Radiology of trauma patients

RADIOLOGY OF TRAUMA PATIENTS

Reem Ahmed Alyahya212522156

Introduction◦ Trauma is a leading cause of mortality globally.

◦ According to the World Health Organization (WHO), road traffic injuries related trauma account for 1.25 million deaths in 2014, and trauma is expected to rise to the third leading cause of disability worldwide by 2030.

◦ All trauma patients require a systematic approach to management in order to maximize outcomes and reduce the risk of undiscovered injuries.

Trauma patients Advanced Trauma Life Support (ATLS) is the standard of care for trauma patients,

and it is built around a consistent approach to patient evaluation. This protocol ensures that the most immediate life-threatening conditions are

quickly identified and addressed in the order of their risk potential. The objectives of the initial evaluation

rapidly identify life-threatening injuries

initiate adequate supportive therapy

organize either definitive therapy

or transfer to a facility that

provides definitive therapy.

ATLSPrimary survey

ABCDE

Adjuncts relevant imaging during resuscitation and re-evaluation

Secondary survey

Head to toe examination

THE BRITISH ROYAL COLLEGE OF RADIOLOGISTS (RCR) GUIDELINES:

The ideal imaging procedure should be rapid, exhaustive,

and capable of immediately and systematically identifying all life-threatening injuries

The classical approach◦ According to the ATLS protocol:

The supine AP chest and pelvic X-rays and FAST remain the reference imaging diagnostic techniques in the primary evaluation

CT scan:◦ The CT scan is the definitive radiographic study in most patients with trauma.◦ CT imaging of the abdomen, pelvis, chest, cervical spine, and head is the most

sensitive and accurate noninvasive diagnostic tool for identifying major injury.

chest x-ray, pelvis x-ray, FAST, and CT

Chest X-ray The most common imaging study performed on trauma patients.

It can be easily obtained during the resuscitation phase.

it provides information on the presence of a hemothorax, pneumothorax, flail chest.

It also aids in the placement of chest and endotracheal tubes, which are critical to the resuscitation effort and the primary survey. 

Pelvis X-ray◦ AP pelvis film can easily be obtained during the resuscitation phase.

◦ This film can help confirm the presence of significant pelvic fractures, which are often the sites of hemorrhage that require external fixation and/or angiographic embolization for control.

FAST scan◦ It is used to identify free fluid in the peritoneal cavity, in the pericardium or pelvis .

◦ Because of its speed, sensitivity, and noninvasive character, FAST largely has supplanted other techniques for rapid assessment of unstable trauma patients.

CT scan◦ The CT scan is the definitive radiographic study in most patients with trauma. 

◦ The ATLS protocol recognizes that CT offers specific information on internal organ damage and its extent, and is able to identify retroperitoneal and pelvic injuries that are difficult to assess through physical examination, FAST or peritoneal lavage.

◦However, it must only be performed in patients without hemodynamic alterations in which there is no apparent indication of emergency laparotomy.

Head CT scan◦ All patients with a head injury should have computed tomography of the head,

especially if they have lost consciousness, have amnesia, or severe headaches.

◦ The National Institute of Clinical Excellence (NICE) new guideline for management of head trauma emphasizes that computed tomography must be done within an hour of the patient arriving at the hospital

Extradural hematoma and a subtle subdural hematoma (left), subdural hematoma (Right )

whole-body CT (WBCT) Explore the patient from “head to toe” in seconds, with simultaneous inclusion of

the head, cervical spine, thorax, abdomen and pelvis.

establish a quick and detailed global detection of the injuries, identifying those that are life-threatening, including possible active bleeding sites and (in many cases) unsuspected injuries.

application of the WBCT protocol has two basic difficulties1. Accessibility2. High radiation dose

References:◦ J.M. Artigas Martín, M. Martí de Gracia et al. Radiology and imaging techniques in

severe trauma: http://www.medintensiva.org/en/radiology-imaging-techniques-in-severe/articulo/S2173572714000794/#bib0365

◦Medscape: Initial Evaluation of the Trauma Patient: http://emedicine.medscape.com/article/434707-overview#a5

◦ Chan O et al. ABC of emergency radiology , Major trauma : clinical review: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC557900/pdf/bmj33001136.pdf

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