Thank you!
Dr. Vachon
Saturday, June 6, 2015
Tuesday, April 7, 2015
Aspirated foreign body in a child
After initial life saving measures, what is appropriate imaging for a suspected foreign body aspiration?
Depending on the age/size of the child, a chest radiograph is usually the first imaging exam.
It is helpful to know that you are worried about an ingested or aspirated object because I can look for secondary signs of bronchogenic obstruction, if it is radiolucent.
The overall appearance of the lungs or subtle mediastinal shift can help find the cause. Also, real time fluoroscopy can be useful to see paradoxical movement. Even with a clearly visible, radio-dense object these supporting finding are helpful to determine the degree of obstruction.
In short - it will be a team effort with the radiologist. Tell me your concern and I can let you know if I see any of the subtle findings.
Of course, the team will expand to include a bronchoscopist if there is persistent clinical concern, even in negative imaging. Direct visualization is hard to beat.
Important: a thin watch battery or 2 thin disc magnets presents significant additional worry for further mucosal damage. It is important to differentiate them from a coin and you can use my experience to help you and your patient.
Educational purposes for licensed providers.
Note to Patients:
Radiology is a very large and ever changing field and this post is to help your provider. When combined with a thorough history and physical exam, this information can be very useful. Your provider is best suited to answer specific questions regarding this post.
A provider is usually a Nurse Practitioner, Physician Assistant or Medical Doctor.
Of course, this is not a substitute for medical care.
Radiology is a very large and ever changing field and this post is to help your provider. When combined with a thorough history and physical exam, this information can be very useful. Your provider is best suited to answer specific questions regarding this post.
A provider is usually a Nurse Practitioner, Physician Assistant or Medical Doctor.
Of course, this is not a substitute for medical care.
Sunday, April 5, 2015
Cardiac #pacing device and #MRI ? #np #pa #ms #choosingwisely
Is there a way to get an MRI for your patient with a cardiac pacing device?
Possibly.
The exact manufacturing information must be available from the device, probably from the card the patient was issued.
Look up that exact information on here:
mrisafety.com/TheList_search.asp
Then careful coordination with the radiologist at the MRI center with the above information - additional cardiology coordination may be needed.
No implanted device can ever be assumed "conditional" or "safe" - it must always be referenced with the MRIsafety.com list and discussed with a radiologist.
Educational purposes for licensed providers.
Note to Patients:
Radiology is a very large and ever changing field and this post is to help your provider. When combined with a thorough history and physical exam, this information can be very useful. Your provider is best suited to answer specific questions regarding this post.
Radiology is a very large and ever changing field and this post is to help your provider. When combined with a thorough history and physical exam, this information can be very useful. Your provider is best suited to answer specific questions regarding this post.
A provider is usually a Nurse Practitioner, Physician Assistant or Medical Doctor.
Of course, this is not a substitute for medical care.
Of course, this is not a substitute for medical care.
Cyclical Breast pain, ultrasound? #orderwhat #AFPjournal #PCareProgress #AANP_NEWS #AAPAorg #choosingwisely
If a woman has cyclical Breast pain, does she need an ultrasound?
Probably not.
Cyclical breast pain, in a pre or peri-menopausal woman is probably benign and related to breast parenchymal response to hormonal changes.
If the pain does not coordinate with menses, a cyst or other structure could cause pain, in which case an ultrasound, or other imaging would be helpful.
Breast pain is not a common indicator of breast cancer.
More information here:
webmd.com breast pain or mastalgia
Probably not.
Cyclical breast pain, in a pre or peri-menopausal woman is probably benign and related to breast parenchymal response to hormonal changes.
If the pain does not coordinate with menses, a cyst or other structure could cause pain, in which case an ultrasound, or other imaging would be helpful.
More information here:
webmd.com breast pain or mastalgia
Educational purposes for licensed providers.
Note to Patients:
Radiology is a very large and ever changing field and this post is to help your provider. When combined with a thorough history and physical exam, this information can be very useful. Your provider is best suited to answer specific questions regarding this post.
