WBR1490

Author	PageAuthor::William J Gibson, Katherine Albutt
Exam Type	ExamType::Surgery Shelf
Main Category
Sub Category
Prompt	[[Prompt::A 72 year old woman presents to the emergency room for a one week history of bright red blood per rectum and constipation. The patient is hemodynamically stable and shows no signs of acute obstruction or peritonitis. She refuses to drink GoLYTELY to prepare for a colonoscopy, but agrees to administration of the solution by nasogastric tube. Which of the following tests is best to confirm the proper placement of the nasogastric tube?]]
Answer A	AnswerA::Upright lateral chest radiograph
Answer A Explanation	AnswerAExp::A lateral chest radiograph can cause the 2D projection of the stomach and the lung to be overlapping and may confuse interpretation of the position of the tube.
Answer B	AnswerB::Upright anterior-posterior chest radiograph
Answer B Explanation	AnswerBExp::One can easily distinguish where or not the nasogastric tube tip is in the stomach or not from an upright anterior-posterior chest radiograph.
Answer C	AnswerC::Kidney, Ureter, Bladder radiograph
Answer C Explanation	AnswerCExp::The key question in nasogastric tube placement is whether one accidentally inserted the tube through the trachea rather than the esophagus. A KUB X-ray would be unable to address this question.
Answer D	AnswerD::Chest CT
Answer D Explanation	AnswerDExp::Computed Tomography of the chest would subject the patient to unnecessary radiation and take longer than a chest radiograph.
Answer E	AnswerE::Transesophageal Ultrasound
Answer E Explanation	AnswerEExp::A chest radiograph is easier to perform, faster and more sensitive for nasogastric tube placement than ultrasound.
Right Answer	RightAnswer::B
Explanation	[[Explanation::After placement of a nasogastric tube it is important to confirm it has been properly positioned. The best test to do so is an upright anterior-posterior chest radiograph. For a variety of examples please see the below excellent article from Radiopaedia. Educational Objective: Confirmation of correct nasogastric tube placement should be confirmed by upright anterior-posterior chest radiograph. References: http://radiopaedia.org/articles/nasogastric-tube-positioning ]]
Approved	Approved::Yes
Keyword	WBRKeyword::Radiology, WBRKeyword::Nasogastric, WBRKeyword::NG tube, WBRKeyword::X-ray, WBRKeyword::X ray, WBRKeyword::Radiograph, WBRKeyword::Imaging
Linked Question	Linked::
Order in Linked Questions	LinkedOrder::