1st yr basics

Plain films:

-CXR: -KUB: -C-spine:

-Frontal: -Lateral: -?Free air -C1-7?

-Airway -Airway -Gas pattern -?Alignment

-Mediast/Hila -Mediast/Hila -Visceral outlines -?Soft tissue swelling

-Heart -Heart -Calcs? -vert body hts & intervert disc spaces

-Diaph/upper abd -Diaph/upper abd -Bones -trace out cortices

-Pleura -Pleura

-Lung fields: -Lung fields:

-infilt/atelect/nodules, etc -spaces: retrosternal/retrocardiac

-Bones& soft tissues:

-ribs/clavs/shoulders/scaps -spine

 

CT:

-Abd/pelv: -Chest: -Head:

-lung bases & heart -Lung windows: 1 lung @ a time -Cisterns:

-liver/GB/spleen/adrenals -Mediast windows: -quadrigem plate

-kidneys/ureters/bladder -heart & vessels -suprasellar

-pancreas -nodes:-AP window -ventricles

-stomach/SB & TI/LB, ?tics -subcarinal -sulci

-vessels -ant to Ao arch -gray/white matter

-mesentery- ?inflam, ?nodes -next to desc Ao -?symmetry

-F: -uterus/adnexa/ovaries -soft tissues -isch window

-bones: pelvis/spine -breast & axil LN -bones

-soft tissues -bones

 

Extrav:

1. ?how much in & how much aspirated

2. mix 0.1ml Hyaluronidase w 0.9ml NS (15unit/ml sol)

3. inject 0.2ml SQ x 5, each w new needle

4. apply 1% hydrocort, cover w sterile dsg & wrap in kling tid until no erythema

5. ice on for 20 min, off for 10 min x 24hr

6. elevate extremity x 3d

7. observe & document for pain, erythema, induration, swelling, necrosis, ROM/sens


Fluoro:

-UGI: Attg particulars: US machine:

Upright -Pt data, enter info, then pt data again

1. Scan chest -Janower:-Frontal esoph w/ 1-2 spots -Scan head

2. LPO: -straight to RAO when table down -Freeze, annotate, then print to save image

-fizzies & thick barium -Calcs- distance for caliper

-just follow 1st swallow: big picture scan, check -Chen: -get shot of upper esoph -Mmode (calcs?)- line up w heart (zoom in)

motility, preview what to take spots of -select HR?

*then ~3-4 spots of esoph & GEJ C/AC -Kanzaria:-upright spots -select lines & print

Table down -Color if too much, ->scale

3. LPO: Pedi: -adjust size to area to eval

-quick look +/- spot 1. L lat -Doppler for wave flow

-Coat stomach as needed -esoph *END EXAM!

*spots:-AC: bulb, body, antrum 2. RAO/R lat

-C: fundus -duod bulb

4. RAO: 3. Supine

*spots:-C: bulb, body, antrum -lig of Treitz

-AC: fundus

-drinking esoph ~2/3

5. RPO:

-valsalva

-water siphon

Upright again for additional views as needed

Overheads: drinking esoph, LPO/RAO/upright stomach, KUB

 

-E-gram: -SBFT: -BE:

Upright 1. Check scout C-> supine: 1. Ba to sigmoid, AP & 2 obliques

1. Scan chest, then ?Frontal/Chin up 2. Check overheads q15 min, adjust freq prn 2. Follow head of column

&follow 1st swallow/big pic scan 3. Scan SB w compression, then TI AC-> supine: Ba thru mid T-colon

2. Lateral (do 1st if suspect aspiration) upright: bag to floor & drain Ba

3. LPO -MBS: supine/prone: air

Table down Upright/Lat: fluoro grabs only 1. Rectum: Frontal & Lateral

4. RAO drinking esoph 2. Sigmoid: ~2-3

5. RPO check reflux -HSG: -VCUG: 3. Splenic flex

Upright again 1. Scout +renal beds 4. T-colon

6. Pill 2. Frontal & 2 obliques & post-void 5. Hep flex

6. Cecum, TI, appendix

-LP: Post-LP orders: Overheads: AP/PA, Prone x-tab lat, Decubs, Post-evac

1. Consent 1. Activity: bedrest w. BRP

2. Mark just under L3/4 spin process 2. Diet: as tol, inc PO as tol

3. Prep 3. VS: q30min x4, then routine, call if SBP<90/HR>120

4. Cover image intensifier 4. HOB<45

5. Anesth: ~2-3 ->10cc lido 5. D/C home p 3 hrs if stable

 

Shoulder arthro Intraartic Steroid Rx (w sm inj Iso 370)

1. Scouts: ER, IR, Abd 80mg/cc Depomedrol & 5cc 0.5%Bupivacaine for intraartic injection (make sure use all)

2. mark site

3. sterile cover Hip arthro: jxn fem neck & head; ~2cm lat to Fem A

4. 9cc lido + 1cc bicarb

5. ~12cc 1/100 gado mix (1cc gado in 50cc D5W, mix 10cc w 5cc Lido & 5cc Iso370 for 20cc)

 

Known/possible contrast all: (RF: alls, cards dz, pheo, sickle cell, hyperprot (eg MM), myasthenia, homocystinuria

Medrol 32g PO 6-24hr before, then 2 hr after Benadryl w 50mg PO

or 50mg Benadryl PO on call w Cimetidine 300mg & Prednisone 50mg PO q6hrx3, 1st dose PM before

 

Renal failure (Cr 1.5-1.7 gray zone) Pelvic trauma ->Retro urethrogram (lat/oblique):

Hydrate & Mucomyst 600ug bid x3d starting day before admin -pedi feeding tube/foley, pinch tip of glans penis & inflate balloon slightly

Also if DM on Metformin, off for 48 hr

 

Indics for emergent studies: CT cystogram:

MR Nucs US 1/10 dil (50 Reno60%/450 NS), 300cc via Foley

1. Epid abscess 1. GIB (sulfur colloid) 1. Ectopic

2. Cord comp 2. Testic torsion 2. Testic torsion Breast feeding pts: ~12hr p V/Q, ~48hr p CT

3. Carotid dissection 3. V/Q 3. ?CCY/pedi appy

4. Ven sin thrombosis 4. HIDA if to operate

5. Brain death

 

Heimlich valve: iodine prep, lido; 2-3rd IC space sup asp, make nick; trocar & introducer to cath w side holes to conn tube to 1 way valve (blue to pt); pull tip thru prox side hole, & pull back once in thru cavity