Roentgen Diagnosis of Emergency Conditions

Abstract

That there should be any doubt in this day concerning the necessity for emergency service in the radiological department of any hospital seems incredible, yet such an opinion is still widely held. Recently one of the foremost hospital organizers in the country, referring specifically to technical service, wrote as follows: “So far as x-ray work is concerned there is practically no need for an emergency service. I cannot state any instance or type of case wherein an emergency x-ray examination is required.... it is most rare that an x-ray examination cannot be postponed for at least 24 hours without damage or danger to the patient. . . . Such work, however (out of regular hours), should only embrace the skeletal system.” No statement could be further from the truth; fortunately, the author of the above quotation has graciously retracted it in toto. It is significant, however, that his opinion was originally derived, not from the advice of clinicians, but rather as a result of consultation' with roentgenologists. Casual inquiry suggests that too many physicians, hospital superintendents, and roentgenologists still share this viewpoint. Without doubt, immediate roentgenography in the case of many fractures is unnecessary, except as a concession to the anxiety of the patient or his family. In some instances, notably in the case of skull fractures, it is not only unnecessary but probably distinctly harmful. The fact is that an acute situation in regard to the skeleton is the least important of the indications for emergency roentgen study. The necessity for the immediate roentgen examination of patients with acute pulmonary and abdominal conditions is much more imperative. In no better way, for example, can the diagnosis of pneumonia be established at an early period. We have observed definite roentgen findings as early as three hours after the onset of pneumonia, and not rarely in from six to eight hours. At this early period the physical findings may be absent, the clinical symptomatology may not be specific, and sputum-typing may be impossible. Yet specific treatment-whether it be chemo-or serotherapy-should not be entered upon lightly; for obvious reasons, patients with a fever resulting from causes other than pneumonia should not be treated in such radical fashion. Likewise, in the post-operative pulmonary complications, such as atelectasis, it is important to institute therapy at the earliest possible moment; here, too, no surer and earlier means of diagnosis is at hand. In the realm of the acute abdominal conditions, most of which connote a surgical emergency, immediate roentgen examination is also of the first importance. The list of diseases amenable to roentgen study, those in which the findings obtained are of great assistance in the determination of the nature of the pathologic process, includes almost all the acute abdominal diseases.