First Pretty, Then Fat

Despite the rather suspect title, and although my mirror is a daily reminder of the horrors of gravity and my ever-shortening telemeres, this isn’t a post about body shaming and the steady decline of beauty. Yes I may have gone from “Baby got Back!” to “Baby got Back Pain!” over the past few decades, but when it comes to my body, I have no choice but to dwell *in* it so I try not to dwell *on* it.

“First pretty, then fat” is a process I created for examining chest x-rays. I PRIMP and then I BLIMP. These two acronyms are, respectively, for assessing the quality of an x-ray and then studying the x-ray for anomalies.


PRIMP –  for assessing quality
Position – AP, PA. Lateral, Lordotic, Decubitus
Rotation – my favorite sentence “The spinous processes of the thoracic vertebrae should be equidistant from the medial ends of the clavicles.”
Inspiration –  The 5th to 7th anterior ribs should intersect with the diaphragm on the mid-clavicular line.
Margins – Can you see the entire lung field from the costaphrenic angles up to the apices of the lungs.
Penetration – The vertebrae should be just visible behind the heart


BLIMP – Just a mnemonic to remember the major areas to cover
ssues with tissues – It’s about the tissues. I needed a damn “I” to make it rhyme. 

One of my clinical rotation shifts I was asked to set up a vent for an incoming patient I knew nothing about so I asked for the details.

“Male, 6’1″, approximately 40, found down for an unknown time, requires lots of suctioning of thick purulent secretions… and oh… the xray they took for ET tube placement showed situs inversus!”

I was excited. I had never seen situs inversus before and I had read about its connection to primary ciliary dyskinesis recently. Again, read too much about zebras – one starts to see zebras.

“Thick purulent secretions? Situs inversus? Was it just dextrocardia or full situs inversus? Was the gastric bubble on the right? was the left hemidiaphragm raised to compensate for the liver? Is there a history of Kartagener syndrome – primary ciliary dyskinesis?”

I annoy people with questions. All of this was unknown. No history. She hadn’t personally seen the x-ray.

So we pulled it up. The computers were slow so I literally had time to primp before it was time to PRIMP. But there it was.

“Position: Portable AP. Rotation… No,” I said, “That is not situs inversus. The gastric bubble is appropriately on the left. And the heart looks odd because the patient is rotated about 30 degrees to the right on the saggital axis.”

“How can you tell?”

Here it was! My big moment. The one I had been rehearsing for! My chance to use my favorite sentence!

“The spinous vertebrae of the equidistant clavicles should be medial to the thoracic… GODDAMMIT!!”

My big moment. And I blew it.

“You mean the spinous processes of the thoracic vertebrae should be equidistant from the medial ends of the clavicles?”, said my understudy Shirley MacLaine, who laughed at my Carol Haney broken ankle and went on to win the Tony for The Pajama Game.

“Who is Carol Haney” you ask?





Author: elijoi

Humanist, Rationalist, Writer, Web Developer, Table Tennis Junky, Composer, Lyricist, Actor, Singer, and very recently with a mid-life career change, a Respiratory Therapist

One thought on “First Pretty, Then Fat”

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