Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

APLS > Imaging in Trauma > Flashcards

Imaging in Trauma Flashcards

1
Q

What type of medical professional should images be discussed with?

A

IMAGING IN TRAUMA

  • Surgeons
    • trauma
    • ortho
    • neurosurgeon
  • Experienced emergency radiographer (technician)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is the best imaging modality for accurately detecting bleeding in trauma?

A

CT.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are the indications for whole body CT and what does this entail? When is it NOT appropriate?

A

TRAUMA

WHOLE BODY CT

  • = head to pubic symphysis
  • Indication
    • CRITICALLY injured
    • MULTISYSTEM trauma
  • WHEN: w/i 30 mins of pt’s arrival
  • ROUTINE use of head to thigh polytrauma CT NOT appropriate
  • although combination injury to head + abdomen + extremities is common, data shows areas b’w injuries are not commonly injured e.g. pelvis/ C-spine injury is RARE => do NOT routinely image B/W 2 injured areas
  • keep the radiation dose ALARA (as low as reasonably possible)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What type, mechanism and area of injury is most common in trauma?

A

TRAUMA

MOST COMMON

  • Blunt > Penetrating
  • Fall > RTA
  • HI > extremities > abdomen
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Who must accompany the injured child to the radiology department and why?

A

A core component of the trauma team - in case there is deterioration.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What ROUTINE imaging is recommended for a primary survey in trauma?

A

PRIMARY SURVEY - TRAUMA

ROUTINE IMAGING

  1. CXR
  2. C-spine XR
    • ONLY if unable to clear clinically
    • OR up front indication for CT

NB do NOT routinely perform pelvic XR

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is the risk of performing a CT C-spine?

A

200 x radiation dose of 3-view XR

Delivered to developing thyroid gland

DO NOT ROUTINELY REQUEST

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Is there a role for FAST (Focused Abdominal Sonography for Trauma) in paediatric trauma?

A

FAST

= Focused Abdominal Sonography for Trauma

  • NO role in paeds trauma
  • Only 50% sensitive for free fluid in the abdomen
  • If suspecting bleeding in the abdomen do CT with contrast

Vs. Formal abdo USS may be helpful

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is the first line investigation for suspected bleeding in the abdomen?

A

CT with contrast.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Are lateral C-spine XR’s useful?

A

BONY injury: Can NOT R/O using this alone.

CORD injury: Normal film does NOT R/O = SCIWORA - need MRI/ clinical assessment whilst awake.

Snapshot of the position of the bones at the time of the film, does not indicate degree of flexion/ extension forces applied to the spine at the time of injury.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

When is a pelvic XR indicated and when is it not?

A

TRAUMA

PELVIC XR

  • ROUTINE use NOT recommended
    • High dose of radiation
    • # s causing sig. pelvic ring disruption are
      • rare (excluding isolate pubic ramus #)
      • usually clinically evident (manage w/ pelvic brace and fluids/ blood)
    • Pubic rami fractures are relatively common but do not cause much bleeding or threat to LOL (life, organ, limb)
  • Indication: strong suspicion of pelvic ring injury
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What type of imaging is indicated if C-spine injury is suspected and WHEN should this be perfomed?

A

C-SPINE INJURY

IMAGING

  • CT C-spine
    • High index of suspicion/ high risk mechanism of injury (bony injury)
    • plain films unclear/ abnormal
  • 3 view C-spine XR
    1. AP
    2. Lateral
    3. Odontoid PEG view (if child is able to open mouth)
    • Lower index of suspicion (bony injury)
  • MRI
    • Strong suspicion of C-spine CORD injury
  • Perform imaging ONLY after life-threatening injuries have been identified & treated
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What should take place before any cervical imaging is performed?

A

C-spine immobilisation.

An inadequately immobilised C-spine # can cause progressive spinal cord damage.

Blocks rather than sandbags ideally.

Sandbags can obscure bony landmarks.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What kind of signs and symptoms raise the suspicion of C-spine CORD injury?

What should be done in these children?

