Trauma Imaging

Question 1

Australasian Triage Scale - Category 1

Answer 1

Immediately Life-Threatening: Cardiac Arrest, Respiratory Arrest, Immediate risk to airway, GCS < 9, Ongoing/prolonged seizure, IV overdose and unresponsive or hypoventilation.

Response: Immediate assessment and treatment.

Question 2

Australasian Triage Scale - Category 2

Answer 2

Imminently Life-Threatening: Airway risk with severe stridor or drooling, Circulatory compromise, Drowsy with GCS < 13, Acute stroke, Major multi-trauma.

Response: Assessment and treatment within 10 minutes.

Question 3

Australasian Triage Scale - Category 3

Answer 3

Potentially Life-Threatening: Severe hypertension, Moderately severe blood loss, Moderate shortness of breath, Moderate limb injury, Limb with altered sensation or acutely absent pulse.

Response: Assessment and treatment start within 30 minutes.

Question 4

Australasian Triage Scale - Category 4

Answer 4

Potentially Serious: Mild haemorrhage, Foreign body aspiration without respiratory distress, Chest injury without rib pain, Difficulty swallowing without respiratory distress, Minor head injury without loss of consciousness.

Response: Assessment and treatment start within 60 minutes.

Question 5

Australasian Triage Scale - Category 5

Answer 5

Less Urgent: Minor symptoms of existing stable illness, Minor symptoms of low-risk conditions, Minor wounds like small abrasions or minor lacerations.

Response: Assessment and treatment start within 120 minutes.

Question 6

ABCDE Primary Survey - Airway

Answer 6

Life Threats: Vomit, blood, teeth obstruction; Blunt/Penetrating Neck Injury may require intubation; Reduced Consciousness poses risk of hypoventilation and/or obstruction.

Question 7

ABCDE Primary Survey - Breathing

Answer 7

Life Threats: Pneumothorax, Flail Chest, Ruptured diaphragm; Assessment includes checking for open wounds, deformity, bruising, and monitoring respiratory rate, effort, and oxygen saturation.

Question 8

ABCDE Primary Survey - Circulation

Answer 8

Types of Shock: Hypovolemic, Cardiogenic; Life Threats include hypovolemic shock from blood loss; Assessment involves monitoring heart rate, blood pressure, peripheral circulation, and skin.

Question 9

ABCDE Primary Survey - Disability

Answer 9

Examples of Causes: Seizure, hypoglycemia, intracranial hemorrhage; Assessment includes Level of Consciousness using Glasgow Coma Scale (GCS) and checking Blood Sugar Levels for metabolic causes.

Question 10

ABCDE Primary Survey - Exposure

Answer 10

Examples include hyperthermia, hypothermia, critical skin conditions; Assessment requires fully exposing the patient to identify any life-threatening injuries while ensuring sequential exposure to prevent hypothermia in trauma patients.

Question 11

What is the Secondary Survey?

Answer 11

Performed after the patient is stabilized/resuscitated to detect other significant but not immediately life-threatening injuries.

Question 12

What does AMPLE stand for in the Secondary Survey - History?

Answer 12

Allergies, Medications, Past medical history, Last meal, Events leading to injury.

Question 13

What should be assessed in the Head/Face during the Secondary Survey?

Answer 13

Lacerations, bruising, CSF leak, deformities, swelling, eye movement, pupillary reflexes, vision, and hearing.

Question 14

What should be assessed in the Neck during the Secondary Survey?

Answer 14

Tracheal deviation, wounds, subcutaneous emphysema, distended veins.

Question 15

What should be assessed in the Chest during the Secondary Survey?

Answer 15

Rib tenderness, subcutaneous emphysema, breath sounds.

Question 16

What should be assessed in the Abdomen during the Secondary Survey?

Answer 16

Areas of tenderness, bruising, lacerations, other injury, bowel sounds.

Question 17

What is the Golden Hour?

Answer 17

The first hour after a traumatic injury when prompt medical treatment significantly improves survival and outcomes.

Question 18

What are key physiological measurements in Vital Signs?

Answer 18

Heart rate (HR), Blood pressure (BP), Respiratory rate (RR), Temperature (T), Oxygen saturation (SpO₂).

Question 19

What are intravenous (IV) fluids used for in trauma management?

Answer 19

To prevent or treat shock due to blood loss or dehydration.

Question 20

What is hypotension?

Answer 20

Low blood pressure, often due to shock or blood loss.

Question 21

What is hypertension?

Answer 21

High blood pressure, can be due to pain, stress, or head injury.

Question 22

What is bradycardia?

Answer 22

Slow heart rate (<60 bpm), may indicate brain injury or hypoxia.

Question 23

What is tachycardia?

Answer 23

Fast heart rate (>100 bpm), often due to blood loss, pain, or shock.

Question 24

What is the Glasgow Coma Scale (GCS)?

Answer 24

A tool used to assess level of consciousness after brain injury, scoring from 3-15 (lower score = more severe brain injury).

Question 25

What is an Endotracheal Tube (ETT)?

Answer 25

A tube inserted into the trachea to secure an airway and support breathing, often used in intubation.

Question 26

What does MVA stand for?

Answer 26

Motor Vehicle Accident, a common cause of traumatic injuries requiring rapid assessment and intervention.

Question 27

What is FAST Ultrasound?

Answer 27

A rapid bedside ultrasound to detect internal bleeding in trauma patients, checking for fluid in the pericardial space, pleural space, and peritoneal cavity.

