Radiology in Trauma Flashcards
What is a FAST Scan?
Focused Assessment with Sonography in Trauma
Looks for blood or free fluid in:
RUQ, LUQ, bladder SOMEWHERE ELSE?
Not used that often as CT is pretty quick and with more detail
When do you do plain film Xrays?
AP chest, pelvis (and c-spine series)
May help rule things out before other management e.g. tension pneumothorax, haemothorax etc
Extremity imaging should wait as not life threatening
What are some signs on CXR?
Contusion - white furring of lung
Widened mediastinum - ?aortic transsection? OTHER?
OTHER?
What is an unstable pelvic fracture?
As pelvis is a ring - tortional forces will always mean a break in two (or more) places
Classification:
1-6
In terms of which direction the force was transmitted during the mechanism - will lead to a different number + location of breaks
e.g.
AP compression = ‘open book’ fracture - widened symphisis pubis and sacroiliac joint
Vertical shear = fallen from height
Lateral compression - would be made worse by compression bands
Are at high risks of uncontrollable bleeding
What views are needed for C-spine XR?
Lateral view
AP view
Open mouth/Odontoid peg view
All three views are required but may be difficult to obtain in practice due to pain - CT is often preferred and taking over in prevalence
What injuries to the C-spine are possible?
C1/Jefferson’s fracture:
Best visualised on open mouth XR view
____
C2/Hangman fracture:
high force hyperextension injury
Fracture involves the anterior displacement of the body and peg of C2
Flexion teardrop fracture:
Due to sudden pull on____ longitudinal ligiment
Very unstable as can be displaced into spinal cord
Burst fracture:
____
Can have an unstable C-spine without breaking bone - can damage ligaments and soft tissue +/- bleeding
What are the indications for a CT head?
NICE guidelines….
How do you interpret CT head for bleeds?
Hyperacute blood (<1hr) = isodense, will look like brain parenchyma, will not be able to see sulci
Acute = bright white - 6-24hrs
Chronic = darkening - density starts to drop - 3-21 days
What does a subarachnoid bleed look like on CT
Ventricles….. SEE SLIDES
Can cause midline shift
What does a subdural bleed look like?
95% supratentorial
Crescent shape on CT
SLIDES
What does an extradural bleed look like?
Middle meningeal artery
Acute injury + skull fracture
Biconvex shape lesion on CT
Mass effect danger
When do we do full body CTs?
For major trauma situations where there may be occult injuries or multisystem damage:
Haemodynamically unstable
Mechanism of injury - more than one body part, RTC + fatalities
Findings on plain film or FAST scan are inconclusive or suggestive of injury
Obvious severe injury
Scanned from head to mid-femur
With venous and arterial contrast
