This is one of those rules that seems so obvious. But you would be surprised how many times it’s ignored. Here’s just one example that can go wrong in so many ways:
- You order a chest xray during a trauma activation for blunt trauma, but don’t view it before the patient is transported to CT scan.
How this can go wrong:
- A very large pneumothorax is present, bordering on a tension pneumothorax. Either the patient must be brought back to the ED or all the equipment needed to insert a chest tube must be taken to CT, which is not an ideal place for this procedure.
- The stomach is in the left chest. The patient should have been taken directly to OR. There is no need for CT.
- A massive hemothorax is noted. However, blood products have not been ordered and the patient suddenly becomes hypotensive in CT. This is not a good place for resuscitation. And the chest tube problem in #1 applies here, too.
- A bullet is plainly seen in the middle of the right chest. This unexpected finding shows that the physical exam (or the history of the event) was inaccurate.
And the list goes on. And this is just one of a zillion possible tests that are ordered every day. In this example, looking at the image is simple in this day and age of having PACS viewers everywhere. However, many tests are not available for hours (coags), or are actually done at a later time (morning hemoglobin). This means more opportunities to miss significant results, and although they may not be as life-threatening as my trauma example, failure to check them can still cause significant problems.
Bottom line: Always review the result of every test you order, on every patient. In this age of shift work and work hour restrictions, a good hand-off to other trauma professionals is very important. You must make sure that somebody sees that result in a timely manner soon after it is available.
Corollary: If you really don’t need to see that result (i.e. it’s not going to change your care anyway), you shouldn’t have ordered the test!
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