UNIT 4: Trauma Flashcards
Is trauma more common in men or women
Men
Golden hour
Recovery rate is best if pt is stabilized within the first hour after the trauma
Trauma centers (Level 1-4)
• Level 1: university-based center, research facility, or large medical center, most comprehensive emergency care available
• Level 2: 24 hour specialized care but not a research or university hospital, some specialty physicians are not available 24 hours a day
• Level 3: Ability to resuscitate and stabilize victims for transfer to a larger facility
• Level 4: clinics or outpatient facilities that transfer patients out
Blunt trauma
non-penetrating trauma or blunt force by impact
• MVA (Motor Vehicle Accidents)
• Falls
• Assault
Closed Head Injuries
most common traumatic brain injury (TBI) in which brain matter is not exposed or penetrated
Coup injury vs Countercoup injury
• Coup Injury- the injury occuring on the same side as the site of impact
• Contrecoup injury- damage to the brain on the side opposite the point of impact as a result of the brain hitting the skull
Watch for signs of neurological deficit from coup/countercoup injuries
• N/V (Nausea/Vomiting)
• Loss of Consciousness
• Slurred Speech
• Confusion/Agitation
• Seizure
Penetrating trauma
when an object pierces the skin and enters a tissue of the body, creating an open wound
• GSW (Gun Shot Wound)
• Stab wounds
• Impalement injuries
• Foreign body ingestion
Explosive trauma
aka blast injury: injury resulting from direct or indirect exposure to an explosion
• Pressure shock waves
• High-velocity projectiles
• Burns
Heat trauma
Burn injuries are classified 1st-4th degree
•fire
•steam
•chemicals
•electricity
•radiation
•frostbite
First-Fourth degree burns
Caring for burn patients
• Inhalation of hot gasses may cause pleural effusion or pneumonia
• Chest X-rays are the usual radiography procedure ordered
• Use reverse/ protective isolation technique
• Movement may cause severe pain
• Ensure patient has pain medications prior to X-ray if possible
Trauma Equipment
• Mobile x-ray machine
• Ceiling mounted stationary tubes
• Lodox Xmplar Total Body Scanner
What modality has largely replaced diagnostic x-rays for trauma patients but has increased patient dose
CT
Role of the Radiographer
• Speed
• Accuracy
• Quality
• Positioning
• Immobilization
• Safety
• Anticipation
• Attention to Detail
• Scope of Practice
• Professionalism
Recognize the Signs
• Vital Signs:
• HR 70-82 bpm
• BP 100/140 60/90
• Change in mental status or consciousness
• Blood or fluid loss
• Loss of sensation or bowel/urine control or N/V
• Medication side effects
Patient Care in trauma
• Never assume a patient can’t hear or understand you!
• Pay attention to verbal and nonverbal signals
• Eye contact if possible
• Watch for changes in patient condition:
• Diaphoresis(Sweating)
• Confusion/Agitation
• N/V (nausea/vomiting)
• LOC (Loss of conscience)
• Increasing abdominal pain and distension
• Know the location of crash cart
T or F: For fractures of the hip, watch for extreme eversion of the foot
True
Imaging the hip/pelvis
• WATCH FOR SIGNS OF HYPOVOLEMIC SHOCK AND ABDOMINAL DISTENSION (internal bleeding)
• Reassess pt condition repeatedly
• DO NOT INTERNALLY ROTATE LOWER LIMBS
• IMMOBILIZERS MUST NOT BE REMOVED FOR IMAGING unless approved by MD
Judet method views
-Oblique views of the acetabulum
•14 X 17 CW IR
•RPO and LPO patient, use sponge if possible
•For UNILATERAL CR enters 2” inferior to ASIS of the affected side
•For Pelvis (when imaging both(BILATERAL) at the same time) CR enters 1”-1.5” from the MSP on the elevated side halfway between PS and ASIS
Judet method Internal Oblique
• Internal Obl = affected side up
• Anterior Iliopubic column - ilium and pubis from ASIS to pubic symphysis
• Posterior rim of acetabulum
Judet method External Oblique
• External Obl = affected side down
• Posterior Ilioischial column
• Anterior rim of acetabulum
AP AXIAL PELVIS - OUTLET PROJECTION TAYLOR METHOD
• IR SIZE: 14 X 17 CW IR with grid
• Supine patient
• flex knees slightly if possible
• CR enters MSP 2” inferior to pubic symphysis
• Women: 30-45 degrees cephalic
• Men: 20-35 degrees cephalic
• Suspend respiration
AP AXIAL PELVIS - OUTLET PROJECTION TAYLOR METHOD Evaluation Criteria
