Trauma radiography POS 3

trauma

severe injury or damage to the body caused by accident or violence

trauma patients are most commonly ______ in age from _____ to early _____

trauma patients are commonly male, in age from teenager to early adult.

list of trauma from most to least common

falls

MVA

struck

transport

cut

firearm

what trauma has the highest fatality rate

firearm

level 1 trauma

university based usually, has research and is a large medical center. has complete imaging capability and all types of specialty physicians 24 hours a day.

level 2 trauma

similar to level 1 but not a research or teaching hospital, and some specialty physicians may not be on site.

level 3 trauma

do not have all the specialists available but can resuscitate stabilize and assess and prepare a patient for transfer to a larger trauma center

level 4 trauma

may not even be a hospital. could be a clinic or other outpatient setting. can provide care for minor injuries and offer stabilization as well as transfer to larger center.

types of trauma forces

blunt

heat

penetrating

explosive

______ is a crucial element in the care of trauma patients

Time

common imaging modality for trauma

ct. since the imaging is instantaneous (only concern is the dose)

this can offer full body imaging in 13 seconds without the need to move the patient. But only 17 exist and it costs a lot

stat scan

What is some equipment you should bring when doing trauma radiography

sponges

tape

sandbags

grid

ir holder

in trauma you want a ____ exposure time

short. (patients will be in pain and you want to avoid motion)

when setting techniques during trauma other than time what else do you need to consider

the patient may be on a backboard, spine board so you need to factor that in. may also have to take pathologic condition into account.

what should you do about a patient being unable to move in trauma

move the tube and the IR around the patient (lateral decubitus, cross table etc)

if another patient is less than 6ft away during a mobile exam what should you do?

give them shielding.

how to speak to trauma patient

calmly, look in their eyes when removing artifacts tell them what and why

central ray for dorsal decubitus lateral c-spine

enters horizontal and perpendicular to the MCP at the level of c4

structures you want to see in lateral c spine

entire c-spine from the sella turcica, to top of T1

you see height and alignment of vertebral bodies

intervertebral disk space

zygapophyseal joints

central ray for lateral cervicothoracic spine dorsal decubitus

horizontal and perpendicular to c7-t1 (2 inches above jugular notch) (can do 3-5 cephalic angle if shoulders are aligned)

what is the central ray for the Ap axial c-spine

15-20 cephalic entering slightly inferior to thyroid cartilage exiting c4

structures you want to see in ap axial c spine

c3 to t1-t2

interspaces should be shown

ap axial oblique c spine where should the ir be centered

at level of c4 and 3 inches lateral to the msp (to the adjacent mastoid process)

central ray for ap axial oblique c spine

45 degree lateromedial angle. enters just lateral to msp at level of thyroid cartilage c4

structures you see in ap axial oblique c spine

intervertebral foramina on side where cr enters (may be foreshortened if you cant do 15 angle)

open intervertebral space

pedicles

(this projection is good to see subluxations and dislocations, and shows facet joints)

when doing spine projections dorsal decubitus which projection should be done first?

lateral. to rule out vertebral fracture or dislocation before the other projections are done

where are patients arms placed for dorsal decubitus t spine and l spine

crossed over their chest

where should top of ir be for lateral t spine dorsal decubitus

1.5 to 2 inches above shoulders (go from jugular notch to inferior costal margin)

where does the field extend for lateral l spine dorsal decubitus

from xiphoid to midsacrum (you center at crest)

structures we want to see for lateral t spine dorsal decub

t3-t4 to L1 and vertebral bodies in profile

structures you want to see for lateral lumbar dorsal decubitus

t12 to the sacrum with vertebral bodies in profile

if you need to see air fluid in the chest what position would you do if patient can only be supine

dorsal decubitus

where to put top of ir and to center for ap chest

top of ir is 1.5 to 2 inches above shoulders central ray is entering 3 inches below jugular notch

what should be done with IR in ap abdomen when using a grid

make sure that the grid is parallel with MCP. use sandbags, sponges, towels etc. you need it to be horizontal to prevent grid cut off

what decubitus position should be used for abdomen for free air

left lateral decubitus to do an ap projection. the density of the liver provides good contrast for air

if a patient is too ill to be on their side for an abdomen projection what should be done

a dorsal decubitus position. (will be a lateral projection) this is to asses fluid or free air.

when a pelvic trauma is suspected what imaging is usually done first

ct. it shows fx extent and visceral and vascular damage

up to what percent of pelvis fractures are fatal

50 percent. due to vascular damage and shock. also they have a high incidence of internal hemorrhage if abdomen becomes distended and firm alert physician

what should you continually reassess during a pelvic exam

levels of consciousness. since hemorrhagic shock is common with pelvis injuries

what is the actual name of a cross table lateral for a hip

axiolateral (danelius-miller)

where should ir be placed for axiolateral hip

parallel to the femoral neck. centered to most prominent part of the greater trochanter

structures you should see in axiolateral hip

acetabulum, head neck and trochanters of the femur, orthopedic appliance in entirety.

when should you do a modified Axio lateral projection of the hip

with pt who has suspected bilateral hip fractures, bilateral hip arthroplasty , or limited movement of unaffected limb

central ray for modified axiolateral projection of the hip (Clements-nakayama)

15 degrees posteriorly perpendicular to femoral neck and grid

what do you need to do to the grid in modified axiolateral hip

tilt top of the grid back 15 degrees

why is a dorsal decubitus lateral done for the skull

ct is preferred but the lateral can show traumatic sphenoid sinus effusion which is a clue to basal skull fx

when imaging the skull when do you alert the physician

ask them if you can elevate head on a sponge, if the patient vomits, (turn them on side as well) and if there is a change in level of consciousness.

CT is first used for which parts of the body

Head and brain

pelvis

thorax

c-spine

Leading cause of death 1-34

Trauma.

1. Trauma

2. Homicide

3. Suicide

What are some things a hospital needs to be level one trauma

Er has c arm, OR is on same level as er, rooms are regulated for radiation requirements

What do you want to see on cross table hip

femoral neck without overlap from greater trochanter as much as possible

Small amount of lesser trochanter on posterior of femur

Hip joint with acetabulum

When doing cross table hip what’s the last thing you should do

Put opposite leg up

Where should ir be for cross table hip (slideshow)

Tucked up high by lower ribs above crest

An open mouth may be difficult if patient in neck brace what should be done instead

Fuchs. Use 10-15 cephalic angle (center just below mandible)