X-Rays in Trauma

Question 1

What are the 2 stages to Advanced Trauma Life Support (ATLS)?

Answer 1

Primary survey (ABCDE examination). Secondary survey (head to toe examination).

Question 2

State one imaging modality.

Answer 2

X-ray. Multi detected computed tomography (MDCT). FAST/eFAST. MRI scan.

Question 3

State one condition observed using a chest x ray.

Answer 3

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).

Question 4

State what is reviewed when looking at the airways.

Answer 4

Trachea. Bronchi.

Question 5

State what is reviewed when looking at breathing.

Answer 5

Lung fields.

Question 6

State what is reviewed when looking at circulation.

Answer 6

Cardiac shadow. Major blood vessels.

Question 7

State how a simple pneumothorax can be observed.

Answer 7

Outer margin of visceral pleura (and lung) is separated from the chest wall.

Question 8

State what is reviewed when looking at environment.

Answer 8

Bones. Scapula. ECG leads. Soft tissues.

Question 9

State how a tension pneumothorax observed.

Answer 9

Air in pleural space.

Question 10

What does ABCDE stand for when looking at a chest X-ray for trauma?

Answer 10

Airways. Breathing. Circulation. Diaphragm. Environment.

Question 11

Define a haemothorax (blood in pleural cavity) and rib fractures.

Answer 11

Blood in pleural cavity.

Question 12

Define a pneumomediastinum.

Answer 12

It’s when there is air present in the mediastinum.

Question 13

State a cause of the pneumomediastinum.

Answer 13

Usually from the rupture alveoli. Trachea/bronchi/oesophagus/bowel and neck injuries.

Question 14

Define the mediastinum.

Answer 14

A central compartment of the thoracic cavity - surrounded by the loose connective tissue, contains heart, oesophagus, trachea, thymus, lymph nodes in central chest.

Question 15

State the cause of a traumatic aorta rupture.

Answer 15

Aortic abdominal aneurysm.

Question 16

How would you determine diaphragmatic fracture?

Answer 16

Inability to trace normal diaphragmatic outline.

Question 17

Define a flail chest.

Answer 17

When a segment of the rib cage breaks due to trauma and becomes detached from the chest wall (can involve multiple fractures across ribs).

Question 18

Give 2 examples of chest injuries.

Answer 18

Simple pneumothorax. Tension pneumothorax. Haemothorax. Pneumomediastinum. Traumatic aortic rupture. Diaphragmatc rupture. Flail chest.

Question 19

State 2 examples of shoulder injuries.

Answer 19

Shoulder dislocation. Posterior shoulder dislocation. Humerus fracture.

Question 20

State 2 features of the Nexus criteria for radiological evaluation.

Answer 20

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.

Question 21

State 2 views for a plain film evaluation.

Answer 21

True-lateral view of cervical spine. AP view. Open-mouth odontoid process.

Question 22

Define the Swimmer’s view.

Answer 22

Lateral projection of the cervical spine to visualise C7/T1 junction.

Question 23

What does AABCDS stand for when observing the spine?

Answer 23

Adequacy and alignment. Bone. Cartilage. Disc. Soft tissue.

Question 24

State what is meant by Adequacy and Alignment.

Answer 24

Should be evaluated using the edges of the vertebral bodies and articular pillars.

Question 25

What could cause an increase in the cartilaginous space?

Answer 25

Fracture of the odontoid process.

Question 26

State what should be observed regarding the disc space on an X-ray.

Answer 26

Disc space height should be equal at all levels.

Question 27

State when a CT scan should be indicated immediately.

Answer 27

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.

Question 28

State 2 injuries observed in the neck.

Answer 28

Bilateral facet dislocation. Unilateral facet dislocation. Hangman fracture. Odontoid fracture. Thoracic/lumbar vertebral injury. Burst fracture.

Question 29

Define a bilateral facet dislocation.

Answer 29

Degree of flexion and anterior subluxation causes ligamentous disruption).

Question 30

Define a unilateral facet dislocation.

Answer 30

2 joints at the back of the vertebrae.

Question 31

Define a Hangman’s fracture.

Answer 31

Fracture of the axis (C2) in the cervical region of the upper cervical spine.

Question 32

What types of odontoid fractures are there?

Answer 32

Type 1 - upper part
Type 2 - fracture of the base
Type 3 - through the odontoid and lateral masses of C2 (below)

Question 33

Define a Burst fracture.

Answer 33

Curved spine.

Question 34

Define a traumatic spinal injury.

Answer 34

Where the vertebra breaks from a high-energy axial load e.g. road traffic accident.

Question 35

State what to expect from a thoracic/lumbar vertebral injury.

Answer 35

Thoracic/lumbar vertebral don’t align.

Question 36

Define two conditions that could affect the pelvis.

Answer 36

Open book injury. Hip fracture.

Question 37

Define an open book injury.

Answer 37

Describes any fracture that disrupts the pelvic ring.

Question 38

Define a Multi detector CT.

Answer 38

CT is a definitive study - offers info on internal organ damage and is able to identify retroperitoneal pelvic injuries.

Question 39

Define a FAST scan.

Answer 39

Focused assessment with Sonography in Trauma - rapid bedside ultrasound examination.

Question 40

What is a FAST scan use to detect?

Answer 40

Pneumothorax. Haemothorax. Pericardial effusion. Detection of intraperitoneal fluid.

Question 41

State which vital signs suggest the need for a body CT scan.

Answer 41

GCS < 12. Systolic BP. Respiratory frequency < 10 or > 30. Pulse > 120bpm. SatO2 < 90%. Age > 65 years. Anticoagulation.