The way I was taught is to get the CXR first THEN the PFA film if the object
is not in the chest for the very reason that if you get the abdo film and
it's not there, it may well be not quite down to the stomach yet possibly
lodged in the oesophagus. So it's not there in the abdo film the first time
round, you send him back for the chest, and there's nothing up in the
mediastinal area to see because it's already passed down to the stomach by
the time he's gone back down to X-ray yet again.....
Theoretically.. With queues and delays in X-ray I guess it is possible..
In small enough kids, you can frequently get them both on the same plate.
Of course, I have no evidence, anecdotal or otherwise to support this
personally at this time. :)
Robert Spykerman
Reg ED Cork Univ Hosp
----- Original Message -----
From: "Adrian Fogarty" <[log in to unmask]>
To: <[log in to unmask]>
Sent: Saturday, April 13, 2002 12:57 AM
Subject: Re: 5th metacarpal base fractures
> ----- Original Message -----
> From: Craig Ellis
> > My personal favourite is the "Paediatric Foreign body" protocol which
> requires a lat neck / chest / abdo films. For many it dosnt matter if the
FB
> is found on the first film - we still religiously get all 3 films -
because
> the protocol says so !!! I dispair.
>
> Slightly off your point I realise Craig, but most radiographers tend to
get
> the neck and chest covered in one film in kiddies. I believe the RCR
believe
> that this neck/chest film is all that is necessary, as you only need to
> exclude an impacted FB in the upper aerodigestive tract (if it has reached
> the stomach, then it is likely to be innocuous). However like yourself I
> feel more comfortable seeing the offending object, so I often ask for an
> abdo film first. If the FB shows in the stomach, I can then avoid a chest
> film, unless the story is suggestive of multiple FBs or is unclear.
>
> Another reason I dislike the chest film, is that many radiographers use a
> normal chest penetration, perhaps under the mistaken impression that a
soft
> tissue view with low penetration is required (help me out here Vikki).
This
> results in a typically white mediastinum, so you can't really be sure
there
> isn't an FB lurking behind the heart. What is actually needed is an
> overpenetrated film, rather like an AP thoracic spine view, which makes
the
> mediastinum disappear, and your metallic FB shows up beautifully!
>
> Adrian Fogarty
>
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