Chapter 10: X-rays, EKGs

________chest x-ray on admission

________EKG

I.         Chest X-ray

Admission chest x-rays should be obtained for all intubated patients, those admitted for suspected inhalation injury, and those with histories of cardiac or respiratory disease (i.e. CHF, CAD, COPD). The chest radiograph may appear normal in the early course of smoke inhalation and is an insensitive indicator of pulmonary injury.[i]  Subsequent chest films may show only diffuse changes consistent with noncardiogenic pulmonary edema.

II.          EKG

A.    An admission EKG should be obtained on all victims of electrical injury.  The electrocardiogram from the referring facility should be repeated in the burn unit to detect any changes and to serve as a baseline study. 

B.    In addition, an EKG should be obtained on patients with the following cardiac risk factors[ii]:

1.                        Historical Factors

a.     MI (especially within the past 3 months)

b.     Congestive heart failure

c.      Angina pectoris

d.     Poorly controlled hypertension

e.      Symptomatic cardiac rhythm disturbance

2.                        Physical Examination Findings

a.     Third heard sound or venous distension

b.     Abnormal cardiac rhythm

c.      Pulmonary rales

d.     Significant valvular murmur

e.      Hypertension