- Pubic rami without foreshortening
- Superimposition of pubic bones over sacrum/coccyx
- Obturator foramen symmetric and open
- Symmetry of pelvis and hips
AP AXIAL PELVIS - OUTLET PROJECTION TAYLOR METHOD male vs female
AP AXIAL PELVIS - INLET PROJECTION BRIDGEMAN METHOD
• 14 X 17 CW IR with grid
• Supine patient
• Flex knees slightly if possible
• CR: MSP at level of ASIS, 40 degrees caudal
• Suspend respiration
AP AXIAL PELVIS - INLET PROJECTION BRIDGEMAN METHOD Evaluation Criteria
- Pelvic ring/inlet
- Superimposed superior and inferior pubic rami
- Nearly superimposed superior and inferior borders of ischial bones
- Symmetry of pelvis and hips
Pelvic trauma images
Transthoracic Lateral Humerus (Lawerence method)
• 10 X 12 IR LW with grid
• Elevate unaffected arm
• CR perpendicular to MCP at surgical neck
• Full inspiration or breathing technique
If supine, build the patient up off the table with pads
Transthoracic Lateral Humerus Evaluation Criteria
- Lateral view of shoulder and humerus
- Ribs blurred if breathing technique used
- Scapula projected over the thoracic spine
AP Oblique Y-View (Shoulder)
• 10 X 12 IR LW with grid
• CR perpendicular to IR
• Pt. rotated 45° with unaffected shoulder against the IR
• (Reverse PA Y-view)
• Roll patient up due to trauma, usually on a stretcher
• Suspend respiration
AP Oblique Y-View (Shoulder) Evaluation Criteria
• Humeral head and glenoid superimposed
• Humeral shaft and scapular body superimposed
• No superimposition of the scapular body over the thorax
• Acromion projected laterally
• Coracoid below clavicle
• Scapula in lateral profile
Chest Mobile AP
• 14 X 17 CW for most adults
• Top of IR 1 1/2 to 2 inches above shoulders
• Consider grid
• Use MAX SID possible
• Mark entrance/exit wounds if applicable
• CR perpendicular 3” below jugular notch
• Shield gonads
• Deep inspiration
Chest Mobile AP Evaluation Criteria
• Evaluate the image:
1. Lung fields in entirety (apex to costophrenic angle)
2. No rotation
3. Lungs expanded (10 posterior ribs)
4. Proper collimation
• fractures
• interstitial air
• pneumothorax/hemothorax
• line placement
Rib fracture
Cervical Spine
• When Cervical spine imaging is requested, ALWAYS perform the cross-table lateral (dorsal decubitus) first
• 72’ SID when possible
• DO NOT MOVE THE PATIENT’S HEAD OR NECK
• DO NOT REMOVE CERVICAL COLLAR OR TAKE OFF THE BACKBOARD
• CR horizontal and perpendicular to C4
• Shield when possible
• Suspend respiration at end of expiration when possible
Cervical Spine Evaluation Criteria
• Sella Turcica to top of T1
• No rotation/tilt
• Intervertebral Discs
• Z joints
Subluxation of C6
Hangman’s fracture
Clay Shovelers Fracture
Skull Cross-Table Lateral
• Cross table lateral skull with a horizontal beam (dorsal decubitus)
1. Elevate head on sponge
2. 10 X 12 IR with grid
3. IPL perpendicular to IR
4. Horizontal CR 2 inches above EAM
Skull Cross-Table Lateral Evaluation Criteria
a. Profile image of the skull
b. Air fluid levels
c. Sphenoid sinus
Skull AP
- 10 X 12 IR with grid
- OML and MSP perpendicular to IR
- CR perpendicular to the nasion
Skull AP Evaluation Criteria
a. Anterior cranium
b. Petrous ridges fill the orbits
c. Orbits magnified
Skull AP Axial Reverse Caldwell
- 10 X 12 IR with grid
- CR: 15 degrees cephalic entering MSP at the nasion
- OML and MSP perpendicular to IR
Skull AP Axial Reverse Caldwell Evaluation Criteria
a. Anterior cranium
b. Petrous ridges lower third of orbits
c. Orbits magnified
AP vs PA Caldwell
Skull AP Axial Towne
- 10 X 12 IR with grid
- CR: 30 degrees caudal to OML or 37 to IOML
- OML or IOML and MSP perpendicular to IR
*CR Passes through EAM
Skull AP Axial Towne Evaluation Criteria
a. Posterior cranium
b. Foramen Magnum
Cross-Table Lateral Hip - Danelius-Miller Method
• Elevate patient off bed if possible
• 10 X 12 GRID LW to the patient
• Top of IR at crest; IR placed parallel to the femoral neck
• Elevate unaffected leg to the vertical position
• DO NOT ROTATE AFFECTED LEG
• CR horizontal and perpendicular to the long axis of the femoral neck
• CR enters the groin midway between the anterior and posterior surfaces of the thigh
Cross-Table Lateral Hip - Danelius-Miller Method Evaluation Criteria
- Hip joint and acetabulum
- Femoral neck without superimposition from greater trochanter
