RDGR Trauma Flashcards
Define Trauma
a severe injury or damage to the body caused by an accident or violence
What ages are leading cause of death for trauma?
15-24
What is level 1 trauma?
- provides the most comprehensive emergency care 24 hrs per day
- Usually a research facility such as universtiy hospitals
(RUH)
what is level 2 trauma?
have all the usual specialized care but are usually not a research centre
(st. pauls)
What is level 3 trauma?
usually do not have all specialists but can stabilize the patient before transferring them to a level 1 centre
(humboldt)
What is level 4 trauma?
- clinics or outpatient centres
- Equipped to handle only minor emergency situations
(clinics and small town hospital)
Motor vechile accidents, falls and assaults are examples of what trauma?
Blunt
Gunshot wounds, stabbings, impalements, foreign body injections or aspiration are examples of what trauma?
Penetrating
Pressure shock waves, high velocity projectiles, burns are example of what trauma?
explosive
Fire, steam and hot water, chemicals, electrcity and frostbite are examples of what trauma?
Burns
What are 5 examples of radiation protection?
- close collimation
- Gonadal shielding
- Lead aprons
- Exposure factors
- Announcement
What is the normal respiations for adults?
12-20 per minute
What is the normal resting pulse for adults?
60-100 beats per minute
What is the normal BP?
systolic- 95-120 mm Hg
Dialstolic - 60-80 mm Hg
What is the normal oxygen saturation?
95-100%
What are the common symptoms of shock?
- diaphoresis (sweating)
- Cool, clammy skin
- Decrease in venous pressure
- Decrease in urine output
- Thirst
- Altered state of consciousness
What is the fracture that has the highest mortality rate?
pelvic (as high as 50%)
What does CAB stand for?
Compression
Airway
Breathing
What changes in status should be reported immediatelt to the physician or radiologist?
- loss of consciusness
- Pale or bluish skin
- Seizures
- Increasing abdominal distension and firmness to palpation
What is the best practices in trauma radiography?
Speed
What are the three trauma series for mobile radiography?
- cross-table lateral cervical spine
- Chest AP supine
- Pelvis - r/o # causing hemorrhagic shock
What are three radiography done if patient is stable in trauma situations?
- remainder of cervical spine
- Lumbar/thoracic spines
- Upper and lower extremities
What is the order of projections for trauma?
- AP’s: Superior to inferior
2. x-table laterals: inferior to superior
What position is done before moving the patient to the imaging table?
cross table laterals using upright grid
How is the CR projected in trauma projections?
perpendicular
What are the three principles for postioning in trauma?
- 2 projections 90 degrees to each other with true CR part iR alignment.
- Entire structure or trauma area on IR
- Maintain the safety of the patient, health care workers and the public
Does the radiographer have to makw a note on type of modification and reason for trauma?
yes
What is always the forst exposure for C-spine?*
lateral projection: dorsal decubitus position
What is the dorsal decubitus psotion for c-spine for?
To rule our fractures of c-spine
What is the SID for lateral c-spine?
72”
Where is the CR directed for lateral c-spine
Horizontal at level of C4
What needs to be included in the lateral c-spine?
sella turcica (2” anterior and superior to the EAM) to T1 (2” above jugular notch)
What must be done if C7-T1 is not shown for lateral c-spine?
swimmers
Does swimmers need approval of the physician?
Yes
Should you document which physicain gave you the approval for swimmers?
yes
Where is the CR directed for swimmers?
horizontal to C7-T1 (about 2” above jugular notch)
What should be done if the shoulders are aligned in the same horizontal plane for swimmers?
angle 3-5 degrees caudad
If you are using the upright bucky for swimmers and the shoulders are in the same horzintal plane, what should be done?
angle the foot of teh stretcher toward the wall 3-5 degrees.
What should all be included in the swimmers projection?
level of mastoid tip to 1” below the jugular notch as well as entire soft tissue.
What are the prevertebral fat stripe visualization used for?
detection and localization of fractures, masses and inflammation
What is the anterior vertebral line for?
used to assess the anterior margin of the vertebral bodies
What is the posterior vertebral line for?
used to assess the posterior margin of the vertebral bodies
What is the spinolaminar line for?
used to assess the posterior margin of the spinal cord
What is the posterior spinous line used for?
used to assess the spinous processes
What should the prevertebral fat stripes of the neck look like?
smooth and slightly lordotic curve
What is the wackenheims line?
- a line drawn from the dorsum sellae along the clivus to the basionm should align with the dens
- A line drawn from the posterior margin of the foramen magnum should meet the spinolaminar line
What is the basion?
the midpoint of the anterior margin of the foramen magnum
What is the opisthion?
the midpoint of the posterior margin of the foramen magnum
-Superior point of spinolaminar line
How should the IR be placed under the patients head for AP Axial c spine?
If the patient is on a spine board, it can be lifted and the IR underneath.
If the patient is not on spine board, it is preferred to have the physician Lift the head
Where should the IR be placed for a AP Axial c-spine?
top of IR 1-2” above EAM
Where is the CR directed for Ap Axial c-spine?
15 degrees cephalad and enters MSP slightly inferior to thyroid cartilage
Where does the CR exit of a AP axial c-spine?
level of C4
Should the patients head be moved on a AP odontoid projection?
NO
What plane is perpendicular to IR for AP open mouth?
occlusal plane
What is the AP Fuchs method (modified waters) for c-spine do?
demonstrates dens within foramen magnum when the open mouth is not possible
What must be done to get air-fluid levels for chest?
lateral projection in the dorsal decubitus position
Where is the CR for chest?
