emergency & trauma Flashcards
initial radiographic assessment of severely injured patient:
- lateral cervical spine
- chest
- pelvis
what are the ten rules of two
- two views/ projections
- two abnormalities
- two joints
- two sides
- two views too many
- two occasions
- two visits
- two opinions and two records
- two specialists
- two investigations
viewing principles in plain radiography
- 2 views are better than 1
- compare with other side
- compare current with previous images
- keep eye on ball
ABCs peripheral and axial skeleton systemic assessment
Alignment
- exclude subluxation and dislocation
Bone
- exclude fracture
- disruption of trabecular pattern
Cartilage and joints
- even joint spaces and uneven loss of joint width
Soft tissues*
- change window settings and contrast on PACS system
- look out for FB
when is MDCT used
- head injuries/headaches or epilepsy
- facial injuries
- chest pain
- severe abdominal pain
- renal/ ureteric colic
- suspected leaking abdominal aortic aneurysm
- suspected gastrointestinal bleeding
- major trauma
protocol for head CT scan
A2BCDEF
Airspaces
Bones
Brain parenchyma
CSF spaces
Dura
Eyes
Face
possible types of intracranial hemorrhage
- epidural hemorrhage
- subdural
- subarachnoid
- intraparenchymal
- intraventricular
types of stroke
- ischemic
- hemorrhagic
what is FAST used for
- identify free fluid in 3 potential body spaces:
pericardial
pleural
peritoneal spaces
primary US windows for the FAST examinations
right upper quadrant view
left upper quadrant view
pelvic view
pericardial view
limitations of MRI in a&e environment
- time prohibitive –> patients cannot be scheduled, and have a higher than usual likelihood of being in pain and unable to remain still for a 30 mins examination
neurologic deficits of the spine that are best triages with MRI
- cord compression
- cauda equina syndrome
- epidural abscess
- epidural hematoma
standards of practice and guidance for trauma radiology in severely injured patients
- CXR might precede MDCT to confirm presence of pneumothorax
- if emergency CT is requested, plain pelvis and abdomen is irrelevant
- extremities imaging should be delayed until life threatening injuries have been diagnosed and treated
- cervical spinal injury precautions and pelvic binders should remain in place until after CT
