Please Reply to the following 2 Discussion Post
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DISCUSSION POST #1 Reply to Alia
This week’s skill reviews were very helpful for me. Although I have worked primarily in the ER for the majority of my career, chest x-ray interpretation is not something I typically do. Normally, I just read the radiologist’s interpretation once the imaging is complete. Depending on the caseload and amount of imaging the radiologist must interpret, the final results can take hours. If I am to treat and manage patients in a timely manner, it is beneficial for me to have a basic understanding of how to interpret radiologic images. Therefore, I chose to review the basic chest x-ray interpretation provided by radiologyassistant.com.
Chest radiography is one of the primary diagnostic imaging procedures in medical image diagnosis (Rahmat et al., 2019). The aim is to evaluate and detect pulmonary diseases such as cardiomegaly, pneumothorax, and pleural thickening (Rahmat et al., 2019). What I especially liked about Radiology Assist’s website, was that it gave systemic approaches to viewing the chest film using the “inside-out” approach. This approach involves starting from the internal structures of the chest and working your way outwards. It focuses on evaluating the lung parenchyma and internal structures before assessing the peripheral or outer areas of the chest x-ray. Here is a breakdown of the key steps:
- Evaluate the lung parenchyma: assess the central structures such as the trachea, bronchi, and major pulmonary vessels. Look for any abnormalities such as airway narrowing, masses, or enlarged lymph nodes in this central area.
- Analyze the lung fields: move outward to assess the lung fields for abnormalities such as opacities, nodules, consolidations, or areas of decreased or increased lung markings. Compare the density and clarity of the lung tissue bilaterally.
- Assess the pleural spaces: examine the pleural spaces for the presence of pleural effusion, pneumothorax, or pleural thickening. Look for any evidence of fluid or air collections in the pleural spaces.
- Evaluate the mediastinum and heart: look for any widening, masses, or lymphadenopathy. Assess the cardiac silhouette for size, shape, and signs of cardiomegaly or other abnormalities.
- Analyze the diaphragm and upper abdomen: evaluate the diaphragmatic contours and movement, looking for abnormalities like diaphragmatic paralysis, elevation, or herniation. Examine the upper abdomen for any abnormalities that may extend into the chest.
- Assess the bony structures and outer areas: this includes the ribs, clavicles, and spine. Evaluate for fractures or other abnormalities. Assess the peripheral lung fields for abnormalities that may have been missed during the initial evaluation.
DISCUSSION POST # 2 Reply to Talia
Basic electrocardiography (ECG) interpretation requires an understanding of electrophysiology and waveform measurements. There are two types of cells in the heart, mechanical and electrical. Electrical (conductive cells) initiate electrical activity and conduct it through the heart, while mechanical (contracting cells) respond to electrical stimulus and contract to pump blood (Prutkin, 2022). You may have electrical without mechanical, but no mechanical without electrical (Prutkin, 2022). A rhythm in pulseless electrical activity (PEA) occurs when any heart rhythm that is observed on the ECG does not produce a pulse (Prutkin, 2022). Most common cause is hypovolemia. Polarization refers to a ready state where the electrical charges are balanced and no electrical current flows (resting state), depolarization is the process of electrical discharge and flow of electrical activity (sodium and potassium trade places), and repolarization is the process where the cells are returning to their original state (Prutkin, 2022). The electrical conduction system consists of the electrical cells in the heart starting with the SA node and travels to the ventricles by way of the AV node (SA node to AV node to Bundle of His to the right and left bundle branches (Prutkin, 2022). Inherent rates within the conduction system are the built in rate in which it initiates impulse (Prutkin, 2022). The escape rhythm mechanism causes the next higher site within the AV junction to kick in if the SA node drops below its normal inherent rate or fails entirely (Prutkin, 2022).
An ECG rhythm strip is a series of cardiac cycles mapped out on a grid. The regularity of a rhythm is determined by looking at the R-R interval across the entire strip, if the pattern is regular, the RRI should remain constant throughout (Prutkin, 2022). It is important to measure all the RRIs to determine regularity (Prutkin, 2022). The two primary ways to calculate heart rates for a regular rhythm is to count the small squares between two R waves and divide the total into 1500, or a faster way is to count the number of large squares between two R waves and divide the total into 300 (Prutkin, 2022). If the rhythm is irregular, count the number of QRS complexes in a 6-second span and multiply by 10 to get HR in bpm (Prutkin, 2022).
