All posts by TheTraumaPro

The Lead Gown Pull-Up: Part 2

Okay, so you’ve seen “other people” wearing perfectly good lead aprons lifting them up to their chin during portable x-rays in the trauma bay. Is that really necessary, or is it just an urban legend?

After hitting the medical radiation physics books (really light reading, I must say), I’ve finally got an answer. Let’s say that the xray is taken in the “usual fashion”:

  • Tube is approximately 5 feet above the xray plate
  • Typical chest settings of 85kVp, 2mAs, 3mm Al filtration
  • Xray plate is 35x43cm

The calculated exposure to the patient is 52 microGrays. Most of the radiation goes through the patient onto the plate. A very small amount reflects off their bones and the table itself. This is the scatter we worry about.

So let’s assume that the closest person to the patient is 3 feet away. Remember that radiation intensity diminishes as the square of the distance. So if the distance doubles, the intensity decreases to one fourth. By calculating the intensity of the small amount of scatter at 3 feet from the patient, we come up with a whopping 0.2 microGrays. Since most people are even further away, the dose is much, much less for them.

Let’s put it perspective now. The background radiation we are exposed to every day (from cosmic rays, brick buildings, etc) amounts to about 2400 microGrays per year. So 0.2 microGrays from chest x-ray scatter is less than the radiation we are exposed to naturally every hour!

The bottom line: unless you need to work out you shoulders and pecs, you probably don’t bother to lift your lead apron every time the portable x-ray unit beeps. It’s a waste of time and effort! Just stand back and enjoy!

July Trauma MedEd Newsletter Topic: Practice Guidelines

The July Trauma MedEd newsletter is just around the corner! The topic is: Practice Guidelines. I’ll be sharing a number of updated guidelines for diagnostic imaging, head injury, anticoagulated patients, and more. 

I see so many trauma programs that recognize the need for a practice guideline, but then insist on taking a huge amount of everyone’s time designing it from scratch. Chances are that 50 other trauma centers already have done this! So take a look at the ones in the newsletter, tweak to your heart’s content, and use them! In addition to printable copies in the newsletter pdf, I’ll share a link to Microsoft Publisher file versions so you can customize them, add your own logo, etc.

The newsletter will be released over the US Independence Day weekend. Subscribers will receive it then. Everyone else will have to wait until the following week. 

So sign up now, or get back issues, by clicking here!

Pet Peeve: Improper Video Laryngoscopy

The invention of video-assisted laryngoscopy and intubation has been a huge boon to trauma professionals. So it irks me to no end when I see them misusing the technology.

I call this phenomenon non-video laryngoscopy and intubation. Take a look at this picture:

What’s wrong, you say? Who’s watching the #@*! video screen??!

This intubator is basically using a clunky, old-fashioned laryngoscope tethered by two huge cables. Which makes it worse than a clunky, old-fashioned laryngoscope.

Bottom line: Your hospital has provided an expensive piece of equipment to help you intubate better and more reliably. You no longer have to peer down a narrow channel in the oropharynx, while blocking your own view with the ET tube.

Watch the damn screen!

(Photo source: epmonthly.com)