
  • Preexisting pulmonary dz
  • Suspected pathologic fx
Thus, a healthy 22 yo w/ mid-CW pain doesn't need a rib series. A simple two-view CXR will provide you w/ all the info that's clinically important. In fact, I think the above list might be a little liberal. What are the questions you really want answered? For me, I want to know if a) they have a PTX or b) is there a flail chest. Pulm contusion and other signs of trauma will show up on the CXR. We don't typically see ribs 1 or 2 fx'd b/c it's typically from high-velocity trauma. Our usual pt population has rib fx's from 4-10. If there is a flail chest, I think most of it will see it on a CXR. And once a flail chest is diagnosed, what are the extra views going to tell you? I haven't dx'd a PTX w/ a rib series but missed it on a CXR.

So the next time you plan to order a rib series, ask yourself the question: will I be able to see what clinically matters on a two-view CXR and does the pt really need those extra views?

One other topic I'd like to touch on is when do you order a U/A in a febrile child without an obvious source of ifx? Remember that there's a much higher propensity of UTI's in females. A rule that I utilize for my patients who don't have a significant h/o UTI's/pyelo is the following:
  • Current recommendations say to check a U/A in any female pt less than 2 years. I will check a U/A in a female older than this b/c of it's frequency.
  • Circumcised males- I don't check a U/A in boys older than 6 months old. This I adhere to.
  • Non-circumcised males- I don't check a U/A in boys older than 12 months old. Again, I follow this policy.
I'd be interested in what other people do and their rationale. Josh- what's your algorithm?

1 Comments:

Blogger Susana said...

Urinary Track Infections are a nuisance, but you can stop them naturally without the use of antibiotics. Use preventive measures daily by drinking plenty of water, consume cranberry juice, take warm baths but don’t use bubble baths only use a cup of baking soda. Also limit your intake of coffee and soda. These simple measures are a natural preventive and effective way to keep those UTI’s out of your body!

If it is too late and the UTI already invaded your body, here’s a safe and natural way to rid the germs. There are many natural herbs that are extremely effective in the treatment and prevention of UTI's. Some of these have been used for centuries and many have been subjected to clinical trials that prove their effectiveness.

Find out more below:

http://naturalsupply.blogspot.com/2007/05/natural-ways-to-stop-constant-and.html

5:22 PM  

Post a Comment

<< Home