Thread by @RyanChristieMD

#WetreadCoW Season 9 Case 1 - back to the basics

Hx: Line placement 😮 OR is calling now for a STAT report. Look OK?

Please answer with professionally appropriate gif responses only. No spoilers! wetread.org #FOAMrad #FOAMed #radres #errad #chestrad

#WetreadCoW S9C1 Answer

1)Malpositioned left subclavian catheter (extends into R IJ)
2)Malpositioned right jugular Swan-Ganz catheter (extends into hepatic vein)

Did you see both? You have to check every one! 🤬

#FOAMrad #FOAMed #radres #chestrad #radtwitter #MedTwitter

Let go through them. Correct ones first.

ETT - tip below the thoracic inlet and >2cm above carina ✅

GI tube - tip/side port below GE junction (hard to see but I think so)✅

Mediastinal drain ✅

Right chest tube x 2✅ (No pneumothorax)

I'm not @radiologistpage but I try 🤣

What about that left subclavian catheter? 👀

Tip extends up into the right jugular vein. ❌

Ideal = tip at SVC-atrial junction. ✅

Repositioning needed! 📞🧑‍⚕️

What about that right jugular Swan-Ganz catheter? 👀

Coils in the right atrium then extends caudal with the tip in one of the hepatic veins ❌

Ideal = extends through right atrium with tip in the right or left main pulmonary artery. ✅

Repositioning needed! 📞🧑‍⚕️

Shortcuts? Not that I know of. Check every tube/line on every image! 😮😢🤬

But remember, the more you do anything, the faster you get at it. Repetition breeds speed. Try and get faster by experience, not by shortcuts. 👍