A

C-SPINE CORD INJURY

  • Positioning: oddly positioned or twisted head/ neck/ back
  • Power: weakness/ paralysis, difficulty breathing
  • Reflexes: loss of bladder/ bowel control
  • Coordination: incoordination
  • Sensation: altered sensation/ paraesthesiae/ numbness, extreme pain/ pressure in the head/ neck/ back
  • Mx
    • continue neck protection measures
    • URGENT MRI
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What landmarks should be imaged in a CT C-spine in different age groups?

A

CT C-SPINE

LANDMARKS

  • < 10 yo
    • upper C-spine incl. craniocervical junction (most common site of injury in < 10 yo)
    • FROM occipital condyles + foramen magnum
    • TO C3
    • avoids radiosensitive thyroid
  • > 10 yo
    • as for adults
    • FROM occipital condyles
    • TO C7/ T1 junction
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is the most common site of C-spine injury in children under the age of 10?

A

Craniocervical junction

= the interface b/w SKULL + C-Spine

Includes:

  • occipital bone surrounding foramen magnum
  • 1st and 2nd vertebra (C1 = atlas, C2 = axis)
17
Q

How do patterns of C-spine injury differ in children and adults & why?

A

PATTERNS OF C-SPINE INJURY

CHILDREN Vs. ADULTS

  • large mass of head (relative)
  • moving on a flexible neck
  • poorly supportive muscles
    • => injury in the higher cervical vertebrae
  • injuries through discs and ligaments at
    • carniovertebral junction (C1, 2, 3)
    • C7 / T1
18
Q

Describe the 3 main patterns of C-spine injury that occur in children.

A

PATTERNS OF SPINAL INJURY

CHILDREN

  1. FRACTURE +/- SUBLUXATION/ DISLOCATION
  2. SUBLUXATION/ DISLOCATON - NO #
  3. SCIWORA (Spinal Cord Injury WithOut Radiographic Abnormality)
19
Q

What is SCIWORA and what is the only way to R/O spinal cord injury?

A

SCIWORA

= Spinal Cord Injury WithOut Radipgraphic Abnormality

  • significant cord injury
  • BUT radiographic films completely normal
  • R/O spinal cord injury
    • MRI
    • clinical assessment in AWAKE child
20
Q

What is the most common site of a missed spinal injury?

A

Where a flexible part of the spine meets a fixed part

e.g. in the neck

cervicocranial junction &

cervicothoracic junction (C7 - T1)

21
Q

How do you check the adequacy of cervical spine imaging and what should be done if it is not adequate?

A

CERVICAL SPINE IMAGING

ADEQUACY

  • whole spine visible
    • FROM lower clivus
    • TO upper body of T1
    • incl. C7-T1 junction
  • If C7-T1 junction not visible
    • conscious child - ‘relax shoulders’
    • assistant - stabilise spinal board (if used)
    • hold arms above elbow joint
    • gentle traction - pull arms down
22
Q

What is chest USS useful for?

A

USS CHEST

Detection of:

PTX

Haemothorax

23
Q

How do you check the adequacy of a CXR?

A

CXR

Adequacy = RIP

  1. ​Rotation: medial ends of both clavicles equally spaced about the spinous processes of the upper thoracic vertebrae, trachea equally spaced b/w the clavicles ​
  2. Inspiration: at least 5 anterior rib ends above the diaphragm on the R side
  3. Penetration: able to just visualise the disc spaces of the lower thoracic vertebrae through the heart shadow
24
Q

When is CT chest NOT required?

A

Normal CXR.

25
Q

Described a structured approach to reporting a CXR and what should be looked for.

