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Discussion

Help reading x-rays

Hi!

I work in a CVICU, and almost every single one of my patients gets a chest x-ray, almost every day. I've been there over a year now, and still have the hardest time knowing what I'm looking at. After someone points it out to me, I can see it, but sometimes not even then. I've tried several online tutorials and spent lots of time reading, but it's still just not clicking.

Of course, I realize that I have surgeons and radiologists to do that, but it's not uncommon for several hours to go by before they can take a look.

I can recognize some very basic things, but basically can only use them to make sure my swan is in the right place and/or if chest tubes are slipping. We have great surgeons, all of whom regard our nursing staff as highly capable non-idiots...so when we have called them with a concern about an x-ray (Mr. so-and-so looks like he's started to develop ____) they usually will check it out right then, and we can get the ball rolling with some more orders to treat the condition. I'd really like to be able to improve my patient's care in that way.

PLUS having no idea what I'm seeing drives me crazy, it's like getting a CBC back and not knowing what the numbers mean!

The vast majority of complications my patients develop are pleural effusions, pneumothorax, hemothorax, and cardiac tamponade. If these things aren't blatantly obvious, to the point where they are about to kill my patient, I just don't see it. It also doesn't help that, since my patients can't tolerate being transported, all of these are AP x-rays, instead of PA.

If anyone has any tips or resources they could share, I would really appreciate it!

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    • Featured Replies

    Do you have any APN's on your unit? Maybe they can put together a brief inservice about reading CXR's for the staff?

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    remember, your interpretation cannot be used for planning care. It would be for your information only.

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    • Author
    Do you have any APN's on your unit? Maybe they can put together a brief inservice about reading CXR's for the staff?

    We do have some APNs. While they are very helpful, they are stretched so thin I don't see them getting overly excited about planning an inservice for RNs! I wish.

    It's not exactly something we are expected to be proficient at, but we all spend a decent amount of time huddled in a group around the computers looking at the x-rays that most nurses have picked up a good amount of info. Maybe I need glasses or something because I'm lost!

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    • Author
    remember, your interpretation cannot be used for planning care. It would be for your information only.

    I know that my interpretation will never be used in a way that affects the way a patient is managed by the MDs. Mainly, I think it's interesting, and it can help the big picture make sense, especially when I'm seeing changes over several days. It's neat to look at when I have down time.

    It can also get our surgeons or the NPs/PAs on the unit a little quicker if we are able to take a look and let them know we think there's been a new development. Then of course, they look for themselves.

    We have radiologists that look at each film, and write a note. Unfortunately, we've found that we can't rely on their judgement, as they've been known to miss some things.

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    Have you Googled it?

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    • Experts

    When I worked in the ED, I used to pick the brains of some of the docs who liked to teach. We had a few who would actually pull you aside to look at the films with them and say, "See this? That's a _____." It was great, and I felt like I really got a lot out of the time I worked there.

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    You've enlisted some good resources - keep at it! Make sure you're looking at the films after they've been interpreted as well - go look for the findings noted in the result.

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    When I worked in the neuro ICU we got a course on how to read a CT of the head. This of course was for our information only, but I found it really helpful. We only had one NP in our unit, but she still managed to inservice all the staff. I used to pick the brains of the intensivists too.

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    As others have said, learning to read them will be for your information. I am in a NP program and one of the resources I have been using to help with chest xrays is Chest Radiology. Good luck!

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    Icufaqs.org has a nice tutorial.

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    • Author

    Thanks guys. Also, I had forgotten about icufaqs!

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    also any resp.therapist worth their "salt".......would be able to help

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