Question 28

What is Tension Pneumothorax?

Answer 28

A life-threatening condition where air trapped in the pleural space causes lung collapse and pressure on the heart, requiring urgent needle decompression and chest tube placement.

Question 29

What are ECG Leads?

Answer 29

Electrodes placed on the chest and limbs to monitor heart electrical activity and detect arrhythmias, ischemia, or trauma-related heart issues.

Question 30

What is Flail Chest?

Answer 30

A serious chest injury where multiple ribs are broken in multiple places, causing paradoxical chest movement and impaired breathing.

Question 31

What is an Intercostal Chest Drain (ICD)?

Answer 31

A tube inserted into the pleural space to drain air, blood, or fluid from conditions like pneumothorax or hemothorax.

Question 32

What is the purpose of the assessment?

Answer 32

Assesses the degree of consciousness in critically ill patients with head injuries.

Question 33

What are the components of the assessment?

Answer 33

Eye Opening (E): 1-4, Verbal Response (V): 1-5, Motor Response (M): 1-6

Question 34

What does a score of 3 indicate?

Answer 34

Compatible with brain death.

Question 35

What does a score of 7 indicate?

Answer 35

Usually accepted as a state of coma.

Question 36

What does a score of 15 indicate?

Answer 36

Indicative of no impairment.

Question 37

What is the first principle of trauma imaging?

Answer 37

Two Projections at 90°.

Question 38

What is the goal of trauma imaging?

Answer 38

Provide a complete view of the injury without patient movement whenever possible.

Question 39

What are exceptions to the goal of trauma imaging?

Answer 39

Artifacts or barriers, Patient positioning limitations.

Question 40

Principle 2: Long Bone Studies

Answer 40

Initial imaging must include both joints surrounding a fracture. 🔹 Follow-up imaging (F/U) may only include the joint closest to the fracture site.

Question 41

Principle 3: Adaptation of Technique

Answer 41

Trauma imaging may require adjustments in: Central Ray (CR) angle Image Receptor (IR) placement 🔹 Additional projections may be needed to fully demonstrate anatomy in one plane.

Question 42

What is the most common type of facial fracture?

Answer 42

Nasal fractures ## Footnote Nasal fractures are frequently encountered in facial trauma cases.

Question 43

What are the two types of fractures in the zygomaticomaxillary complex?

Answer 43

Mandibular and Temporal bone ## Footnote These fractures involve the zygomatic bone and adjacent structures.

Question 44

What imaging techniques are preferred for diagnosing facial fractures?

Answer 44

Plain X-ray, CT (preferred) ## Footnote CT is often preferred due to its detailed imaging capabilities.

Question 45

What is unique about mandibular fractures?

Answer 45

Fractures often occur in at least two locations ## Footnote This is due to the mandible being a ring-like structure.

Question 46

Which imaging techniques are used for mandibular fractures?

Answer 46

Plain X-ray, CT (preferred), OPG (Orthopantomogram) ## Footnote OPG provides detailed imaging specifically for the mandible.

Question 47

What is the gold standard imaging for temporal bone fractures?

Answer 47

CT ## Footnote CT is considered the most reliable method for assessing temporal bone injuries.

Question 48

What are common causes of Traumatic Brain Injury (TBI)?

Answer 48

Falls, Motor Vehicle Accidents (MVA), Violence / Assault, Sports injuries, Explosive blasts ## Footnote These causes highlight the various contexts in which TBIs may occur.

Question 49

What is a common cause of rib fractures and blunt thoracic trauma?

Answer 49

Blunt trauma (e.g., falls, MVA, impact injuries).

Question 50

Are isolated rib fractures clinically significant?

Answer 50

Usually not clinically significant, but cause pain.

Question 51

What are the complications of rib fractures?

Answer 51

Pneumothorax (air in pleural space) and Hemothorax (blood in pleural space).

Question 52

What imaging projections are used for upper ribs?

Answer 52

PA Chest X-ray (to check for pneumothorax) and Oblique Rib X-rays (sometimes needed for more detail).

Question 53

What imaging projection is used for lower ribs?

Answer 53

AP Upper Abdomen X-ray (assesses lower rib fractures).

Question 54

What is the patient positioning for oblique ribs?

Answer 54

Erect or supine, with back against IR; affected side rotated 30-45° towards IR; arm on affected side abducted.

Question 55

What is the centering for oblique ribs?

Answer 55

HCR at approximately T7 to include full rib length. ## Footnote Breathing instructions: Inspiration for upper ribs (1-8/9), Expiration for lower ribs.

Question 56

What are the technical factors for oblique ribs?

Answer 56

SID: 110 cm; Exposure settings: AEC (Automatic Exposure Control).

Question 57

Sternum - Patient Positioning

Answer 57

Erect position with MSP (mid-sagittal plane) parallel to the IR (lateral position). Shoulders pulled back to avoid superimposition. Long axis of the sternum aligned to the IR.

Question 58

Sternum - Centering

Answer 58

CR: Perpendicular to the IR. CP (Central Point): Midway between sternal notch and xiphisternum.

Question 59

Image Criteria for Oblique Rib Imaging

Answer 59

✅ 1st to 12th ribs clearly visible on the affected side ✅ Minimal scapular overlap on lung fields ✅ Clavicle positioned in a horizontal plane ✅ Arm & chin do not superimpose the thorax ✅ At least 10 posterior ribs visible above the diaphragm