A

CXR REPORTING

Position + ABCDEFGHI

  • Position: AP/ PA/ Lateral?
  • Airway + Apparatus + Alignment
    • Airway:
      • Trachea central/ deviated (mass effect e.g. PTX, pleural effusion or pulled by lung collapse)
        • Apparatus:
      • ETT - 1st thing to r/v in intubated pt’s (below clavicles & at least 1cm above carina)
      • NGT/ OGT (should bisect the carina i.e. below the carina => not in oesophagus)
      • CVP
      • chest drains
      • Wires/ clips from previous surgery
    • Alignment (spine) - 4 lines - the continuity of the lines should be maintained regardless of the degree of neck flexion/ extension - look for steps and angulation
      1. anterior vertebral line
      2. posterior vertebral line (anterior wall of the spinal canal)
      3. facet line
      4. spino-laminar line (posterior line of the spinal canal)
  • Bones & Soft tissues
    • Bones
      • posterior, lateral and anterior aspects of each rib
      • vertebrae - flattening = thoracic injury
      • clavicles
      • scapulae
      • proximal humerus
    • Look for
      • symmetry
      • fractures
        • of ribs only w/ considerable force
        • even greater if multiple or first rib # (look for other injuries inside & outside chest)
        • 1st 3 ribs –> look for great vessel injury + major spinal trauma
      • osteoporosis
      • lesions
      • widening
        • disc spaces (thoracic injury)
        • gaps b/w spinous processes of pedicles (increased vertical or horizontal distance = unstable fracture)
    • Soft tissues
      • FB
      • SC air
      • haematoma
  • Cardiac
    • 1/3 to the R of the midline + 2/3 to L
    • mediastinal shift
      • pushing (mass effect) = Tension PTX, pleural effusion
      • pulling = collapse
    • cannot assess heart size on trauma films as these are all AP
    • Cardiophrenic angle blunting = consolidation
    • Globular shape = pericardial effusion (use cardiac ECHO if in doubt)
  • Diaphragm OR Disc spaces (spine)
    • L diaphragm should be visible behind the heart (if not - LLL collapse)
    • unilaterally raised (Hump)
      • normal slight on R (liver)
      • PTX
      • FB / collapse
      • diaphragmatic rupture
      • effusion
      • nerve palsy
    • B/L flattened - chronic asthma/ emphysema
    • Subdiaphragmatic free air
  • Disc spaces (spine)
  • Effusions
    • blunted costophrenic angles = pleural effusion/ haemothorax
    • lateral film ? posterior effusion
  • Fields/ Fissures + FB
    • Fields
      • APICES
      • Consolidation
      • air bronchograms
      • masses
      • PTX – classical signs (lack of vascular markings at lung peripheries) not seen in supine film as air rises anteriorly –> look for abnormal sharpness of diaphragm/ cardiac border
    • Fissures:
      • thickening
      • fluid = upper lobe collapse
      • change in position (elevation) = “
  • Great vessels + Gastric bubble
    • Great vessels
      • aortic size + shape + aortic knob/ knuckle (loss of definition = aneurysm)
      • pulmonary vessel outlines
      • aortopulmonary window (loss of definition = lymphadenopathy e.g. malignancy)
    • Gastric bubble
      • present + not diplaced
  • Hila & mediastinum
    • Hila
      • lymphadenopathy
      • masses
      • L often higher than R
    • Mediastinum
      • widening e.g. aortic dissection, spinal trauma, major vessel injury (rare in small children) –> USS/ CT/ angiogram
      • < 18 months –> thymus simulates superior mediastinal widening (above carina) – may reach L/R chest wall or diaphragm
  • Impression
26
Q

What are the indications for abdominal CT with contrast in trauma?

A

ABDO CT + CONTRAST

INDICATIONS

  • Abdo tenderness (conscious pt)
  • Hypovolaemia - persistent
  • Blood from rectum/ NGT
  • Handle bar injuries (significant)
  • Bruising/ injury of abdo wall/ lap belt area
  • Abdo distension
27
Q

What is the prime modality for excluding acute intracranial haemorrhage?

A

CT brain.

NB intracranial bleeding in children often occurs WITHOUT skull # => do not do a skull film.

28
Q

How do you assess alignment in the cervical spine? What 4 lines should you be looking for?

A

C-SPINE XR

ALIGNMENT

  • 4 lines
    1. anterior vertebral line
    2. posterior vertebral line (anterior wall of the spinal canal)
    3. facet line
    4. spino-laminar line (posterior line of the spinal canal)
  • the continuity of the lines should be maintained regardless of the degree of neck flexion/ extension
  • look for steps and angulation
29
Q

What is the most common mechanism of injury of the lumbar and thoracic spine? What is the most common radiographic finding?

A

Hyper-flexion

Wedge or beak shaped vertebra from compression

APLS (25 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions