Teaching in Accident and Emergency Medicine:
10 Commandments of Accident and Emergency Radiology
BMJ 1995;310:642-5
1. 治療病人,而不是治療片子
Treat the patient, not the radiograpy
若病人情況危急,應直接治療處置而非等影像確診。例:張力性氣胸
2. 照片子前,先問病史和做理學檢查
3. 只照必要的片子Take a history and examine the patient before requesting a radiograph
Request a radiograph only when necessary
檢查能夠影響病患的治療處置,才是有用的檢查
4. 不要只看片子不看病人;也不要只看病人不看片子不要亂槍打鳥式的檢查
Never look at a radiograph without seeing the patient, and never see the patient without the looking at the radiograph
影像發現要和臨床檢查相關,才能減少誤判
若病人回診,務必再看看先前照過的片子
5. 每一張片子都要看;整張片子都要看別太相信放射科的報告
Look at every radiograph, the whole radiograph, and the radiograph as a whole
最常見的錯誤是只看最嚴重且顯而易見的異常,導致忽略掉其他的異常
影像判讀 ABC
ABCs for interpreting radiographs
- Adequacy
- Alignment
- Bones
- Cartilage and joints
- Soft tissues
7. 2的法則Re-examine the patient when there is an incongruity between the radiograph and the expected findings
The rule of twos
8. 執行處置前後都要照片子
- 要照兩個角度
- 包含兩個關節
- 比較正常與受傷側的片子
- 比較受傷前後的片子
- 比較已知正常的片子
Take radiographs before and after procedures
9. 如果影像看起來不對勁,問問或聽聽看放射科或其他資深醫師的意見,可能真的有問題異物移除、脫臼復位
10. 確認失效安全機制來保護自己If a radiograph does not look quite right ask and listen: there is probably something wrong
相關文章: 急診十誡Ensure you are protected by fail safe mechanisms
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