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ACAD-AE-MED  April 2002

ACAD-AE-MED April 2002

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Subject:

Re: 5th metacarpal base fractures

From:

John Ryan <[log in to unmask]>

Reply-To:

Accident and Emergency Academic List <[log in to unmask]>

Date:

Sat, 13 Apr 2002 10:14:23 +0100

Content-Type:

text/plain

Parts/Attachments:

Parts/Attachments

text/plain (78 lines)

Isn't anyone using metal detectors in their protocol instead of imaging ?

John Ryan


Dr John Ryan
----- Original Message -----
From: Robert Spykerman <[log in to unmask]>
To: <[log in to unmask]>
Sent: Saturday, April 13, 2002 05:41
Subject: Re: 5th metacarpal base fractures


> 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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