I keep remembering things so I’ll add to this post as they re-emerge in my brain. Similar posts can be found under the RadTips tag.
Some other questions which have come up are of the following type:
How would you perform an OM30 on an uncooperative patient?
Now, I’m something of a pedant, I’ll freely admit that, so when I was asked this, I answered with two questions: how uncooperative are they, and why are they uncooperative? Personally, I don’t think that you can answer the question without knowing this information. Are they drunk? Aggressive? Confused? Suffering from dementia? Drunks can sometimes be reasoned with, as can aggressive patients (in my experience, a new face can sometimes be all it takes to reason with an unfriendly patient) but if they are suffering from neurological problems which they cannot control then you’re probably out of luck (and if they’re suffering from neuro problems due to head trauma then they should probably be going to CT anyway; their facial injuries can be assessed that way). Inappropriate or excessive movement which cannot be prevented is bad; if there’s no chance of getting a diagnostic quality image (the whole point of the damn process) then don’t waste your time. But why are they unable to keep still? Have they been sent round to radiology before having analgaesics? If so, don’t be afraid to send them back! If that was your mum with a facial bone injury, would you be happy for her to press her face up against a cassette without painkillers?
These questions apply to any “uncooperative patient” scenario; before going into robot-mode and rattling through the positioning, make it clear that you would not perform the examination unless you genuinely think you can get a diagnostic quality image. Don’t be afraid to send a patient back for analgaesics, sedation, or even just a coffee to sober up. And never ever put yourself in a position where you feel threatened by a patient.
It’s 2am, you’re working alone when you get a bleep for a trauma series, a NICU portable, and a femoral nailing in theatre. What do you do?
Once you’re done panicking, ring theatre, and tell them you’ll be there after the trauma series. Ask NICU what it’s for, explain the situation and ask if they can wait. It’s probably for NG tube placement, so as long as they don’t desperately need to feed them, they can hold off for a little while. The point of this question is to show both initiative and reasoning; it’s not necessarily about getting the answer right (although you probably ought to) more about proving you’re capable of thinking clearly under pressure. Practically, the trauma series comes first, this should be obvious. The patient’s life is at risk, they are the most urgent in the queue. Theatre is next; this isn’t a planned elective, it’s a trauma call and they can’t do it without imaging. They can, however, prep the patient etc while you finish the trauma series as long as they know that’s what you’re doing. Then, once you’ve got your breath back, trot off up to NICU and see if the feeding tube is in the right place.
The point is, the trauma patient has unknown injuries which could kill them; the theatre patient’s injuries are known, but serious and need treating immediately; and the NICU baby is being constantly monitored and unlikely to starve in the time it takes you to get to them. You need to not only show your reasoning with this, but also demonstrate your communication skills; it’s pointless getting the order right but then fail by not telling theatre or NICU what you’re up to.
Sometimes they like to hit you with something crazy like trauma theatre, #NOF, and a pile up on the motorway- 6 patients with injuries varying from #wrists to c-spine- ambulances are on their way. I’ve never had this in an interview, but my answer would be:
- Call 2nd cover and ask them to come in. Tell them to avoid the motorway!
- Tell trauma theatre what’s happening and that another radiographer is coming in.
- Tell A&E that I’m currently on my own, but that cover is on its way.
- Ask the A&E referrers to send the patients in priority order.
- Get the #NOF done if possible while the ambulances are still en route, if that’s impossible, send the patient back to A&E where they’ll be more comfortable. They can sleep and have access to analgaesics if necessary; their injury isn’t life threatening, and their comfort is paramount.
- Send the 2nd radiographer to theatre when they arrive.
- Explain the situation to the porters so that they’re able to help.
- Let A&E make the decisions and prioritise your patients, and examine them accordingly.
- Ask the 2nd radiographer to assist when they’re done in theatre.
- Get the #NOF done (if it wasn’t done earlier) once the serious injuries have been examined.
This is a similar concept to the previous question: it’s all about communication. Speak to theatre, A&E, 2nd cover, porters, etc etc. If you explain why you can’t be in theatre right away they won’t be thrilled, but at least they’ll know why. Instead of letting the A&E referrals line up, get them to send them to you in an order of their choosing; they know best.
I’d love to hear some opinions on answering these scenarios; would you say something different? These are heavily based on my (very limited) experience, so I’d be really interested in any new input.