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!
I can see pneumonia. And like you said, things that are so obvious that they are basically whacking me upside the head. I wish I could read films... and I wish I could read CTs, and MRIs, and I really really wish I could read EEGs :) I LOVE looking at broken bones, etc - and even then, I can see the break (obvious, they are in the hospital the break is a nasty one!), but can't tell you how bad it is. I once saw a femur fracture and I was like oh that's not a nasty one at all... then the ortho comes in and is telling this kid his leg will be shorter than the other one and he may have extensive trouble walking. DO'H! I don't even try anymore. I have been looking at films for over 3 years and I still don't know what I am looking for.
I guess I'm getting better, and I never ever pass up an opportunity to sit with a physician, surgeon, etc - and have them go over things with me (especially the ortho guys, they love to show off) - and I know I know more than when I started. But man, it's just so extensive. I leave the interpreting to the docs.
Like PedsRN I can't see things either. Maybe I (you, we) have some neurological defect akin to color blindness...black and white vision defect? (We all can't be perfect!) I can never really see much on ultrasounds either. I try to note the obvious, blatant, anomalies...but just leave the interpreting to the MD's and don't bother my head about it.
I am only mediocre at xray as like you I work in an ICU so our patients get one every day if they are tubed. This book is amazing and helped me a lot. The key is finding landmarks and anatomy then working from there.
It touches on CT scans but most of that is beyond me.
sallyrnrrt, ADN, RN
2,399 Posts
also any resp.therapist worth their "salt".......would be able to help