A provider is usually a Nurse Practitioner, Physician's Assistant or Medical Doctor.
Of course, this is not a substitute for medical care.
Radiology is a very large and ever changing field and this post is to help your provider. When combined with a thorough history and physical exam, this information can be very useful. Your provider is best suited to answer specific questions regarding this post.
A provider is usually a Nurse Practitioner, Physician's Assistant or Medical Doctor.
Of course, this is not a substitute for medical care.
Sunday, August 31, 2014
#Fat? So what?
I read a lot of #CT scans. People come in different shapes and sizes.
Many requests say "abdominal pain" and more than half of my reports say normal or close to it.
Two patients, similar age with no acute findings to explain their pain.
What do the blue arrows represent?
Should my report still say normal?
Should my report include: Correlate with risk factors for metabolic syndrome?
Here's what the Mayo Clinic thinks of metabolic syndrome.
As of right now, I do not include this on my report - should I?
Will it make a difference when you meet with the patient with the results of the scan?
Blue arrows are subcutaneous fat, btw.
____________________________
Note to Patients:
Radiology is a very large and ever changing field and this post is to help your provider. When combined with a thorough history and physical exam, this information can be very useful. Your provider is best suited to answer specific questions regarding this post.
Many requests say "abdominal pain" and more than half of my reports say normal or close to it.
Two patients, similar age with no acute findings to explain their pain.
What do the blue arrows represent?
Should my report still say normal?
Should my report include: Correlate with risk factors for metabolic syndrome?
Here's what the Mayo Clinic thinks of metabolic syndrome.
As of right now, I do not include this on my report - should I?
Will it make a difference when you meet with the patient with the results of the scan?
Blue arrows are subcutaneous fat, btw.
____________________________
Educational purposes for licensed providers.
Note to Patients:
Radiology is a very large and ever changing field and this post is to help your provider. When combined with a thorough history and physical exam, this information can be very useful. Your provider is best suited to answer specific questions regarding this post.
A provider is usually a Nurse Practitioner, Physician Assistant or Medical Doctor.
Of course, this is not a substitute for medical care.
Of course, this is not a substitute for medical care.
Sunday, August 24, 2014
#Poop and #belly #pain!
Too much stool? #orderwhat @AFPjournal @PCareProgress @AANP_NEWS @AAPAorg
Many radiologist would not specifically comment on stool burden. I have made it part of my practice to include "Dense stool and air filled colon, correlate with signs and symptoms of constipation" when I see a radiograph like this.
If you get a normal report and you see the colon looking like this, consider constipation.
Educational purposes for licensed providers.
Note to Patients:
Radiology is a very large and ever changing field and this post is to help your provider. When combined with a thorough history and physical exam, this information can be very useful. Your provider is best suited to answer specific questions regarding this post.
A provider is usually a Nurse Practitioner, Physician Assistant or Medical Doctor.
Of course, this is not a substitute for medical care.
Image credit:
http://pediatriceducation.files.wordpress.com/2009/01/122704constipationaxr.jpg?w=367&h=474
Suspected Physical Abuse Child
2 years or younger? Over 2? Neurologic findings? #NAT #orderwhat @AFPjournal @PCareProgress @AANP_NEWS @AAPAorg
2 years old or younger, no focal neuro symptoms => Skeletal survey
2 or younger, head trauma with no focal neuro symptoms => Skeletal survey and non con head CT
2 or younger, WITH focal neuro symptoms => Skeletal survey and non con head CT, probably brain MRI
OVER 2, WITH focal neuro symptoms => Non con head CT, probably brain MRI
Any age with obvious chest, abdomen or pelvic trauma => Skeletal survey and indicated CT
Educational purposes for licensed providers.
Note to Patients:
Radiology is a very large and ever changing field and this post is to help your provider. When combined with a thorough history and physical exam, this information can be very useful. Your provider is best suited to answer specific questions regarding this post.
A provider is usually a Nurse Practitioner, Physician Assistant or Medical Doctor.
Of course, this is not a substitute for medical care.
Of course, this is not a substitute for medical care.
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