- Small amount of lesser trochanter
- Small amount of greater trochanter
- Trochanter Ischial tuberosity
Trauma Hip - Clements/Nakayama
• Bilateral Hip fractures
• 10 X 12 IR with Grid LW to patient
• DO NOT INTERNALLY ROTATE LOWER LIMBS
• IR parallel to femoral neck, tilted back 15 degrees
• CR 15 degrees posteriorly to enter the femoral neck of interest
Trauma Hip - Clements/Nakayama Evaluation Criteria
- Acetabulum and proximal femur in profile
- Greater and lesser trochanters in profile
- Compare to Dani-Miller
Extremity Imaging
• Support injured limbs at both joints AND at fracture site
• If extremity must be lifted to place the IR underneath, do so slowly and with patient permission
• If the limb is severely deformed, do not attempt to position for true AP and lateral images
• Expose two projections, 90 degrees apart, moving limb as little as possible
• Long bone images MUST include both joints above and below the injury
• Shoulder images should be initially imaged in neutral rotation
• Assess patient condition for signs of shock throughout examination
Elbow - Partial flexion AP (2 views)
• 10 X 12 IR LW
a. CR perpendicular to humerus entering elbow joint
• closed joint, distortion of the forearm
b. CR perpendicular to forearm entering elbow joint
• partially open elbow joint
Elbow - Partial flexion AP (2 views) Evaluation Criteria
a. Distal Humerus:
1. Closed elbow joint
2. Distortion of forearm
b. Proximal Forearm:
1. Partially open elbow joint
2. Distortion of humerus
Avulsion Fractures
Medial and Lateral epicondyles
Proximal Ulna Fracture
Lateral Epicondyle fracture and Dislocation
Elbow - Coyle method
• 10 X 12 IR LW
• Elbow flexed 90 degrees *RADIAL HEAD
-CR 45 degrees towards shoulder
• Elbow flexed 80 degrees *CORONOID PROCESS
-CR 45 degrees away from shoulder
Elbow - Coyle method Evaluation Criteria
a. Radial head: open joint space between head and capitulum; head and tuberosity free of superimposition
b. Coronoid process: open joint space between coronoid and trochlea; coronoid process in profile
• fractures
• subluxation
• dislocation
Elbow Dislocation
Lower Extremity
Mobile Radiography
Many patients are too ill or unable to come to the department, mobile x-rays take the machine to them
- Set manual techniques
- Radiation safety is important, due to high occupational exposure
- Shielding considerations for patients
- SSD cannot be less than 12 inches
Common Mobile Procedures:
• Chest
• Abdomen
• Pelvis
• C-spine
• Extremities
• Infant Chest/Abd
Mobile Radiography - preliminary steps
- Announce presence and ask for assistance based on pt condition
- Check orders, patient room number, correct patient in the room
- Introduce yourself to the patient and family, explain procedure
- Maneuver around medical equipment in the room and connected to the patient, move if necessary
- Ask family to step out
-Shield patient and work carefully; work as a team; put things back in their place; Thank your patient
T or F: Falls and MVA are the most common
True
T or F: firearms as a cause of injury are the least common but have the highest fatality rate
True
the primary responsibilities of a radiographer in an emergency situation include the following:
• Perform quality diagnostic imaging procedures as requested.
• Practice ethical radiation protection for self, patient, and other personnel.
• Provide competent patient care.
If patient on stretcher is less than ___ ft away from the x-ray tube, appropriate shielding should be provided
6ft (72 inches)
Some of the greatest exposures to patients and medical personnel comes from
Fluoroscopic procedures
Symptoms and Causes
Hypovolemic or hemorrhagic shock
Most common type of shock in trauma patients. Symptoms include diaphoresis(excessive sweating), cool and clammy skin, decrease in venous pressure, decrease in urine output, thirst, and altered state of consciousness.
Vasovagal reaction
-Also called a vasovagal attack, situational syncope, and vasovagal syncope
-Patients may complain of nausea, feeling flushed (warm), and feeling lightheaded. They may appear pale before they lose consciousness for several seconds.
Cerebrovascular accident
commonly called a stroke and may be caused by thrombosis, embolism, or hemorrhage in the vessels of the brain
