PA Chest Clinical Help (first sem. student)

Sparky · Joined: 03 Feb 2009 Posts: 4

Hello. You can call me Sparky. Today was my first day of clinical. Why is it that the registered rad techs did not want to help me? When they did show me how to do stuff, they talked about 100mph, and had this posture and attitude of "don't talk to me, don't look at me, don't ask me anything". It was not a comfortable place to work. I had a lot of questions, but I felt like I was bugging the technologist, so I didn't get to ask as many as I would have liked. I barely know how to do a PA Chest. I know that you are supposed to find the T-7 on females, T-8 on males, and the IR has to be 1 1/2" above the shoulder, with a 72inch SID, shield, and collimate (even though I don't know how much).

Do you line their ventral side to the wall bucky first, and then adjust the CR, or vice versa. What is the easiest way to do it? Also, what do you say to the patient the entire time? At anytime. I can't think of anything to say. How do you introduce yourself? Also, I havn't mastered how I am supposed to tell them the breathing instructions. Is there anybody out there who can tell me step by step the best way to do a PA chest from the time the patient comes into the room all the way through? That would help me so so much. I have heard so many different ways of doing a PA chest, so it is scrambled in my brain. PA chest is the first thing I have to comp. on.

Today, I stood in the room when the patient was in there and had no idea what I was supposed to be doing. I didn't even understand what the technician was doing. She was just hitting buttons and scanning stuff, and typing stuff into the computer, and making copies of stuff.

The last job I worked at, I was the "trainer", not the "trainee" and I loved to train people. I loved to show people new things, and make their first day a great experience. The majority of the techs, and the radiologists, don't want to have anything to do with me. It's like I'm not even there. My clinical instructor is rarely around the department I'm in either. One of the tech's was really nice though, but she went through everything super fast. So fast that it might as well just of bounced right back out my ear. Why does nobody smile? Everyone has a look of concern on their face.

I know that if I can figure out the steps on how to do this stuff, then I can get a feel for how all of this works. All my book work, and memorizing goes out the window when I get into the exam room, because I am so nervous. I can barely remember my own name, or where I am, because adrenalin is pumping through me at an intense rate.

I am afraid to say anything to the patient, for fear that I might say something that will offend them or it will be a Hippa violation.

Basically, I look like a trembling little bunny, around other bunnies, who know where their carrots are, and what to do with them.

If there is any advice or any information (esp. on the steps for a PA chest) that you guys could send my way, that would be awesome.

I have OCD, and panic disorder, so I tend to get really cranked up when I have to deal with new situations. I know I bounced all over the place.

Thanks for reading.

~ Sparky
_________________
~first semester Rad Tech Student~

wvaio · Joined: 22 Sep 2007 Posts: 85

Ok, Sparky. First off take a deep breath. Next, read this post and come back.

http://www.radiologyworkers.com/radiologyforums/viewtopic.php?t=5319

Now I will address your questions about a chest x-ray.

The PA chest is performed differently by many people. There are many different ways to achieve a diagnostic image. All methods are correct as long as they achieve the same goal.

Merrill's suggest using the inferior angles of the scapula as the spot for the central ray(T7). The problem with this method is that you can not always find the inferior angles.

Using the light above the shoulders takes practice. Differences in patient size take some time to learn to compensate for. To use this method, you must put the light about 1.5" above the shoulders, not the neck. You really have to look at the most lateral aspect of the shoulders. C7-T1 should be included at the top of the light field. That can be assessed by palpating the Vertebral Prominence, the first big bump that you feel if you run your fingers down the back of your neck. It sticks out the furthest.

Some use the sternum. If you place your four fingers on the sternal notch(where the clavicles meet the sternum), you can place the top of the light field at the level of the top finger.

Yet another method is to make a "hang-loose" sign with your hand. Basically a fist with the thumb and fifth finger extended. Your hand should stretch out about to about 7 inches. If you place your thumb on the base of the neck (C7-T1) place the CR about 1 inch below your pinky. This method is described in Bontrager's positioning book.

I always line up the light and them move the bucky to the light. Many people do it the opposite way.

When you go from the PA to the lateral drop the bucky and tube down about 1 inch for the lateral.

When it comes to starting from the time they walk into the room there is a basic layout that you should practice for all exam's.

1. Introduce yourself
2. Confirm that you have the right patient using patient identifiers
3. Patient history- Ask them why they are in need of the exam.
4. Check for jewelry.
5. If female, ask if there is ANY chance that they could be pregnant
6. Shield as needed.

When giving breathing instructions, say "please take in a big breath." pause for a half second. Say"hold your breath." Expose. Say"breathe". If your facility does a second inspiration do that procedure, but in this area everyone skips the second inspiration.

It will all come in time. Relax and enjoy it.

Wvaio

Sparky · Joined: 03 Feb 2009 Posts: 4

Thank you very very very much. This program, since it started in the beginning of January has had me running to the psychiatrist for more anti-anxiety pills. I can't thank you enough for clarifying my questions! I quit my other job to pursue this career. I went from being the guy who knows everything about his profession, to the guy who knows diddly poo. It was, and still is a stressful transformation. I consider myself great when it comes to making people feel comfortable (1 on 1). However, when I don't feel comfortable, or confident, in what I am doing, the fear is written all over my face.

Thanks again for clarifying the PA chest for me. I will add that to my guidebook before my next clinical. It helps me when I can see the steps layed out, like a recipie.

I always get really anxious when something new comes along. I don't particularly enjoy change. I like routine. I like to stick with what I know. I could be wrong, but it looks as if being a Radiologic Technologist would be the kind of job where one would get set in a groove.

Well, this was my procrastination stage of the night. I better get back to studying. Thanks again Wvaio! I might ask for your help again in the future when I start being to panic / freak out. It doesn't happen as often, thanks to my SSRI.

I'll post more questions and concerns as this semester goes along.

~ Sparky
_________________
~first semester Rad Tech Student~

wvaio · Joined: 22 Sep 2007 Posts: 85

Sparky, I had a very similar situation. I worked as a machinery mechanic and adjuster of production equipment for 10 years. When they closed I had been training apprentices for 7 years. I know that it can be very difficult to go from being the competent to the incompetent.

Take what you know of being a trainer and use it to be the best trainee anyone ever had. Things that drove you crazy about trainees, don't do.
Here are a few words of advice that I have acquired that may help you:

Know the information you are required to know plus 10%.
Learn everything you can about everything you can.
Disregard no information as unnecessary.
Listen more than you talk.
There is ALWAYS something you can be doing.
Believe nothing that you hear and only half of what you see.
Take criticism with a grain of salt, its easier to swallow.
Give credit where credit is due.
Control negative self-talk. Don't let your mind defeat itself.
When in doubt, take a deep breath.

Oh yeah 1 more newly acquired from papa: never meddle in the affairs of a dragon, for you are crunchy, and taste good with ketchup. Laughing

It will all come in time. I have been taking Selective Serotonin Reuptake Inhibitor's and anti-anxiety medications for more than 10 years. They only work if you allow yourself the distinct opportunity to change the things that make you take them in the first place. You can overcome anxiety with confidence.

The best of luck to you. I assure you, it will all work out in the end. Its up to you, how well it works out.
wvaio

CigarPete · Power User Joined: 21 May 2007 Posts: 152

Sparky

The first thing to do in any emergency is to take your own pulse.

relax.. it'll come if you let it..

ohhmmmmmmmmmm... ohhmmmmm

Pete