EM Bound

If dispo is king in the ED, the plan is the prince. But imaging plans can be tricky. You want to look at someone's abdomen, sure. But CT or MRI? Or is this one of the rare instances plain films help? Do they need IV contrast? PO contrast? By no means exhaustive, the guide below outlines common points of confusion with radiology. X-ray -AP vs PA Lateral: The "AP" or "PA" refers to the direction the beam is traveling to the receiver - either anterior to posterior (AP) or posterior to anterior (PA). Despite this being an x-ray this matters because is changes the observed size of images. Imagine your lamp is the x-ray beam and your desk is the receiver: putting your hand close to the desk results in a small hand shadow, moving it towards the lamp increases the size of the shadow. Why we care about this happening at all is the cardiac shadow on a chest x-ray. When the beam goes AP the heart, being more anterior, casts a bigger shadow that may overemphasize ...

The only thing you'll see more than chest x-rays in the ED will be EKGs. Even if you've never seen a specific pathology before you need to be able to read it. In other words, you need a system! In the end, whatever works for you is important, but this is one I learned: Technical ABCDE. Technical This is all the non-anatomy parts of the film. ID: name, type of image, position of image (AP vs PA), correct date and MRN tend to be skipped, though some attendings will like to hear them. You should still verify these regardless. Image: Inspiration (can you count 8-10 posterior ribs), penetration (usually less of an issue with digitally captured x-rays), and rotation (look for symmetric angle of clavicles with sternum in non-rotated film). Patient: Any tubes, wires, catheters you see - especially note where central lines, PICC lines, and ET tubes end. A Airway: Is the trachea midline or deviated? B Bones: Look for overt fractures, dislocations, and lytic lesions ...

Welcome to EM BOUND. A blog for medical students interested in pursuing emergency medicine as a career.  As program directors for the sub-internship in emergency medicine @NYPEM  we've been noticing a need for more trusted, student focused, and curated online content. The EM BOUND project is designed to fulfill that gap. It is a collaborative project run by medical students and the NYPEM faculty to give you a high yield focused view of the EM bound process.  Here you will find regular posts relevant to where you are in your career when you need it. To start we have created an EM Handbook on Flipboard  filled with curated and original content that will help you plan your fourth year, succeed in your sub-internships, and get your  ERAS and interview skills honed to perfection. Please follow along and stay tuned for more great EM BOUND educational content in the days ahead. The EM BOUND Team @NYPEM