FINAL REPORT
 PORTABLE AP CHEST FROM ___ AT 16:18
 
 CLINICAL INDICATION:  ___-year-old with right rib fracture, status post right
 chest tube placement, now intubated, assess endotracheal tube placement and
 assess for pneumothorax.
 
 Comparison is made to the patient's previous study of ___ at 14:27 and
 ___ at 21:45.
 
 A portable AP supine chest film ___ at 16:18 is submitted.
 
 IMPRESSION:
 Right-sided rib fractures now have plates with multiple screws traversing the fractures. A right chest tube remains in place. No pneumothorax is seen, although the sensitivity to detect pneumothorax has diminished given supine positioning. There is improved aeration of both lung bases with residual patchy opacities which may reflect residual atelectasis, although acute pneumonia cannot be excluded. No evidence of pulmonary edema. Endotracheal tube has its tip approximately 5 cm above the carina. Right internal jugular central line has its tip in the mid-to-distal SVC, unchanged. Nasogastric tube is seen with the tip just below the gastroesophageal junction and the side port within the distal esophagus. Advancement is advised at this time. The recommendation for advancing the nasogastric tube was conveyed to the patient's house staff, Dr. ___, by phone on ___ at 5:04 p.m.