MSP perpendicular to T7 (3” inferior to jugular notch)
What is the exposure made on for chest? Inspiration or expiration?
inspiration
How should the grid be for a AP projection of pelvis?
horizontal and parallel to MCP to minimize distortion and rotation
Where is the CR directed for AP pelvis?
MSP, level 2” inferior to ASIS (or 2” superior to pubic symphysis)
When taking a pelvis image, what must be reported immediately to physician?
if the abdomen becomes distended and firm
What is common in pelvic injuries?
hemorrhagic shock
-reasses LOC repeatedly
Where should the IR be placed for a AP hip?
top of IR at level of iliac crest and center to the symphysis pubis
Why must the CR be directed at the center of the symphysis pubis?
so the surgeon can see entire acetabulum and hip
What is the inital examination for hip trauma?
AP pelvis for comparison of 2 hips
Where should the grid IR be placed for axiolateral cross table lateral Hip?
parallel with the femoral neck, centered to the most prominent portion of the grater trochanter and at a level to place the midline of the hip in the midline of the IR
Where is teh CR directed for axiolateral cross table hip?
horizontal and perpendicualr to th center of the IR
When is the modified axiolateral projection of the hip used?
patients suspected bilateral hip fractures or limited movement of unaffected limb
How should the IR be placed for the modified axiolateral hip?
aligned parallel to the femoral neck at a height to place the center the hip on the IR. Tilt the top of the IR back (away from hip) 15 degrees
Where is the CR for the modified axiolateral hip?
15 degrees posteriorly and aligned perpendicular to the femoral neck and IR
Should th physicain review any dorsal decubitus before performing other exams?
yes
Where should the IR be placed for lateral t spine?
top of IR 2” above the patients relaxed shoulders
What should be included in lateral t spine?
jugular notch to inferior costal margin. Centered at MCP.
T3 or T4 to L1
Where is the CR for lateral L spine?
MCP at the level of the iliac crests
What should all be included for the Lateral L spine?
xiphoid to the midsacrum
T12 to sacrum
What is common with abdomen injuries?
hemorrhagic shock
What is the SID for abdomen AP?
40”
Where is the CR perependicular to for abdomen AP?
MCP at the level of the iliac crest
Is the exposure on inspriation or expiration for abdomen?
expiration
What must be included on avdomen projections?
diaphragm to pubic sympysis
Denstiy and contrast on abdomen must include..
liver, kidney, psoas muscle and cortical margins of bones
What is lateral decubitius abdomen for?
air/fluid levels
How long should the patient be in lateral for for abdomen?
5 minutes
Where is the CR direced for left lateral decubitus for abdomen?
entering MSP at a level of 2” above the iliac crests to include diaphragm
What is the SID for left lateral decubitus for abdomen?
40” SID
What are the three trauma skull projections?
- Dorsal decubitus lateral
- AP or Ap axial (caldwell)
- AP Axial Townes
what can vomiting be a sign of?
intracranial injury
What projection must be done first before any other skull prjections?
Lateral projection. rule out C-spine injury
Where is teh CR for lateral dorsal decubitus for Skull?
level 2” above the EAM
What plane shold the skull the lined up to fr dorsal decub lateral skull?
IPL perpendicular to the IR and MSP vertical
What plane should be perpendicular for AP skull?
OML and MSP perpendicular
whre should the CR be for AP skull?
Perpendicular to MSP at the nasion
what should the plane be fore ap axial skull reverse caldwell?
OML and MSP perpendicular to the IT
Where should the CR be for AP Axial skull reverse caldwell?
CR angled 15 degrees cephalad entering MSP at the nasion
What plane is perpendcular for AP axial towne skull?
OML or IOML and MSP perpendicular to IR
What should be done on a AP axial towne skull if OML or IOML cant be met?
CR angle to increased 60 degrees to maintain 30 degrees angle of OML
What should the angle of the CR be for AP axial towne skull?
30 degrees caudad to OML or 37 degrees to the IOML
Where does the CR pass through for Ap axial towne skull?
exits the foramen magnum
What are the three facial bone projections?
- Lateral dorsal decibitus
- AP axial caldwell
- AP acanthioparietal (reverse waters)
(possibly mandible and zygoma)
What is the sid for lateral facial bones?
40”
Which way should the IR face for lateral facial bones?
vertical
Where should the R be for lateral facial bones?
midway between outer canthus and EAM
How should the CR be angles for acanthioparietal projections reverse waters for facial bones?
CR angled cephalad until it is paralell with MML, enters the acanthion
How should AP shoulders be projected?
imaged as is
How should AP oblique be postioned for shoulder?
patients affected side is elevated 45 degrees and supported in position
Where should the CR be for shoulder?
level of the glenohumeral joint at the center of the proximal humerus
What should be done before turning a patient for shoulder projections?
c spine images cleared
How should AP ankle be positioned?
not dorsi flexed
How should Ap oblique ankle be postioned (mortise)?
15-20 degrees lateromedial angle to the long axis of foot
What should be included as much as possible for lateral images of the ankle?
distal tib/fib
Where is the CR directed for the knee?
1/2 inch distal to apex of patella
How should the CR be for AP Foot?
angle 10 degrees posterior to plantar surface of foot and plae of IR
How much should kVp be increased for medium plaster?
7 kVp
How much kVp should be increased for large plaster?
10 kVp
How much should fiberglass be increased?
4 kVp
