X-Rays in Trauma Flashcards
What are the 2 stages to Advanced Trauma Life Support (ATLS)?
Primary survey (ABCDE examination). Secondary survey (head to toe examination).
State one imaging modality.
X-ray. Multi detected computed tomography (MDCT). FAST/eFAST. MRI scan.
State one condition observed using a chest x ray.
Haemothorax (collection of blood in pleural cavity). Flail chest (segment of rib cage that breaks due to trauma). Mediastinal injury (membranous portion between 2 body cavities).
State what is reviewed when looking at the airways.
Trachea. Bronchi.
State what is reviewed when looking at breathing.
Lung fields.
State what is reviewed when looking at circulation.
Cardiac shadow. Major blood vessels.
State how a simple pneumothorax can be observed.
Outer margin of visceral pleura (and lung) is separated from the chest wall.
State what is reviewed when looking at environment.
Bones. Scapula. ECG leads. Soft tissues.
State how a tension pneumothorax observed.
Air in pleural space.
What does ABCDE stand for when looking at a chest X-ray for trauma?
Airways. Breathing. Circulation. Diaphragm. Environment.
Define a haemothorax (blood in pleural cavity) and rib fractures.
Blood in pleural cavity.
Define a pneumomediastinum.
It’s when there is air present in the mediastinum.
State a cause of the pneumomediastinum.
Usually from the rupture alveoli. Trachea/bronchi/oesophagus/bowel and neck injuries.
Define the mediastinum.
A central compartment of the thoracic cavity - surrounded by the loose connective tissue, contains heart, oesophagus, trachea, thymus, lymph nodes in central chest.
State the cause of a traumatic aorta rupture.
Aortic abdominal aneurysm.
How would you determine diaphragmatic fracture?
Inability to trace normal diaphragmatic outline.
Define a flail chest.
When a segment of the rib cage breaks due to trauma and becomes detached from the chest wall (can involve multiple fractures across ribs).
Give 2 examples of chest injuries.
Simple pneumothorax. Tension pneumothorax. Haemothorax. Pneumomediastinum. Traumatic aortic rupture. Diaphragmatc rupture. Flail chest.
State 2 examples of shoulder injuries.
Shoulder dislocation. Posterior shoulder dislocation. Humerus fracture.
State 2 features of the Nexus criteria for radiological evaluation.
Tenderness at the posterior midline of cervical spine. Focal neurological deficit. Decreased level of alertness. Evidence of intoxication. Distracting injury i.e. painful injury somewhere else.
State 2 views for a plain film evaluation.
True-lateral view of cervical spine. AP view. Open-mouth odontoid process.
Define the Swimmer’s view.
Lateral projection of the cervical spine to visualise C7/T1 junction.
What does AABCDS stand for when observing the spine?
Adequacy and alignment. Bone. Cartilage. Disc. Soft tissue.
State what is meant by Adequacy and Alignment.
Should be evaluated using the edges of the vertebral bodies and articular pillars.
What could cause an increase in the cartilaginous space?
Fracture of the odontoid process.
State what should be observed regarding the disc space on an X-ray.
Disc space height should be equal at all levels.
State when a CT scan should be indicated immediately.
Patient has a Glasgow Coma Scale less than 8. Patient has been intubated/scanned for multi-region trauma. Plain films are inadequate/abnormal. Definitive diagnosis needed immediately. Focal peripheral neurological deficit. Paresthesia in upper/lower limb.
State 2 injuries observed in the neck.
Bilateral facet dislocation. Unilateral facet dislocation. Hangman fracture. Odontoid fracture. Thoracic/lumbar vertebral injury. Burst fracture.
Define a bilateral facet dislocation.
Degree of flexion and anterior subluxation causes ligamentous disruption).
Define a unilateral facet dislocation.
2 joints at the back of the vertebrae.
Define a Hangman’s fracture.
Fracture of the axis (C2) in the cervical region of the upper cervical spine.
What types of odontoid fractures are there?
Type 1 - upper part
Type 2 - fracture of the base
Type 3 - through the odontoid and lateral masses of C2 (below)
Define a Burst fracture.
Curved spine.
Define a traumatic spinal injury.
Where the vertebra breaks from a high-energy axial load e.g. road traffic accident.
State what to expect from a thoracic/lumbar vertebral injury.
Thoracic/lumbar vertebral don’t align.
Define two conditions that could affect the pelvis.
Open book injury. Hip fracture.
Define an open book injury.
Describes any fracture that disrupts the pelvic ring.
Define a Multi detector CT.
CT is a definitive study - offers info on internal organ damage and is able to identify retroperitoneal pelvic injuries.
Define a FAST scan.
Focused assessment with Sonography in Trauma - rapid bedside ultrasound examination.
What is a FAST scan use to detect?
Pneumothorax. Haemothorax. Pericardial effusion. Detection of intraperitoneal fluid.
State which vital signs suggest the need for a body CT scan.
GCS < 12. Systolic BP. Respiratory frequency < 10 or > 30. Pulse > 120bpm. SatO2 < 90%. Age > 65 years. Anticoagulation.
