An ED intern requests an urgent chest X-ray for a patient with chest pain and shortness of breath. It has been over an hour since the request and the X-ray has not been performed. What is the most appropriate next step?

An ED intern requests an urgent chest X-ray for a patient with chest pain and shortness of breath. It has been over an hour since the request and the X-ray has not been performed. What is the most appropriate next step?

• A. Continue monitoring and perform ECG and troponin
• B. Call radiology and try to get portable CXR asap, describing urgency
• C. Wait for the radiology slot
• D. Describe to radiology the urgency of the situation

Answer: (B)

Urgent imaging needs to be expedited in a patient with chest pain and shortness of breath. When there’s a delay after requesting a chest X-ray, the quickest way to move the process forward is to actively escalate with radiology and request a portable chest X-ray at the bedside right away. This approach directly communicates the clinical urgency and uses a bedside option to avoid transport delays, enabling faster diagnostic decisions and treatment. While ongoing monitoring and ECG/troponin are important parts of the workup, they don’t address the immediate need to obtain imaging that could reveal life‑threatening conditions (such as pneumothorax, edema-related causes, or focal consolidation). Waiting for a radiology slot without escalation risks further delay. Simply describing urgency to radiology is helpful but may not reliably prompt rapid action; a direct escalation to radiology with a request for a portable, bedside X-ray is the most effective next step.

Urgent imaging needs to be expedited in a patient with chest pain and shortness of breath. When there’s a delay after requesting a chest X-ray, the quickest way to move the process forward is to actively escalate with radiology and request a portable chest X-ray at the bedside right away. This approach directly communicates the clinical urgency and uses a bedside option to avoid transport delays, enabling faster diagnostic decisions and treatment.

While ongoing monitoring and ECG/troponin are important parts of the workup, they don’t address the immediate need to obtain imaging that could reveal life‑threatening conditions (such as pneumothorax, edema-related causes, or focal consolidation). Waiting for a radiology slot without escalation risks further delay. Simply describing urgency to radiology is helpful but may not reliably prompt rapid action; a direct escalation to radiology with a request for a portable, bedside X-ray is the most effective next step.